" Do not resuscitate " question

[David1961]

I have a parent who has completed the required forms to not be resuscitated if cardiac arrest occurs. Should she have some kind of bracelet on her that also states this? The doctor said to have the form in the house, but it seems like in an emergency, the medics would not have time to look for the form. I was thinking about getting a bracelet that just states her name and that she wishes to not be resuscitated. In know there are others here in the same boat and was wondering what you have done. If so, can you direct me to a web site where we can order a bracelet? If we go the bracelet route, what should be ingraved on it? Thanks.

[braumeister]

It's a tough situation. Having been through this several times with relatives, here's what I think I know.

Many hospitals will ignore DNR instructions unless the properly executed form (advance directive, living will, whatever it's called where you live) has been entered into their system so they can see it on the screen.

Some doctors will ignore it even then. They were trained to take heroic measures to save any life and by golly that's what they will do.

Many EMTs (life squad, whatever your 911 service sends) will also ignore such instructions. They're trained to look for information about drug allergies and such things, but otherwise they're full bore to resuscitate.

It's probably apocryphal, but I once heard of a person getting DNR tattooed on his chest where the defibrillator would go, but the EMT assumed it was just his initials.

[travelover]

Quote:

Originally Posted by braumeister ......... It's probably apocryphal, but I once heard of a person getting DNR tattooed on his chest where the defibrillator would go, but the EMT assumed it was just his initials.

Did this person work for the Department of Natural Resources?

[newtoseattle]

Yes - most will ignore some piece of paper until there is family (or patient) can confirm that indeed that is their wishes. People change their mind frequently and there are often nuances that the forms don't cover.

Most EMT's do look for health bracelets (medications, etc). Having a DNR - which clearly states - no CPR - would likely help. Saying no to defibrillation is harder - what if you're in a rhythm that is easily survivable with no bad outcome - would you want it then?

People don't "ignore" these orders because they're callous or don't care about people's wishes. They err on the side of life - hoping that someone's wishes can be sorted out later if need be. DNR sounds simple - but its really not - there are a million different configurations as to what people mean with that exactly - that's why more than any piece of paper - you need to make sure your loved ones know what was your intention - i.e. "I don't want to live on a machine for even a day" or "I would not want to stay in a nursing home for even a day". versus "give me a shot, but if its not clear I'm rapidly recovering, let me go after a week" etc, etc, etc...

[Meadbh]

Jurisdictions vary as to the validity of advance care directives; some require that a representative be designated in the directive. I presume your parent has completed all the legal documentation. As newtoseattle says, the devil is in the details. If someone dies in hospital, or at home in palliative care, the care providers will be prepared. If someone has an emergency at home, and the emergency services are called, they will not be privy to that information and will be obliged to provide emergency care. The situation will be clarified later. I know of one case where a physician called 911 when her mother had a cardiac arrest at home, and was very upset when the paramedics administered CPR. I don't know what else they could have done. If everyone was clear that no CPR was to be administered, she should not have called 911. Rather, she should have called the family doctor, who could certify the death.

I think the rules of thumb are:
1. Make your wishes clear in writing, using whetever documentation will be recognized where you live;
2. Tell your loved ones what you want. Provide a copy of the document to your physician, your lawyer, and your close family members.
3. Post a memo about your advance directive on your fridge (will not stick to a stainless steel fridge!) or on a kitchen bulletin board, where paramedics can find it.
4. Consider getting an advance directive bracelet from a site like this one:
DNR: Do Not Resuscitate Guidelines

[lhamo]

Here in Washington state, they have implemented the new POLST (Physician's Orders for Life Sustaining Treatment). It is bright green, and pretty hard to miss. We were told to keep a copy of my mom's on the fridge -- EMTs know to look for it when they come in. Each of us kids also has a copy, and there is one in mom's medical file as well.

[ChiliPepr]

there is always this... Joy Tomkins, 81, has 'do not resuscitate' tattoo on her chest and PTO inked on her back | Daily Mail Online