DNR / DNI forms and EMS

[fzwarrior]

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If you get advanced directives in an outpatient clinic, how does it work with DNR / DNI when EMS is called to the home of the patient? I have heard that there are forms that need to be on file with the county. Anyone know how to obtain these forms and go about filing them?

 

[southerndoc]

As an EMS and fire medical director, my EMT's and paramedics will honor any signed DNR/DNI form. Nothing needs to be on file with the county.

 

[Siggy]

As an EMS and fire medical director, my EMT's and paramedics will honor any signed DNR/DNI form. Nothing needs to be on file with the county.

Unfortunately that is not always true. There are a rather large number of states where EMS can only recognize the state DNR/Physician Orders for Life Sustaining Treatment (POLST, for the OP) forms. They don't have to be filed with the county or state, but they do need to be on the state mandated form. Unfortunately a lot of times inpatients will only get the hospital specific form and not the state form filled out.

 

[CajunMedic]

Unfortunately that is not always true. There are a rather large number of states where EMS can only recognize the state DNR/Physician Orders for Life Sustaining Treatment (POLST, for the OP) forms. They don't have to be filed with the county or state, but they do need to be on the state mandated form. Unfortunately a lot of times inpatients will only get the hospital specific form and not the state form filled out.

To add to Siggy's info: also depending on the jurisdiction, there may be an EMS Specific DNR/DNI, some may not be able to honor the hospital/outpatient form. The POLST Is preferred on the colored form, but a copy is acceptable.

 

[styphon]

Unfortunately that is not always true. There are a rather large number of states where EMS can only recognize the state DNR/Physician Orders for Life Sustaining Treatment (POLST, for the OP) forms. They don't have to be filed with the county or state, but they do need to be on the state mandated form. Unfortunately a lot of times inpatients will only get the hospital specific form and not the state form filled out.

In NY state, hospital specific forms were eliminated and we all use the same form - MOLST (medical orders for life sustaining treatment) - they are always bright pink (unless they are photocopied of course).

Makes things easier in hospital (and for EMS) as we used to have >15 forms in hospital for DNRs depending on who signs, condition of pt, etc.

 

[southerndoc]

Unfortunately that is not always true. There are a rather large number of states where EMS can only recognize the state DNR/Physician Orders for Life Sustaining Treatment (POLST, for the OP) forms. They don't have to be filed with the county or state, but they do need to be on the state mandated form. Unfortunately a lot of times inpatients will only get the hospital specific form and not the state form filled out.

I'm sorry, when I said nothing needs to be on file with the county, I meant the two counties were I serve as medical director.

 

[rbnsafsadgf]

Depends where you are.

We have a state wide registry. But this just means that EMS and hospitals can pull up a copy. A POLST is still valid without being filed, but may just be harder to find or access.

http://www.orpolstregistry.org/oregon-polst-registry/ems/
http://www.ncbi.nlm.nih.gov/pubmed/23332803

 

[Bigeminy]

Depends where you are.

We have a state wide registry. But this just means that EMS and hospitals can pull up a copy. A POLST is still valid without being filed, but may just be harder to find or access.

http://www.orpolstregistry.org/oregon-polst-registry/ems/
http://www.ncbi.nlm.nih.gov/pubmed/23332803

An online registry seems like an obvious solution and one I wish we had. I'm in NYC and I can't tell you how many times we get patients who are supposedly/maybe DNR/DNI brought in tubed by EMS, or how many times we intubate patients in the ED only to find out hours later they were DNR/DNI.