DESIGNATION OF CONDITION

To honor an EMS DNR ORDER there must be a completed EMS DNR ORDER or the approved Medic Alert bracelet or neck medallion, and patient identification. Resuscitation attempts should be initiated until the order or bracelet/medallion and identification are presented. If a family member or other caregiver has "DURABLE POWER OF ATTORNEY" they should be consulted for instructions on patient care or withholding patient care. These protocols pertain only to patients with valid and verifiable "Advanced Directives". If a patient presents in New Mexico with a DNR or DNR identification that appears substantially equivalent to the NM DNR, EMS personnel should honor the out of state DNR described in this protocol.

EMPHASIS ON PATIENT CARE

Verification of documents, medical direction involvement.

FIRST RESPONDER, BASIC, INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

1. EMS personnel shall follow EMS DNR Orders or Durable Powers of Attorney when encountering persons in pre-hospital settings in accordance with State Regulations and local EMS protocols.

2. EMS procedures for verifying EMS DNR Orders include:

• Perform initial assessment, i.e., assess airway, breathing and circulation.
• Verify identification by:
  • Driver's license or other signed photo identification; or
  • Identification by a family member; or
  • Positive third-party identification by someone who knows the person.
• Verify the existence of an EMS DNR Order for the person, using the following indicators:
  • EMS DNR Order.
  • Intact Medic Alert or EMS bracelet.
• If there is any question about the validity of an EMS DNR Order, or there is any indication of an attempted homicide or suicide, initiate resuscitation until such time that the questions have been answered. If possible, contact medical control for consultation.

3. EMS procedures for implementing EMS DNR Orders include:

• For all persons, the following procedures may be initiated for the comfort of the person if they have not been refused by the person or by the authorized health care decision-maker, by:
  • Administer oxygen by mask or cannula.
  • Suctioning.
  • Managing airway, except intubation and other advanced airway maneuvers.
  • Administering analgesics, including IV route (EMT-I, EMT-P).
  • Controlling bleeding.
  • Making patient comfortable.
  • Comforting family.
• For covered persons in cardiac or respiratory arrest, resuscitative measures to be withheld include:
• External chest compression.
• Artificial ventilations, intubation or other advanced airway maneuvers.
• Defibrillation/external cardiac pacing.
• Administration of cardiac medications.
• Artificial respiration.

4. EMS procedures for implementing Durable Powers of Attorney include:

• Perform initial primary assessment, i.e., assess airway, breathing and circulation.
• Verify identification by:
  • Driver's license or other signed photo identification; or,
  • Identification by a family member; or,
  • Positive third-party identification by someone who knows the person.
  • Verification of identity of the person named in the Durable Power of Attorney as the authorized health care decision-maker.
• Follow that person's instructions as authorized by the Durable Power of Attorney.
• If there is any question about the validity of a Durable Power of Attorney, or there is any indication of an attempted homicide or suicide, initiate resuscitation until such time that the questions have been answered. If possible, contact medical control for consultation.