DNR Standards

Question 1

When was the DNR first introduced?

Answer 1

Introduced in 1999.

Question 2

What were the initial limitations of early DNR versions?

Answer 2

Early versions were restrictive, limiting application.

Question 3

What is the new directive regarding DNR?

Answer 3

Allows for greater flexibility in recognizing and honoring patient wishes.

Question 4

What does a Do Not Resuscitate (DNR) order reflect?

Answer 4

A DNR order reflects a patient’s expressed wish or the consent of a substitute decision-maker that CPR not be included in the treatment plan.

Question 5

When can a physician issue a DNR?

Answer 5

A physician may issue a DNR if they determine that CPR will almost certainly not benefit the patient.

Question 6

What is Cardiopulmonary Resuscitation (CPR)?

Answer 6

Immediate application of life-saving measures to a person who has suffered sudden respiratory or cardiorespiratory arrest.

Question 7

What interventions are included in CPR?

Answer 7

Basic and advanced cardiac life support, chest compressions, artificial ventilation, defibrillation, advanced airway management, and administration of cardiac medications.

Question 8

When will paramedics not initiate CPR interventions?

Answer 8

Paramedics will not initiate any interventions if a valid DNR exists.

Question 9

What is a unique identifier for a DNR form?

Answer 9

Each DNR form is imprinted with a 7-digit serial number in the top right corner.

Question 10

What does the identification box on a DNR form state?

Answer 10

States the purpose of the form and identifies the patient and the attending physician or authorized decision-maker.

Question 11

What does Point 1 on a DNR form define?

Answer 11

Defines the DNR order and treatment directives before arrival.

Question 12

What does Point 2 on a DNR form define?

Answer 12

Defines palliative care and comfort measures for the patient.

Question 13

What can be a reason for the DNR?

Answer 13

Can be based on the patient’s expressed wishes or the physician’s professional opinion that CPR would not benefit the patient.

Question 14

What signatures are required on a valid DNR form?

Answer 14

Must include the level of provider and the printed name and signature of the authorizing physician or decision-maker.

Question 15

What is the initial care protocol upon arrival at a scene?

Answer 15

Initiate care as per Basic Life Support Patient Care Standards (BLS PCS) until presented with a valid DNR.

Question 16

What should be done to verify a DNR?

Answer 16

Check the validity of the DNR and continue resuscitation if it is not valid.

Question 17

What should be confirmed regarding the DNR?

Answer 17

Ensure the DNR applies to the patient being treated.

Question 18

What should be done once DNR validity is confirmed?

Answer 18

Stop resuscitation and notify applicable authorities.

Question 19

When should a DNR not be honored?

Answer 19

If the DNR form is absent or incomplete, if a capable patient verbally requests resuscitation, if the SDM explicitly revokes the order, or if there is uncertainty about SDM authority.

Question 20

What should be done for patients NOT in respiratory/cardiac arrest?

Answer 20

Confirm and document the presence of a valid DNR, focus on comfort measures, and allow non-medical escorts.

Question 21

What should be done if death occurs during transport?

Answer 21

Perform respiratory and pulse check for 3 minutes, note the time of death, notify dispatch, and continue transport as per protocol.

Question 22

What should be reported if a patient with a valid DNR is NOT in arrest?

Answer 22

Report the presence of a valid DNR to the receiving staff and provide the validity form.

Question 23

What should be reported if a patient with a valid DNR is in arrest?

Answer 23

Report the DNR status in your communication to staff and present the validity form upon arrival.

Question 24

What should be completed in all cases of death?

Answer 24

Complete an Ambulance Call Report (ACR) and document relevant information thoroughly.

Question 25

How should a deceased patient be treated?

Answer 25

Maintain professionalism and empathy in handling the body.

Question 26

What should be done if foul play is suspected?

Answer 26

Contact local police and ensure law enforcement is notified when applicable.

Question 27

What should be followed after a death occurs en route?

Answer 27

Notify Central Ambulance Communication Centre (CACC) to inform the coroner and proceed to the receiving facility for official confirmation.

Question 28

What are the key points to remember regarding DNR and patient care?

Answer 28

Always treat the patient and their family with compassion, utilize dispatch for authority contact, document thoroughly, and leave a copy for the coroner.

Question 29

Why was the initial DNR directive considered limited?

Answer 29

It had restrictive application and lacked flexibility in honoring patient wishes.

Question 30

What does the updated DNR directive allow?

Answer 30

Greater flexibility in recognizing and honoring patient wishes.

Question 31

How is a Do Not Resuscitate (DNR) order defined?

Answer 31

A plan of treatment that reflects the patient’s expressed wish, or the consent of a substitute decision-maker (SDM), that CPR not be included in treatment.

Question 32

When can a physician issue a DNR without patient/SDM consent?

Answer 32

When it is the physician’s professional opinion that CPR will almost certainly not benefit the patient.

Question 33

Define Cardiopulmonary Resuscitation (CPR).

Answer 33

Immediate application of life-saving measures to a person in respiratory or cardiac arrest, including chest compressions, ventilation, defibrillation, and medication administration.

Question 34

What happens when a valid DNR order is presented?

Answer 34

Paramedics do not initiate any CPR interventions.

Question 35

What unique feature is found on all valid DNR forms?

Answer 35

A 7-digit serial number in the top right corner.

Question 36

What is the purpose of the identification box on a DNR form?

Answer 36

To state the purpose of the form and identify the patient.

Question 37

What must be included in the signature section of a valid DNR?

Answer 37

The level of provider, the name, and the signature of the authorizing physician or SDM.

Question 38

What are the two primary reasons for issuing a DNR?

Answer 38

1. The patient’s expressed wishes. 2. The physician’s opinion that CPR will almost certainly not benefit the patient.

Question 39

What should paramedics do upon arrival if a DNR form is presented?

Answer 39

1. Initiate care per BLS PCS until the DNR is verified. 2. Check the validity of the DNR. 3. Stop resuscitation if the DNR is valid. 4. Notify applicable authorities.

Question 40

When should paramedics continue resuscitation even if a DNR is presented?

Answer 40

• If the DNR is invalid or incomplete. • If a capable patient requests resuscitation. • If the SDM revokes the order. • If there is confusion about the SDM’s authority.

Question 41

What is the protocol for patients who are NOT in respiratory or cardiac arrest but have a valid DNR?

Answer 41

• Confirm the presence of the DNR. • Utilize palliative care techniques. • Allow non-medical escorts if requested.

Question 42

How do paramedics confirm death during transport?

Answer 42

Perform a respiratory and pulse check for 3 minutes.

Question 43

What information should be documented after confirming death during transport?

Answer 43

• Time of death. • Presence of a valid DNR. • Notification to dispatch.

Question 44

What should paramedics do if a patient with a valid DNR is NOT in arrest upon arrival?

Answer 44

• Report the DNR status to the receiving staff. • Provide the validity form.

Question 45

What should paramedics do if a patient with a valid DNR is in arrest upon arrival?

Answer 45

• Report the DNR status in the handoff communication. • Provide the validity form.

Question 46

What documentation must be completed in all cases of death?

Answer 46

Ambulance Call Report (ACR).

Question 47

How should deceased patients be treated?

Answer 47

With respect and dignity.

Question 48

Who should be contacted if foul play is suspected?

Answer 48

The local police department.

Question 49

What should paramedics do if death or termination of resuscitation (TOR) occurs en route?

Answer 49

Notify CACC to inform the coroner. Continue transport to the receiving facility.

Question 50

When should a DNR not be honored?

Answer 50

No valid confirmation form. Patient verbally requests resuscitation. SDM rescinds the order. Uncertainty about SDM authority or family disputes.

Question 51

You arrive at a nursing home where a patient has gone into cardiac arrest. The nurse presents a DNR form with a 7-digit serial number and valid signatures. What should you do?

Answer 51

Cease resuscitation, notify dispatch, and confirm that the DNR applies to the patient.

Question 52

A family member presents a DNR form that is incomplete and missing the physician’s signature. The patient is in cardiac arrest. What should you do?

Answer 52

Continue resuscitation as the DNR is invalid.

Question 53

A conscious and capable patient with a valid DNR verbally requests resuscitation after experiencing severe chest pain. What action should you take?

Answer 53

Honor the patient’s request and initiate CPR, as capable patients can override their DNR.

Question 54

During a home visit, the substitute decision-maker (SDM) verbally rescinds the DNR order for the patient. What should you do?

Answer 54

Initiate CPR and continue care as the DNR has been revoked.

Question 55

A patient with a valid DNR is experiencing severe respiratory distress but is not in cardiac arrest. What should you do?

Answer 55

Utilize palliative care techniques to provide comfort and symptom relief.

Question 56

A patient with a valid DNR stops breathing during transport. What should you do?

Answer 56

Confirm death by checking for respiration and pulse for 3 minutes, document time of death, notify dispatch, and continue transport.

Question 57

At a scene, multiple family members are arguing about who the legitimate substitute decision-maker (SDM) is. What should you do?

Answer 57

Initiate resuscitation until the SDM situation is clarified.

Question 58

You arrive at the scene of an unresponsive patient, and the family verbally informs you about a DNR, but no document is presented. What should you do?

Answer 58

Initiate resuscitation until valid documentation is provided.

Question 59

You encounter a deceased patient where the circumstances suggest possible foul play. What is your next step?

Answer 59

Treat the body with respect, contact the local police department, and notify the coroner.

Question 60

You are transporting a patient with a valid DNR who passes away during transport. What should you do?

Answer 60

Confirm death, notify CACC to inform the coroner, and proceed to the receiving facility.

Question 61

An SDM verbally revokes a DNR during transport. What is your immediate action?

Answer 61

Initiate resuscitation immediately and document the change in the patient care record.

Question 62

You arrive at a hospital with a patient who has a valid DNR and is NOT in arrest. What do you do?

Answer 62

Report the DNR status to the receiving staff and provide the validity form.

Question 63

You are transporting a terminally ill patient with a valid DNR who is experiencing severe pain. What should you do?

Answer 63

Utilize palliative care techniques to manage pain and provide comfort.

Question 64

A capable patient with a DNR form presented by family verbally revokes the DNR. What should you do?

Answer 64

Respect the patient’s wishes and initiate resuscitation if necessary.