DNR POLST

Emergency Service Organizations are often called upon to provide patient care to the public that involve terminally ill persons or patients and family members that are dealing with death in real time.  These situations require tact and professionalism at its highest level.  Even if end of life is expected due to known medical conditions the ESO must handle these type calls properly and legally to ensure that all the wishes of the patient are respected.  Specific training is needed to complete this task as well as deal with grief concerns and remain within the scope of local and state regulations. 

During the recent survey of your organization it was noted that no formal protocol or guideline exist to address these serious and emotionally charged situations. Without a specific protocol or guideline to follow, your organization has an additional exposure arising from not practicing within the scope of legal requirements as well as a public relations concern.

We recommend your organization develop a protocol or guideline that addresses this particular type of call.  Many state EMS agencies have developed strict guidelines for end of life situations.  These may be Advanced Directives, Do Not Resuscitate orders (DNR) or Physicians Orders for Life Sustaining Treatment (POLST).  If a state specific protocol does not exist; one should be developed by the ESO in conjunction with the local Medical Director and legal counsel.  

Further state specific information may be found at www.polst.org.