DNR Standard

Question 1

What is the definition of Cardiopulmonary Resuscitation (CPR)?

Answer 1

An immediate application of life-saving measures to a person who has suffered sudden respiratory or cardiorespiratory arrest. These measures include but are not limited to basic or advanced cardiac life support interventions outlined in the ALS PCS such as:
1. Chest compression
2. Defibrillation
3. Artificial ventilation
4. Insertion of an oropharyngeal, nasopharyngeal or supraglottic airway
5. Endotracheal intubation
6. Transcutaneous pacing
7. Advanced resuscitation drugs such as, but not limited to, vasopressors, antiarrhythmic agents and opioid antagonists.

Question 2

What is the definition of Do Not Resuscitate?

Answer 2

means that the paramedic (in accordance with his/her level of certification) will not initiate any of the interventions listed in the definition of CPR, above.

Question 3

What is the definition of Treatment?

Answer 3

Any action or service that is provided for a therapeutic, preventative, palliative, diagnostic, cosmetic, or other health-related purpose, and includes a course of treatment or plan of treatment.

Question 4

What is a Valid MOH DNR Confirmation Form?

Answer 4

A DNR Confirmation Form with pre-printed serial number that has been completed, in full, with the following information:
1. The name of the patient (including both surname and first name) to whom the Form applies.
2. A check box that has been checked to identify that one of the following conditions has been met:
a. A current plan of treatment exists that reflects the patient’s expressed wish when capable, or consent of the substitute decision maker when the patient is incapable, that CPR not be included in the patient’s plan of treatment.
b. The physician’s current opinion is that CPR will almost certainly not benefit the patient and is not part of the plan of treatment, and the physician has discussed this with the capable patient or the substitute decision maker when the patient is incapable.
3. A check box that has been checked to identify the professional designation of the Medical Doctor (M.D.), Registered Practical Nurse (R.P.N.), Registered Nurse (R.N.), or Registered Nurse in the Extended Class (R.N. [EC]) who has signed the Form.
4. Printed name of the M.D., R.P.N., R.N., or R.N. (EC) signing the Form.
5. A signature by the appropriate M.D., R.P.N., R.N., or R.N. (EC).
6. The date that the Form was signed, which must be the same as or precede the date of request for ambulance service.

Question 5

Can a DNR be a copy?

Answer 5

A Valid DNR Confirmation Form may be a fully completed original, or a copy of a fully completed original.

Question 6

General Directive

What will a paramedic do upon obtaining a Valid MOH DNR Confirmation Form? (1.)

Answer 6

1. A paramedic, upon obtaining a Valid MOH DNR Confirmation Form and subject to paragraph 2 below, SHALL NOT initiate CPR (as per the definition above) on the patient in the event that the patient experiences respiratory or cardiopulmonary arrest (i.e. respirations and pulse are absent for at least three minutes from the time that respiratory or cardiac arrest was noted by the paramedic).

Question 7

General Directive

When shall a paramedic initiate CPR? (2.)

Answer 7

2. A paramedic shall initiate CPR (as per the definition above) on a patient who has experienced respiratory or cardiorespiratory arrest when:
   a. the patient with a Valid MOH DNR Confirmation Form appears to the paramedic to be capable and expresses clearly a wish to be resuscitated in the event that he/she experiences a respiratory or cardiac arrest; or
   b. the patient with a Valid MOH DNR Confirmation Form appears to the paramedic to be capable and expresses a wish to be resuscitated in the event that he/she experiences respiratory or cardiopulmonary arrest, but the request is vague, incomplete or ambiguous such that it is no longer clear what the wishes of the patient are.

Question 8

General Directive

What patient management can a paramedic provide with a DNR? (3.)

Answer 8

3. The paramedic shall provide patient management necessary to provide comfort or alleviate pain, as required by the patient’s clinical condition.

Question 9

General Directive

What will a paramedic do once it is determined that death has occured? (4.)

Answer 9

4. Once it has been determined that death has occured, the paramedic shall:
   a. advise the CACC/ACS; and
   b. follow the Deceased Patient Standard

Question 10

General Directive

What will the paramedic do in conjunction with the Documentation of Patient Care Standard. (5.)

Answer 10

5. In conjunction with the Documentation of Patient Care Standard, the paramedic shall note and document the time at which the paramedic confirms the patient was deceased as per paragraph 1 above.