clarendon county emergency medical responder fileclarendon county fire department emr guidelines...

CLARENDON COUNTY FIRE DEPARTMENT EMR GUIDELINES

CLARENDON COUNTY EMERGENCY MEDICAL RESPONDER

PATIENT TREATMENT GUIDELINES JANUARY 2016

______________________________________ ________________________ Robert L. Ridgeway, III, M.D. Date

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Definitions 3Universal Patient Care Protocol 7Abdomen Pain / GI Bleed 7Altered Mental Status / Unresponsive Patient 8Anaphylaxis / Severe Allergic Reaction 8Behavioral Emergencies 9Burns 9Cardiac Arrest 10Chest Pain / Respiratory Distress 10Chest Trauma 11CVA / TIA (Stroke) 11Diabetic Emergencies 11Determination of Death 12Discontinuation of Field Resuscitation 13Environmental (Heat) Emergencies 14Environmental Emergencies (Hypothermia) 16Head Injuries 17Hypertension (High Blood Pressure) 17Hypotension (Low Blood Pressure) - Non-Traumatic 18OB / GYN Emergencies 18Seizure / Postictal (Post-Seizure) State 18Syncope (Fainting) 19Toxicology (Poisoning / Overdose) 19Trauma / Shock 20Pediatric Determination of Death / Field Resuscitation 21Pediatric Resuscitation 22Neonate (Newborn) Resuscitation 23Do Not Resuscitate Order (DNR) 24

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Definitions

Apnea - no respiratory effort (not breathing)

AVPU Level of Consciousness - A - Alert V - Voice Stimuli P - Painful Stimuli U - Unresponsive

Blow by Method - Method of administering oxygen, where the end of the oxygen tubing or a mask is placed very close to the face so as to have the oxygen flow into the area immediately in front of the mouth and nose.

Brachial Artery - The artery located in the upper inner arm, between the biceps muscle and the humorous (upper arm bone).

BSA - Body Surface Area

Carotid Artery - The artery located in the neck; one on either side of the windpipe, between the windpipe (trachea) and the neck muscles.

Category 4 Patient - A discreet way of stating that the patient is dead over the radio.

Chief Complaint - The main problem that the patient is experiencing. (What they called you for.)

Crowning - During delivery of a baby, when part of the baby’s scalp is present and visible at the opening of the mother’s vagina.

Distal - Away from the middle of the body in reference to another location on the body. (The wrist is distal to the elbow.)

Flail Segment - Are of the chest where two (2) or more neighboring ribs are each broken in two (2) or more places. This creates an area of the chest that moves opposite of the movement of the rest of the chest when breathing.

Hypertensive (Hypotension) - High blood pressure.

Hypotensive (Hypotension) - Low blood pressure.

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Impaled Object - An object that penetrates the body, causing injury (Knife, screwdriver, rebar) and the object remains in the body.

Initial Medical Assessment - Includes, but is not limited to: vital signs (pulse, respirations and blood pressure), SAMPLE history, assessment of the patient’s Chief Complaint using OPQRST. If the patient is unconscious, confused, or is unable to relate their Chief Complaint, this assessment should be done rapidly to quickly identify existing or potentially life-threatening conditions. In an unconscious patient, assessment of the Chief Complain using OPQRST is replaced with DCAP-BTLS. O - Onset of signs & symptoms (What was the patient doing with they first occurred? Was the onset sudden or gradual?) P - Provocation / Palliation (Is there anything that makes the symptom better or worse?) Q - Quality of the pain (What is the patient feeling? Is the pain dull, sharp, crushing, aching, tearing, throbbing?) R - Region / Radiation (Where is the pain located and does it move to another part of the body?) S - Severity (How sever is the symptom, on a scale of 1 to 10?) T - Time (When did the sign/symptoms first occur?)

Medical First Responder - (Not to be confused with the term “First Responder”.) Member of the Clarendon County Fire Department who has completed BLS Healthcare Provider and First Aid certifications, in addition to training in the areas of oxygen administration and spinal immobilization. Completion of an approved Emergency Medical Responder course, Medical First Responder course, EMT Basic course or higher level of training will satisfy this definition.

Penetration Injury - Injury that results usually in the skin being broken and is deep enough to involve an underlying body cavity. (Through the chest wall, into where the lungs are located, or through the abdomen wall into where the intestines are located.) Can also be in one side of an arm or leg and out the other side.

Position of Comfort - The position in which the patient is most comfortable. The patient will usually assume this position unless instructed to do otherwise. Usually this is a sitting position, but may be a side-lying position for some who is confined to bed.

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Primary Survey - a crucial element of the initial assessment of an injured or ill patient. The patient’s vital functions are quickly and efficiently assessed to determine the presence of, and treat, life threatening conditions. The information gathered in a primary survey will determine if the secondary assessment of the patient will consist of an Initial Medical Assessment or a Rapid Trauma Assessment. The primary survey consists of an evaluation of the following vital functions: A - Airway assessment and maintenance with cervical spine control B - Breathing / respiratory effort C - Circulation with bleeding control D - Disability / Neurologic status (level of consciousness) During the primary survey, life-threatening conditions are identified and management is begun simultaneously.

Prone - Patient lying face-down

Proximal - Closer to the middle of the body in reference to another location on the body. The opposite of distal. (The hip is proximal to the knee.)

Rapid Trauma Assessment - Performed on patients with significant mechanism of injury to determine potential life threatening injuries. In the conscious patient, symptoms should be sough before and during the Rapid Trauma Assessment. The EMR will estimate the the severity of the injuries, consider the Golden Hour, rapidly assess the patient form head to toe using DCAP-BTLS, obtain a baseline set of vital signs, and perform a SAMPLE history. D - Deformities C - Contusions (Bruises) A - Abrasions & Avulsions (Wounds resulting in a “skin flap” injury) P - Penetrations & Punctures B - Burns T - Tenderness L - Lacerations (Cuts) S - Swelling & Symmetry

SAMPLE History - S - Signs and symptoms A - Allergies M - Medications P - Past medical history L - Last meal/last menstrual period E - Events leading up to current illness/condition

Sign - What you see. (Skin color and temperature. Level of consciousness, deformity of a limb, etc.)

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Supine - Patient lying face-up

Symptom - What the patient tells you. (Pain level and location, dizziness, difficulty breathing, nausea, etc.)

Valid EMS DNR - (See Page 24) EMS DNR form that is fully filled out, signed, dated, and not mutilated.

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Universal Patient Care Protocol

1. Assure scene safety. Assure appropriate personal protective equipment (gloves, safety glasses/goggles, etc.) are utilized.

2. Assess ABC’s (Airway, Breathing Circulation).

3. Apply oxygen, as needed, at 15 liters per minute (lpm) via non-rebreather mask (if available).

4. Perform initial assessment following appropriate assessment procedure.

5. Assess vital signs.

6. Obtain history.

7. Proceed to protocol appropriate for patient’s chief complaint and assessment findings.

8. Notify dispatch of the number of patients and severity of injuries as soon as possible.

Abdomen Pain / GI Bleed

1. Perform appropriate primary survey and initial medical assessment.

2. Perform appropriate airway management. Be alert for vomiting.

3. Apply oxygen, as needed, at 15 lpm via non-rebreather mask (if available).

4. Place patient in position of comfort.

5. Give patient nothing by mouth.

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Altered Mental Status / Unresponsive Patient


2. Perform appropriate airway management. Be alert for vomiting.

3. Consider reason for altered mental status and the possible need for C-Spine precautions.


5. If no spinal injury is suspected, place patient in the recovery position.

6. Look for signs/symptoms of possible Diabetic emergency, overdose, etc.

***If suspected Diabetic Emergency, refer to page 11.***

Anaphylaxis / Severe Allergic Reaction

1. Perform appropriate primary survey and initial medical assessment. Determine what caused reaction.

2. If the patient has received a sting from an insect and the stinger remains, remove it by scraping.

3. Perform appropriate airway management, be alert for vomiting

4. Apply oxygen, as needed, at 15 lpm via non-rebreather mask (if available). Assist ventilations as necessary.

5. Monitor the patient for rapid deterioration.

6. Treat signs and symptoms of shock.

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Behavioral Emergencies

1. If a patient is intoxicated, has a head injury, has a history of overdose, history of mental illness, or is thought to be an immediate danger to self or to others, that person is most likely not capable of refusing medical care. Use the following steps in an effort to maintain control of the patient:

A. Every effort should be taken in an attempt to deescalate the scene B. Contact law enforcement C. Remain calm and friendly toward the patient D. Keep yourself positioned between the patient and your exit, should the scene escalate E. Listen to the patient’s concerns and give positive feedback F. Be reassuring. Outline the patient’s choices G. Calmly set boundaries of acceptable behavior

2. If it becomes necessary to restrain a combative patient to prevent injury to others, FD personnel, or the patient, consider the following guidelines: A. Law Enforcement should assist in restraining the patient, if possible B. As much care as possible should be taken to prevent further injury to the patient C. Soft padded restraints should be used to secure the patient D. The patient should be placed on his/her back while restrained E. Check extremities distal to the restraint to ensure good circulation

3. Consider additional treatment guidelines based on patient complaints or signs and symptoms

Burns

1. Perform appropriate primary survey and rapid trauma assessment.

2. Perform appropriate airway management. Be prepared to assist respirations.


4. Remove clothing and jewelry near the affected area.

5. Prevent further contamination of the burned area.

6. For non-critical (<15%) BSA, use moist sterile dressing. For all others, use dry sterile dressing.

7. Cover the patient with burn sheet. Keep warm.

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Cardiac Arrest

1. Check for responsiveness.

2. Look over the patient for attempt at breathing*

3. Feel for a pulse at the appropriate location for the patient’s age, no more than 10 seconds.

4. Begin CPR appropriate for the patient’s age and size, using the C-A-B method

5. Apply AED (if available) and, if prompted, defibrillate as soon as possible. (Consider contraindications for AED use: Water, hypothermia, etc. - PEDIATRICS, see page ?)

6. Continue CPR and follow AED prompts until relieved by higher trained personnel or spontaneous circulation resumes

7. If the patient regains a pulse, but is not breathing, continue artificial respirations ADULT CARDIAC ARREST

* Check for pulse at CAROTID artery; assess for 5-10 seconds. * Check for respirations by looking at chest movement

Chest Pain / Respiratory Distress

1. Perform primary survey and initial medical assessment.

2. Perform appropriate airway management.


4. Keep the patient calm and in a position of comfort. Do not allow the patient to move him/herself.

5. Keep the patient warm and treat signs and symptoms of shock.

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Chest Trauma

1. Perform primary survey and rapid trauma assessment.

2. Consider spinal precautions.

3. Apply oxygen at 15 ppm via non-rebreather (if available)

4. Treat injuries as follows: A. Penetration, open or sucking: place occlusive dressing (taped on three sides), or Asherman Chest (if available) seal over area(s) B. Flail Segment: stabilize with bulky dressing and tape as needed C. Impaled Object: leave and secure in place

CVA / TIA (Stroke)



3. Apply oxygen (if available) at 15 lpm via non-rebreather mask; assist ventilations as needed

4. Position the patient with the head in an elevated position

5. Keep the patient at rest and protect all paralyzed extremities

6. Provide emotional support

Diabetic Emergencies



3. Apply oxygen (if available) at 15 lpm via non-rebreather mask; assist ventilations as needed

4. If the patient has an altered mental status, but is able to maintain his/her own airway and follow commands - orally (by mouth) administer sugar solution (orange juice, Gatorade, etc.)

5. Be alert for secretions and excessive saliva

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Determination of Death

1. A determination of death may be made on scene if patient is pulseless with the presence of apnea and absence of neurological reflexes, in addition to one or more of the following criteria:

a. Decapitation assessed by visual examination b. Massive crush injury to the head, neck, or trunk c. Separation from the body of either the brain, liver, or heart d. Obvious signs of rigor mortis, such as rigidity of muscular tissues and joints in the body e. Post-mortem lividity presenting as dark spot(s) on dependent portions of the body f. Decomposition assessed by visual examination g. Incineration of the torso and/or the head h. Blunt or penetrating traumatic arrests with absence of signs of life i. Confirmed submersions of 40 minutes or longer j. Declared multi-casualty incidents where triage principles preclude resuscitative measures k. Un-witnessed medical cardiac arrests with no rigor mortis or post-mortem lividity present and all of the following: - Absence of cardiopulmonary resuscitative efforts of 15 minutes or longer - Absence of respirations, pulses, or other signs of life - No evidence of hypothermia, drug ingestion, or poisoning present 2. The senior member may, at their discretion, elect to initiate resuscitative efforts until

the arrival of higher trained emergency medical personnel.

3. The deceased patient shall be confirmed by a second Emergency Medical Responder, if available.

4. Advise Clarendon Dispatch that your patient is Category 4. Do not call for the County Coroner’s Office. This will be done by EMS. Call the Clarendon County Sheriff’s Office, if the location is a possible crime scene or if the scene needs to be secured.

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Discontinuation of Field Resuscitation

1. Resuscitation need not be attempted in the field if any of the following conditions are met: a. A determination of death was made using the criteria from the Determination of Death

patient treatment guidelines. b. The patient has already been pronounced dead by authorized medical personnel, the

Coroner, Medical Examiner, or a physician licensed to practice in South Carolina. c. A valid EMS DNR is presented or found by the crew

2. Once resuscitation in the field has begun, it may not be terminated until one of the following occurs: a. Effective spontaneous circulation and ventilation are restored. b. Resuscitation efforts are transferred to others of at least equal skill level, training, and

experience. c. A valid EMS DNR is presented or found by the crew. d. The responders are physically exhausted and unable to continue. e. The scene becomes unsafe for responders.

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Environmental (Heat) Emergencies

1. Perform appropriate primary survey and initial medical assessment

2. Remove the patient to a cooler environment

3. Remove or loosen clothing as needed to allow air flow and aid in cooling the patient. Do not cool the patient to the point of chilling

Heat Cramps

Generally characterized by cramps in the fingers, arms, legs, or abdominal muscles. The patient is generally alert, with feelings of weakness. The patient may feel dizzy or faint. Body temperature may be normal to slightly elevated. The skin is likely to be moist and warm.

a. If patient is able to take fluids by mouth, administer oral saline solution (4 teaspoons of salt to a gallon of water) or a sports drink (Gatorade).

b. Apply oxygen at 15 lpm, as needed, and if available

Heat Exhaustion

Signs and symptoms included an increased body temperature (over 100oF), skin that is cool and clammy with heavy perspiration, breathing is rapid and shallow, and pulse is weak. There may be signs of diarrhea and muscle cramps. The patient will generally feel weak and, in some cases, may lose consciousness. Other symptoms may include headache, anxiety, and impaired judgement

a. Place patient in a supine position b. If patient is able to take fluids by mouth, administer saline solution (4 teaspoons of salt to a

gallon of water) or a sports drink (Gatorade) c. Apply oxygen at 15 ppm, as needed and if available

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Environmental (Heat) Emergencies(Cont’d)

Heat Stroke

Generally characterized by a core temperature of at least 105oF. Although the patient may no longer be sweating, the skin may still have moisture present. The skin will be hot to the touch; respirations may be deep, becoming shallow; rapid at first and later slowing. Pulse is rapid and full and may slow later. The patient may be confused, disoriented, or unconscious. Seizures are possible.

a. Initiate rapid active cooling. A target temperature of 102oF is used to avoid overcooling. Remove the patient’s clothing and cover with sheets soaked with room temperature water

b. Apply oxygen at 15 lpm, if available c. In case of unresponsiveness or seizures, monitor airway closely. Turn patient on left side if

secretions are noted

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Environmental Emergencies (Hypothermia)

1. Actions for all patients a. Remove wet garments b. Protect against heat loss and wind-chill c. Maintain horizontal position d. Avoid rough movement and excessive activity

2. Assess responsiveness, breathing, and pulse: a. If pulse/breathing present, refer to Step 3. b. If pulse/breathing absent, refer to Step 7.

3. If pulse/breathing are present, determine core temperature with a thermometer (if available)

a. Mild Hypothermia: 34-36oC (93-97oF), refer to Step 4.

b. Moderate Hypothermia: 30-34oC (86-93oF), refer to Step 5

c. Severe Hypothermia: < 30oC (86oF), refer to Step 6

4. Mild Hypothermia: a. Initiate passive rewarming (cover entire body with blankets, including head) after wet

garments have been removed b. Administer warm, sweet fluids by mouth, if possible (not coffee or alcohol) c. Administer oxygen at 15 lpm (if available)

5. Moderate Hypothermia: a. Initiate passive rewarming as described above b. Administer nothing by mouth c. Active external rewarming of truck areas only (heat packs to neck, armpits, groin) d. Administer oxygen at 15 lpm (if available)

6. Severe Hypothermia: a. Initiate passive rewarming as described above b. Administer nothing by mouth

7. If pulse/breathing is absent: a. Start CPR, and move patient to a warm environment b. AED (if available) use only after patient has been rewarmed

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Head Injuries

1. Perform primary survey and rapid trauma assessment

2. Consider spinal precautions

3. Perform appropriate airway management, monitoring for vomiting

4. Be alert for excessive restlessness

5. Administer oxygen at 15 lpm (if available)

6. Assess responsiveness

7. Open wounds with exposed brain tissue should be covered with saline soaked gauze

8. Bleeding from ears: cover lightly with 4x4; do not pack; do not cover tightly

9. Trauma to mouth/throat: apply bandage with pressure, if possible, and without obstructing the airway

Hypertension (High Blood Pressure)

1. Perform primary survey and initial medical assessment

2. Perform appropriate airway management


4. Consider placing the patient in a reclining position

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Hypotension (Low Blood Pressure) - Non-Traumatic




4. Maintain patient warmth

5. Consider placing patient in elevated leg position. Lower extremities 8-10 inches off ground

OB / GYN Emergencies



3. Administer at 15 lpm (if available) as needed

4. If know or suspected pregnancy, place patient on her left side

5. Be prepared for possible delivery; contractions >/= 2 minutes or presence of crowning = pending delivery

6. If needed, refer to page ?? for Neonate Resuscitation

Seizure / Postictal (Post-Seizure) State


2. Consider spinal precautions as needed



5. Protect patient form injury during seizure activity

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Syncope (Fainting)





5. Keep patient still, in position of comfort, or relaxed reclining position

Toxicology (Poisoning / Overdose)



3. Administer oxygen at 15 lpm, as needed (if available)

4. Obtain history of substance; name, amount, time, MSDS sheets if available, labels and/or containers. (Use caution to avoid contamination of yourself and others)

5. If external substance exposure (absorbed or inhaled), remove patient from dangerous area if it is safe to do so. Avoid self contamination. Irrigate patient as needed. Trap runoff if feasible to do so. Brush off dry agents. Remove patient’s clothing and bag to avoid additional contamination.

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Trauma / Shock

1. Perform primary survey and rapid trauma assessment




5. Control external bleeding

6. Keep the patient warm

7. Elevate the lower extremities 8-10 inches, if no pelvic injury is suspected. Do not elevate legs with fractures unless proper splinting is in place.

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Pediatric Determination of Death / Field Resuscitation

1. A determination of death may be made on scene of the pediatric patient if pulseless with the presence of apnea and absence of neurological reflexes, in addition to one or more of the following criteria:

a. Decapitation assessed by visual examination b. Massive crush injury to the head, neck, or trunk c. Separation from the body of either the brain, liver, or heart d. Obvious signs of rigor mortis, such as rigidity of muscular tissues and joints in the body e. Post-mortem lividity presenting as dark spot(s) on dependent portions of the body f. Decomposition assessed by visual examination g. Incineration of the torso and/or the head h. Blunt or penetrating traumatic arrests with absence of signs of life i. Confirmed submersions of 40 minutes or longer j. Declared multi-casualty incidents where triage principles preclude resuscitative measures 2. If the above conditions are not met, and there is any possibility that life signs exist or

can be restored, every effort should be made to resuscitate the patient.

3. Resuscitative efforts, once initiated in the field on the pediatric patient, may not be terminated until one of the following occurs: 1. Effective spontaneous circulation and ventilation are restored 2. Resuscitative efforts are transferred to others of at least equal skill, training, and

experience

4. The senior member may, at their discretion, elect to initiate resuscitative efforts until the arrival of higher trained emergency medical personnel in response to patient’s age, scene environment, or other mitigating circumstances.

5. The deceased patient shall be confirmed by a second Emergency Medical Responder, if available.

6. Advise Clarendon Dispatch that your patient is Category 4. Do not call for the County Coroner’s Office. This will be done by EMS. Call the Clarendon County Sheriff’s Office, if the location is a possible crime scene or if the scene needs to be secured.

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Pediatric Resuscitation


2. Perform appropriate airway management with oxygen (if oxygen is available)

3. Begin or continue CPR for five (5) cycles or two minutes, then reassess

4. Apply AED (if available) as soon as possible, using pediatric pads (if available)

5. Check for a pulse at the BRACHIAL artery, look for breathing. Assess pulse and breathing for no more than 10 seconds

6. FOR PEDIATRICS UNDER 8 YEARS OLD OR WEIGHING LESS THAN 55 POUNDS (25 Kg) USE PEDIATRIC AED PADS (IF AVAILABLE). IF OLDER THAN 8 YEARS OLD OR WEIGHING GREATER THAN 55 POUNDS (25 Kg) , USE ADULT PADS

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Pediatric Vital Signs

Respirations Pulse Rate

20-30 90-130


Neonate (Newborn) Resuscitation


2. Dry/warm infant. Check airway for mucous (may be clear or greenish). Use bulb syringe (if available) to suction mouth first and then nose regardless

3. Keep infant at the level of the mother’s vagina

4. Stimulate infant (tapping on bottom of foot) and note APGAR score at 1 and 5 minutes

5. Perform appropriate airway management. Provide oxygen by “blow-by” method (if available)

6. If pulse is less than 60 bpm - Begin CPR (encircling thumbs)

7. If pulse is 60-80 bpm and does not increase within 30 seconds of manual ventilation - Begin CPR

8. Reassess newborn at one minute intervals

9. IF spontaneous heart rate exceeds 80 bpm - discontinue CPR

10. Check for a pulse at the BRACHIAL artery, looking for breathing. Assess pulse and breathing for no more than 10 seconds

APGAR Score

Sign 0 1 2

Appearance (skin color) Blue, pale Body pink, extremities pink

Completely pink

Pulse Rate (heart rate) Absent Below 100 bpm Above 100 bpm

Grimace (irritability) No Response Grimace Cries

Activity (muscle tone) Limp Some flexion of extremities

Active motion

Respiratory Effort Absent Slow and Irregular Strong Cry

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Newborn Vital Signs

Respirations Pulse Rate

30-40 120-160


Do Not Resuscitate Order (DNR)Comfort of Care (Palliative Care)

1. Upon arrival on scene, the emergency medical responder shall perform a patient assessment. If an EMS DNR bracelet or necklace is found, responders shall make a reasonable effort to determine that an EMS DNR form exists and to assure that the EMS DNR for applies to the person on which the assessment is being made. If no DNR form is found, resuscitative efforts will be initiated. If, after starting resuscitative efforts, an EMS DNR form is later found, resuscitative measures must be stopped.

2. Procedures to provide comfort of care (palliative care) to patients who have executed a valid EMS DNR order: a. Oxygen (if available) b. Assistance in the maintenance of an open airway c. Control of bleeding d. Comfort of care e. Support to the patient and the family/caretakers

3. Resuscitative efforts that are to be withheld or withdrawn in the event that the patient has a valid EMS DNR form: a. CPR b. Artificial Ventilation c. AED use

4. The EMS DNR may be revoked at anytime by the oral expression of the patient to responders by the mutilation, obliteration, or destruction of the document in any manner. If the order is revoked, responders shall perform full resuscitation and treatment of the patient.

5. Give the original of copy of the EMS DNR to the arriving Emergency Medical Unit.

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DHEC 3462 (09/21015) SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL

Emergency Medical ServicesDo Not Resuscitate Order

SOUTH CAROLINA EMERGENCY MEDICAL SERVICES

RESUSCITATE

DO NOT RESUSCITATE ORDER

NOTICE TO EMS PERSONNEL

This notice is to inform all emergency medical personnel who may be called to render assistance to

that he/she has a terminal condition which has been diagnosed by me and is at

least eighteen (18) years of age, and has specifically requested that no resuscitative efforts including artificial stimulation

of the cardiopulmonary system by electrical, mechanical, or manual means be made in the event of cardiopulmonary

arrest.

REVOCATION PROCEDURE

THIS FORM MAY BE REVOKED BY AN ORAL STATEMENT BY THE PATIENT TO EMS PERSONNEL, OR BY MUTILATING, OBLITERATING, OR DESTROYING THE DOCUMENT IN ANY MANNER.

(Name of Patient)

Date Patient's Signature (or Surrogate or Agent)

Physician's Name (Please Print) Physician's Signature

Physician's Address Physician's Telephone Number

DNR INFORMATION FOR THE PATIENT, THE PATIENT'S FAMILY, THE HEALTH CARE PROVIDER AND EMS PERSONNEL

1. Responsibilities of the Patient or his/her Surrogate or Agent

The patient and his/her surrogate or agent:

Will make all care givers aware of the location of the EMS DNR Form and will ensure that the form is

displayed in such a manner that it will be visible and available to EMS personnel.

Understanding the consequences of refusing resuscitative measures.

Are aware that if the form is altered in any manner resuscitative measures will be initiated.

Understand that in all cases, supportive care will be provided to the patient.

2. Responsibilities of the Health Care Provider (Physician)

The patient's physician:

Has determined that the patient has a terminal condition.

Has completed the patient's EMS DNR Form.

Has explained to the patient and family the consequences of withholding resuscitative care; the

medical procedures that will be withheld and the palliative and supportive care that will be

administrated to the patient.

3. Responsibilities of EMS Personnel

EMS personnel:

WillconfirmthepresenceoftheEMSDNRFormandtheidentityofthePatient.

UponfindinganunalteredEMSDNRForm,willwithholdorwithdrawresuscitativemeasuressuchasCPR,endotrachealintubationorotheradvancedairwaymanagement,artificialventilation,defibrillation,cardiacresuscitationmedicationandrelatedprocedures.

Will provide paliative and supportive treatment such as suctioning the airway, administration of

oxygen, control bleeding, provision of pain and non-cardiac medications, provide comfort care and

provide emotional support for the patient and the patient's family.

Will assure that the DNR Form accompanies the patient during transport.

DHEC-3462 (09/2015)

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