Tag Archives: do not resuscitate (DNR)

Do Not Resuscitate (DNR) California

Document Name
Emergency Medical Services Pre-Hospital Do Not Resuscitate (DNR) form
Where do you get the form
You should get the form from a medical professional or download it here: http://www.emsa.ca.gov/Forms
Who is permitted to request a DNR

A patient with a life threatening illness or injury can request a DNR.

Who signs the form
The form is signed by the physician as well as the patient.
Patient Identification
There is no requirement for a patient to wear a DNR identification medallion.  However, California does recognize the medallion as proof of the patient having a DNR order.
How do you obtain a DNR medallion
There are currently only two state approved providers who can produce the pre-hospital DNR medallions.  They are:
Medic Alert Foundation 888-633-4298  http://www.medicalert.org
Caring Advocates 800-647-3223 http://www.caringadvocates.org
You will have to submit a copy of the DNR prior to being allowed to purchase a medallion.
Revoking a DNR
A DNR order can be revoked at any time.  Just destroy the paperwork and also notify your doctor’s office and family.
Photocopy
Photocopies of a completed DNR form are valid.
State info link

http://www.emsa.ca.gov/Forms

Other links
http://www.vialoflife.com/
Special Notes
Order a Vial of Life decal for your front door. The decal informs Emergency Medical Services team a DNR has been prepared and can be found in your refrigerator.

Health Care Directives

WHAT OTHER DOCUMENTS MAKE CHOICES ABOUT YOUR HEALTH CARE?

Living Wills and Health Care Power of Attorney forms are two common health care directives.    Here are some other health care directives you should know about:

Q. Why do you need a DNR?

A. A Do Not Resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.   Unless paramedics or other emergency staff are given other instructions, paramedics and hospital staff will try to resuscitate a patient whose heart has stopped or who has stopped breathing.

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Q. Why do you need to complete a living will and a DNR?

A. The directions in your living will are only followed when your doctor believes you are in a terminal state and will not recover from your illness or injury.   The directions in your DNR are effective the moment you sign them and do not require any type of medical condition to be present for the DNR to be effective.

Elderly people sometimes want a DNR if they suffer from chronic illness and are concerned that their quality of life will suffer if they require resuscitation.

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Q. What happens if the paramedics do not know you have completed a DNR?

A. If the paramedics or other medical personnel cannot locate your DNR, they will make an effort to save your life.

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Q. How can you help the paramedics make the right treatment choices.

A. You can help the paramedics in several ways.

  • Participate in the Vial of Life program, a nationwide effort to assist emergency personnel administer proper medical treatment for you when you can’t speak for yourself.
    • A  vial of life sticker is placed on your door.  This sticker tells the paramedic to look for your DNR and other medical information in a vial placed in your refrigerator.
  • Some people recommend storing the DNR in the freezer in a blue bag, as paramedics are trained to look in the freezer for DNR documents stored in a blue bag.
  • Some states authorize the use of identification bracelets or tags as a way  to notify medical personnel that you have signed a DNR.

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Q. What is HIPPA?

A. HIPPA is the acronym for the Health Insurance Portability and Accountability Act passed in 2003.  In an effort to protect our privacy, HIPPA restricts the freedom of medical care providers to share medical information about you without your consent.

The provisions of HIPPA give you the right to view information contained in your medical records and to designate other persons with whom your medical information may be shared.

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Q. What if you have not completed a HIPPA form giving someone the right to view our medical records?

A. Without a written authorization from you, medical professionals and medical facilities fact stiff penalties for violating HIPPA.

Without advanced authorization by you, your health care agent, spouse, family and others will not be able to access your medical records to make an informed decisions about the best plan of care for you.

FACT.  HIPPA and adult children

If an adult has a child attending college, they should consider having the child sign a HIPPA form giving their parent the right to access their medical records.   Otherwise, if the student is in an accident, the parent may not have the right to iew the child’s medical records to make decisions about their care.

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Q. What is In Case of Emergency (ICE)?

A. If you are in a car accident or other accident requiring unexpected medical care, the physicians and emergency personnel must find a way to contact someone regarding your medical emergency.  Time is important.  Some medical procedures require authorization from a spouse or a health care agent before treatment can begin.  A shorthand process has been developed to facilitate this communication process, referred to as ICE.

Q. How does ICE work?

A.  ICE reflects the list of persons who you want contacted in case of an emergency.   This list of persons and their telephone numbers is stored on your cell phone.   The steps are as follows:

  • Decide whom you want contacted in case of emergency
  • Enter ICE as the contact name in your cell phone contact list
  • Add the phone number of the person ou want called in case of emergency
  • If you want to name more than one person, make an ICE1 and ICE2 entry in your contact list.

Paramedics and other emergency responders are trained to examine your cell phone and look under “ICE” for information on who to contact.

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Do Not Resuscitate (DNR) form

WHAT ARE YOUR END OF LIFE WISHES?

A living will is one directive you complete documenting your end of life choices. 

A Do Not Resuscitate (DNR) order is another kind of advance directive documenting your end of life choices.

Here are some common questions and answers about a DNR.

What is the purpose of a DNR?

Why do you need to complete a living will and a DNR?

What happens if the  paramedics do not know you have signed a DNR?

How do you create an out of hospital DNR?

Q.   What is the purpose of a DNR?

A.  A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.  Unless paramedics or other emergency staff is given other instructions, they will try to resuscitate any patient whose heart has stopped or who has stopped breathing.

FACT: The exact rules for obtaining a DNR and for proving its validity vary widely from state to state.

Once you complete a DNR, make sure your physician and others are aware of your wishes.  Give a copy of your DNR to your primary physician and request that this information is added to your medical records.  If you are in a hospital, make sure a copy of your DNR is included with your medical chart.  Keep a copy of the original DNR form in your estate planning files.

FACT: Generally, doctors and hospitals in all states respect DNR orders.

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Q. Why do you need to complete a living will and a DNR?

A. The directions in your living will are only followed when your doctor believes you are in a terminal state and will not recover from your illness or injury.  The directions in your DNR are effective the moment you sign them and do not require any type of medical condition to be present for the DNR to be effective.

Elderly people sometimes want a DNR if they suffer from chronic illnesses and are concerned that their quality of life will suffer if they require resuscitation.

Q. What happens if the paramedics do not know you have completed a DNR?

A. If the paramedics or other medical personnel cannot locate your DNR, they will make an effort to save your life.

You can help the paramedics make the right treatment choices in several ways:

· Participate in the Vial of Life program.  The Vial of Life program is a nationwide effort to assist emergency personnel administer proper medical treatment for you when you can’t speak for yourself. A Vial of Life sticker is placed on your door.  This sticker tells the paramedic to look for your DNR and other medical information in a vial placed in your refrigerator. Some people recommend storing the DNR in the freezer in a blue freezer bag, as paramedics are trained to look there for DNR documents.

· Some states authorize the use of identification bracelets or tags as a way for you to notify medical personnel that you have signed a DNR.  Although all states authorize the use of a DNR, some states require special paper be used when printing as a means of authentication.

A FAMILY STORY: No DNR Present.

Kathy’s 92-year old mother was at Kathy’s house watching TV when she suddenly said she could not breathe. Kathy called an ambulance.

As they prepared to take her mother to the hospital, Kathy explained to the paramedic that she and her mother had decided not to resuscitate if the situation was such that her quality of life could be impaired.

The paramedic asked to see the DNR form.  Kathy replied the form was at her mother’s house in another state. Kathy could not provide a copy of the DNR signed by her mother to the paramedic.

The paramedic said they were allowed to wait sixty seconds for someone to provide the DNR.  After that, they are required by law to administer all available life saving techniques.

Kathy now keeps a copy of the DNR in her freezer and in her purse.  Her mother wears a DNR bracelet.

 

Q. How do you complete a DNR?

A. Your physician must complete and sign a DNR on your behalf.  In some states, you must wear a DNR bracelet showing you have a DNR on file.    The DNR state rules identify the name of the form required in your state and other facts you need to create an effective DNR. 

Like all legal documents, you need to complete a DNR before you  have a heart attack or other medical condition that would appear to compromise your mental abilities.   Once your mental capacity has been substantially compromised, it is possible for a physician to determine that you lack sufficient mental capacity to provide informed medical consent.

If the physician considers your mental capacity is diminished, it will be too late for you to instruct the medical staff not to resuscitate you.  These orders must be made when you are healthy.