Prehospital care directives allow choice

A prehospital care directive is a written document in which a person may refuse cardiopulmonary resuscitation or CPR in the event of a cardiac or respiratory arrest.

The prehospital care directive allows people to choose whether or not they want to have resuscitative efforts performed on them in the prehospital setting. The prehospital care directive also is known as "Do Not Resuscitate" or DNR order.

A prehospital care directive is only valid when a person is in the emergency department of a hospital or before a person is admitted to a healthcare facility. In other words, prehospital care directives are just that--prehospital. Responding emergency services personnel must honor the patient's request if the appropriate documents are presented to them.

Authorization for the withholding of CPR does not include the withholding of other medical interventions, such as intravenous (IV) fluids, oxygen or other interventions deemed necessary to provide comfort-care or to alleviate pain.

While prehospital care directives are most commonly used by people who are terminally ill, they also can be used by anyone who does not wish to be resuscitated. Either the patient or someone legally designated by the patient can make this decision under the law ARS 36-3251.

Patients who wish to initiate a prehospital care directive should meet with his or her healthcare provider to discuss the implications of this decision. After the consultation, the healthcare provider, the patient and a witness must sign a legal document. The document must contain all three signatures to be valid. The prehospital care directive must be printed on orange paper and may be either letter or wallet size. Without the appropriate document, emergency services personnel must perform CPR.

The legal form has two sides. The first side includes two sections. The top section is the list of procedures the patient wishes to be withheld. This section must be dated and signed by the patient or the patient's legal representative to be valid.

The lower section is a written description of the patient, including a recent photograph. If the patient is being cared for in a facility or by a home caregiver in

addition to their healthcare provider, this information should be listed on side one as well. The name and phone number of the patient's physician is required to be on side one.

Side two of the form contains the signature of the patient's licensed healthcare provider and the date the formed was signed. In most cases, this should be the patient's physician. The physician's signature verifies the patient was informed that any withheld treatment may result in death.

The signature of the witness verifies that he or she was present when the patient signed the document and the patient appeared to be of sound mind and free from duress. The witness cannot be a relative, beneficiary or person designated to make medical decisions for the patient.

Although Arizona law does not require a hospital-type bracelet, the patient may choose to wear a DNR bracelet on the wrist or ankle. This bracelet will inform emergency services personnel that a prehospital care directive exists so that they will request the document before performing CPR.

For more information on healthcare directives, log on to www.azag.gov, call 602 542-2124, or call your physician.

(Janine Anderson, R.N., is the prehospital care coordinator at Flagstaff Medical Center.

Is there a health topic you'd like to know more about? Please write to Mountain Medicine, c/o Flagstaff Medical Center, Public Affairs, 1200 North Beaver Street, Flagstaff, AZ 86001, or visit FMC's website at www.FlagstaffMedicalCenter.com. For more information, please see your physician.)

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