Good day,
I was hoping I could get some clarification on CPR with a DNR patient. My agency is at a dilemma with this topic.
Scenario: 2nd party caller states he believes his elderly father has passed away during the night. Caller stated that the patient was slumped over, still a bit clammy, and was still a bit warm. The patient had some medical history but was not, per se, expected to pass when he did.
The Emergency Dispatcher records the Sub-Chief Complaint as OBVIOUS DEATH and proceeds to KQ 2 at which time the caller states that the patient is a DNR.
I have a few questions. Should the Sub-Chief Complaint be changed to EXPECTED DEATH with DNR? Should the Emergency Dispatcher be trying to have the caller do CPR until responders arrive and visually see the DNR? Or is this circumstance something that is up to the agency medical director?
I’d appreciate any clarification you could provide.
Thank you,
Nina Hawkins
QA Coordinator/CTO
Okaloosa County Sheriff’s Office
Shalimar, Florida (USA)
Hi Nina:
Ideally, the caller provides either an OBVIOUS or EXPECTED DEATH complaint at Case Entry where a choice can easily be made but, as you point out this is not always the case, or the distinction may not be clear.
I have not heard the call so I will continue on the assumption that the caller’s concern was not OBVIOUS DEATH criteria, but rather the DNR.
Anyway, we cannot validate a DNR over the phone at this time. This option is included in EXPECTED DEATH criteria for cases where the caller does not want to provide CPR because of the order and this reasoning is then confirmed with KQ 1b. So, if DNR criteria is offered by the caller as a reason not to do CPR, choose the EXPECTED DEATH pathway. If the patient’s physical condition is the reason, and that condition is locally approved as OBVIOUS DEATH criteria, choose the OBVIOUS DEATH pathway. If both criteria apply, use the one the caller offers as their reason not to do CPR.
Sometimes, the information is not provided by the caller until instructions are started, in which case the EMD can use the link options in the PAI pathway.
It’s important to note that the MPDS® only attempts to confirm the caller’s intent; it does not attempt to validate the criteria offered, DNR or otherwise. Confirmation of the caller’s intent happens during Key Questioning (Protocol 9 KQs 1a and 1b in cardset).
Please let me know if this answers your question.
Brett A. Patterson
Chair, Medical Council of Standards
International Academies of Emergency Dispatch®
Nina,
Many years ago in my center, I was approached by a dispatch supervisor who came to my upstairs Fire Department Medical office. Such a visit was extremely rare, so I was sure it was most likely an important thing. Frank C. mentioned that we had just implemented the MPDS version 5 protocol change in the “Alarm Office” adding in the OBVIOUS DEATH process and its new, now much less critical determinant code, 9-BRAVO-1.
He then asked bluntly, “Just what is this ‘unquestionable’ crap all about?”. This EMD was known as a very tough guy (his previous “job” was as a Hell’s Angel in Fresno) so I knew he always meant business, and I needed to get this one right or I might be eating it later on the end of the proverbial 2 x 4. I thought for longer than was comfortable, but finally stated, “Frank, it means that you’re willing to bet your job on that decision, so only make it if you’re sure.” He paused, turned, and then said, “Doc, that makes sense to me. I’ll pass the word.”
The protocol has continued to evolve to make that “unquestionable” decision easier and more accurate with time and several studies have shown that it is. Unfortunately, Frank still wouldn’t let me ride his Harley ...
... Doc
