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Idaho Do Not Resuscitate Form


Idaho Do Not Resuscitate Form
Idaho Do Not Resuscitate Form
Version 0708 (previous versions should be disregarded/destroyed)
GENERAL
The Idaho EMS Bureau has taken extreme caution to ensure all information is accurate and in accordance with professional standards in
effect at the time of publication. This guideline is for reference and may be modified at the discretion of the EMS Medical Director. It is
recommended that care be based on the patient’s clinical presentation and on authorized policies and guidelines.
0708 Page 1 of 4 POST/DNR - General
IDAHO EMS GUIDELINE
Idaho Physician Orders for Scope of Treatment/Do Not Resuscitate
UINDICATIONS:
Patient is in respiratory or cardiac arrest
AND
Patient has a valid Idaho DNR order.
- Intact (original or photocopy) signed (by a
physician
UandU patient or surrogate),
Idaho POST/DNR order, dated after 1
July 2007, or an Idaho POST/DNR
bracelet.
- Patient has an intact (original or
photocopy) signed Idaho Comfort
ONE/DNR order, dated prior to 1 July
2007.
- Patient has a signed DNR order from
another state.
OR
Patient is wearing DNR identification
jewelry (Idaho POST/DNR or Comfort
ONE/DNR.)
UCONTRAINDICATIONS:
The maker of the form or physician has
revoked the DNR order.
DNR order (photocopy or original, bracelet
or necklace) is not physically present or has
been defaced or destroyed.
Verbal or Physical Threats from Bystanders
1. Perform routine patient assessment, resuscitation, or other medical interventions while an
attempt is made to determine DNR status.
2. If a valid DNR order or DNR identification jewelry is found, obtain reasonable assurance
that the patient is the person for whom the order was written. (see items 10 and 11 of this
document for examples of DNR identification jewelry)
3. If the patient UisU in respiratory or cardiac arrest UandU DNR status is confirmed:
EMS providers WILL NOT
Initiate CPR
Provide ventilatory assistance
Initiate cardiac monitoring (unless to confirm death)
Defibrillate
Administer resuscitative medications
EMS providers WILL
Provide comfort care
Provide emotional support (to the patient and family)
POST/DNR
Idaho Do Not Resuscitate Form
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