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Emergency squads and other health care providers must provide CPR (cardiopulmonary resuscitation) and attempt to resuscitate patients by a variety of means whenever it is medically appropriate. If you do not want to be resuscitated, you always have the right to refuse this or any other medical treatment. Most likely, however, you won’t be able to state your wishes when an emergency happens. Therefore, if you do not want to be resuscitated, you should talk with your doctor about whether it would be appropriate for your doctor to write a medical order called a DNR (“do not resuscitate”) order.
A DNR order addresses the various methods used to revive people whose hearts have stopped working or who have stopped breathing. Examples of these treatments include chest compressions, electric heart shock, artificial breathing tubes, and special drugs.
For more information, see www.ohiocathconf.org/hopes_fears/dnrfrm.pdf
Q: If I have a DNR order, does that mean I won’t get resuscitated?
A: If you and your doctor have decided it is appropriate for you to have a “DNRCC,” then you will receive “comfort care” only for any medical emergency, and you will not be resuscitated. This type of DNR order might be appropriate if you are terminally ill and resuscitation would be likely only to prolong your suffering.
However, you and your doctor may decide it is more appropriate for you to have another type of DNR order called a “DNRCC-Arrest” order. If you have a DNRCC-Arrest order, medical personnel will try to resuscitate you, but will stop those efforts if you go into cardiac arrest.
Q: If I have a DNR order from my doctor, where should I keep the document so that medical personnel are likely to find it if I’m unable to communicate?
A: Since emergency squad personnel generally look for what medicines a patient is taking, it might be wise to store your DNR order with your medications - in your medicine cabinet or on a bedside table.
Q: I’ve heard someone speak of a “vial of life.” What, exactly, is that?
A: The “vial of life” is a cylindrical container, available at most pharmacies, from your family physician, your local Council on Aging or even your local fire or EMS department, that can be used to hold a copy of your DNR order and other information about medical conditions, allergies, lists of medications, family contact information, etc. Most people store the vial of life in the refrigerator, where medical personnel generally look for it. Also, a note may be attached to the outside of the refrigerator to alert medical personnel that the “vial of life” is inside.
You may also include in your “vial of life” instructions about the location of your medications and copies of your living will and/or health care power of attorney documents. The living will document tells medical personnel your wishes concerning end-of-life care when you are unable to speak for yourself, and the health care power of attorney document names someone to speak for you about all facets of your medical care when you cannot speak for yourself.
Q: If I’m not at home when I have such a medical emergency, how will medical personnel know that I have a DNR order?
A: You may wish to wear a DNR bracelet or necklace, and/or you may wish to carry a DNR wallet card to indicate that you have a DNR order. Or, you may wish to use a more general medical alert necklace or bracelet (such as those provided by MedicAlert®) that can include your name, medical conditions, allergies, etc., as well as a reference your DNR status. For example, it might include a direction such as, “DNRCC—see wallet card.” This will alert medical personnel to contact your doctor so they can confirm that you have a valid DNR order. Samples of the format to be used for the insert in bracelets, necklaces and wallet cards are available through the Web site of the Ohio Department of Health (www.odh.ohio.gov). Note: The Ohio Department of Health does not supply the actual jewelry. An Internet search may identify potential jewelry suppliers.
Q: What will paramedics do if I am not wearing DNR identification, and they cannot find my DNR order?
A: The paramedics will perform CPR and follow their resuscitation protocol, which may include one or more of many resuscitation measures. For example, they may use an AED (Automatic External Defibrillator) to shock your heart with an electric current, or they may use intubation, intravenous fluids and drugs, or an external pacemaker.
Law You Can Use is a weekly consumer legal information column provided by the Ohio State Bar Association (OSBA). This article was prepared by attorney Larry Bennett, program chair, Fire Science & Emergency Management at the University of Cincinnati; and paramedic Bill Barks, manager of the Center for EMS at The Ohio State University Medical Center. It was updated by Larry Bennett.