Regional Emergency Medical Advisory Committee of New York City Prehospital Advanced Life Support Protocols Copyright January 1996 (3/96)

Do Not Resuscitate(DNR) orders are authorized under Chapter 370 of Article 29-B of the New York State Public Health Law. The law establishes a presumption in favor of the consent of a patient to CPR, but also establishes the lawfulness of a DNR order issued in compliance with the provisions of the law. Chapter 370 of Article 29-B requires prehospital personnel to comply with an order not to resuscitate issued by the patient's attending physician whenever the patient is being transferred from one institution to another. Such institutions include acute care hospitals, skilled nursing homes, intermediate care facilities, hospice beds in hospitals, and psychiatric hospitals.

The transferring institution must provide the EMS personnel with a written DNR order, which may be incorporated into the transfer order and need not be a separate sheet of paper.

Effective January 1, 1992, DNR orders are also applicable to adults living at home.

NOTE:

A non-hospital order not to resuscitate directs emergency medical services personnel not to attempt cardiopulmonary resuscitation in the event a patient suffers cardiac or respiratory arrest.

Cardiopulmonary resuscitation means measures to restore cardiac function or to support ventilation in the event of a cardiac or ventilatory arrest. Cardiopulmonary resuscitation shall not include measures to improve ventilation and cardiac functions in the absence of an arrest. Hence all appropriate care in compliance with regional protocols is to be provided to patients who are not experiencing a cardiac or respiratory arrest, even if a valid DNR exists.

The EMS personnel must present the DNR order to the receiving institution, and obtain a copy to attach to the EMS copy of the ambulance call report.

If there is a cessation of vital signs during the transport of the patient, and the crew is in possession of a properly issued DNR order, no life sustaining measures will be undertaken.

In addition, a verbal DNR should not be accepted by prehospital patient care providers.

Patients enrolled in certified hospice programs must also have formal DNR orders. Hospice programs are designated as home care programs, each with a back-up support agreement with an acute care hospital. An order written on hospice program stationary and signed by a physician, is no longer covered under the New York State Statutes. The standard "Department of Health Non-Hospital DNR Order" is now the only official DNR to be honored in the prehospital care setting. If a prehospital care provider chooses to honor a DNR on hospice program stationary, they will not be covered under the New York State Statutes.

Chapter 370 of Article 29-B confers legal immunity upon patient care providers who resuscitate a patient despite the issuance of a DNR order if the patient care provider was reasonably, and in good faith, unaware of the order, or believed the order to be revoked.

One should also note that a Health Care Proxy, Living Will, or Medical "Power of Attorney" is NOT recognized in the Prehospital setting. They should be brought with the patient to the hospital.

Refer to the New York State Department of Health Memorandum 92-32, 11/2/92 on DNR Law Changes.

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