Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-27T10:09:13.305Z Has data issue: false hasContentIssue false
  • English
  • Français

Prehospital Do-Not-Resuscitate Orders: A Survey of State Policies in the United States

Published online by Cambridge University Press:  28 June 2012

James G. Adams
James G. Adams*
Affiliation:
Department of Emergency Medicine, Wilford Hall USAF Medical Center, Lackland AFB, Texas, Clinical Faculty, Uniformed Services, University of Health Sciences, Adjunct Assistant Professor of Medicine, University of Pittsburgh School of Medicine
*
2200 Berquist Dr., Suite 1/PSAE, Lackland AFB, TX 78236USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Many states in the United States ‘have developed policies that enable prehospital emergency medical services (EMS) providers to withhold cardiopulmonary resuscitation (CPR) in the terminally ill. Several states also have policies that enable the implementation of do-not-resuscitate (DNR) orders.

Objectives:

1) assess which states have statutes governing DNR orders for the prehospital setting; 2) determine which states authorize DNR orders in ways other than by specific state statue; and 3) define those states that had regional protocols which address prehospital DNR orders.

Methods:

Survey of the state EMS directors in each of the 50 U.S. states, the District of Columbia, and Puerto Rico.

Results:

As of 1992, specific legislation authorizing the implementation of DNR orders was in place in 11 states. In addition, six others have a legal opinion or policy allowing the implementation of DNR orders. Fourteen additional states have either working groups or legislation pending that address prehospital DNR orders. In only five were there no existing regional protocols for implementation of DNR orders in the prehospital setting.

Conclusions:

There exists great variation in legal authorization by states for implementation of DNR orders in the prehospital setting. Despite the existence of enabling legislation, many state, regional, or local EMS systems have implemented policies dealing with DNR orders.

Keywords

emergency medical services (EMS)EMS directorsdo-not resuscitate (DNR)legislationmedical controlmedical directionpoliciesprehospitalprotocolsresuscitationterminally ill
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 4 , December 1993 , pp. 317 - 322
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Sachs, GS, Miles, SH, Levin, RA: Limiting resuscitation: Emerging policy in the emergency medical system. Ann Int Med 1991;114:151–154.CrossRefGoogle ScholarPubMed
2. Miles, SH, Crimmins, TJ: Orders to limit emergency treatment for an ambulance service in a large metropolitan area. JAMA 1985:254:525–527.CrossRefGoogle Scholar
3. Marshall, L: Resuscitating the terminally ill. JEMS 1985;24–8.Google Scholar
4. American College of Emergency Physicians: Guidelines for do not resuscitate orders in the prehospital setting. Ann Emerg Med 1988:17:1106–1108.CrossRefGoogle Scholar
5. Stratton, SJ: Withholding CPR in the prehospital setting. Prehospital and Disaster Medicine 1990;5:45–46.CrossRefGoogle Scholar
6. Crimmins, TJ: The need for a prehospital DNR system. Prehospital and Disaster Medicine 1990;5:47–48.CrossRefGoogle Scholar
7. Ayres, RJ: Current controversies in prehospital resuscitation of the terminally ill patient. Prehospital and Disaster Medicine 1990:5:49–57.CrossRefGoogle Scholar
8. Iserson, KV: Foregoing prehospital care: Should ambulance staff always resuscitate? J Med Eth 1991;17:19–24.CrossRefGoogle ScholarPubMed
9. Emergency Medical News: Calls to 9-1-1 may trigger unwanted care. 10 Oct 1989, pl.Google Scholar
10. ACEP News: North Carolina's new prehospital DNR order gets state attorney general's endorsement. June 1991, Vol. 10, p 12.Google Scholar
11. American Medical News: States move to get advance directives. November 11, 1991 p 3.Google Scholar
12. Emergency Cardiac Care Committee and Subcommittees, American Heart Association: Ethical considerations in resuscitation. JAMA 1992:266:2282–2288.Google Scholar