4.4. STATUS “DO NOT RESUSCITATE “/PRELIMINARY ORDER/STATUS OF THE PERSON AUTHORIZED TO MAKE DECISIONS IN THE HEALTH CARE SYSTEM

Related Names

Do not resuscitate, soothing help.

Purpose of assistance

Recognize and support the diverse ways patients can express their wishes for cardiopulmonary resuscitation or end-of-life decisions.

Patient description

Inclusion/exclusion criteria

1. The patient must carry one of these documents or a valid alternative (for example, an identification bracelet on which the patient’s desire is indicated). Note that some features may differ in different states:

a) a doctor’s order to carry out life support or a Medical order to carry out life support – directly contain a list of permitted procedures in the form of an order, the validity of the document is determined by the existing signature of the doctor or other authorized medical person;
b) the order “Do not resuscitate” defines a ban on CPR and intubation in a cardiac arrest situation or its onset in a patient. The list of allowed procedures and details of their implementation varies from document to document;
c) preliminary orders – a document describing the procedures allowed for these medical conditions, including all or only partially of the following: what to do in cardiac arrest, whether artificial nutrition is allowed, the desire to be a donor or not, dialysis, as well as other parameters. This advance order may often not be applicable to emergency or transient medical conditions;
d) depending on the legislative framework, in the absence of a formal written order (Medical or Medical to support life, Do not reanimate, Preliminary orders) and in the presence of a person authorized to make decisions, this person can determine the boundaries of assistance.

2. Each of the above documents is valid if all criteria are met:

a) has a color and structure corresponding to the law;
b) is intact: there are no cuts, tears or traces of recovery;
c) name of patient and physician.

3. If there are doubts about the validity of the document/instrument, resuscitation procedures will be best until information is received that will determine the further course of assistance.

4. If the patient has a valid one of the above documents, this will be considered an exclusion criterion in this instruction for assisting the patient.

Patient Management

1. In the presence of a valid document prohibiting the initiation of resuscitation or respiratory tract control, it does not exclude the provision of sedative care, including the introduction of painkillers.
2. In the event that CPR has been initiated and only a valid no-carry document has subsequently been identified, discontinue the procedure and contact medical guidance

Treatment and intervention

1. In the presence of a valid document on the prohibition of resuscitation and signs of life (pulse and breathing), rescuers must provide standard assistance in accordance with the valid protocols in accordance with the patient’s condition:

a) if the patient has a medical or medical order to support life, then it may indicate the rules for assisting in this situation;
b) directives should be implemented as accurately as possible and if necessary you can contact the medical leadership.

2. The patient should receive assistance in full, with the exception of the procedures specified in the documents prohibiting certain interventions defined as prohibited.

3. If you need an intervention that is prohibited by the patient’s document, contact the medical management.

Patient safety

In the event that the patient’s clear condition is unknown and there are doubts about the resuscitation procedure, EMF employees should immediately begin CPR and only then contact the medical leadership.

Useful information for training

Key points

1. If the patient’s personal doctor is present at the site, he can decide on resuscitation.
2. If there is a nurse on site who works in a clinic or hospice, cares for the patient and follows the orders of a personal doctor, she can (if she has the authority) decide on resuscitation.
3. If a doctor or nurse has given permission for resuscitation, follow all standard procedures.
4. Special warnings: to ensure safety at the scene and/or fulfill the wishes of relatives, the rescuer can begin the procedure of resuscitation even if there are all signs of death.

Relevant evaluation results

There are no recommendations.

Key points in the documentation

1. A detailed description of the valid documents prohibiting resuscitation, which guided the provision of assistance (including a copy of the document).
2. Names/contact details of third parties whose presence at the scene is important.

Criteria for the effectiveness of care

There are no recommendations.