Sleepless in Seattle? No, this geriatric care manager was slightly sleepless in New Rochelle, New York. The reason? An elderly client’s Out of Hospital Do Not Resuscitate was about to expire and the newly signed document had not been received. The current one is taped to the front door of the refrigerator and each aide who cares for my client knows its exact purpose.
Depending on the circumstances, hospital personnel may ask the health care agent to consider signing a Do Not Resuscitate (DNR) for the duration of a patient’s hospital stay. Should the family wish for the continuation of the DNR upon discharge, an alternate form is used in the home: The Out of Hospital Do Not Resuscitate. The form is specific to New York State.
The Non Hospital or Out of Hospital DNR document informs the EMS providers that in the event of cardiac or respiratory arrest, no chest compressions, ventilation, defibrillation, intubation or medications will be provided to extend the life of the individual. If the person is not in cardiac or respiratory arrest, full treatment by EMS providers will be given. Put another away, this form becomes effective if the heart and/or the lungs have stopped pumping. Should these conditions exist without the presentation of this form, CPR will be initiated.
The document itself is quite simple. It states the name of the person, date of birth and expresses the wish not to be resuscitated. It is signed and dated by the doctor along with his/her license number. The form can be downloaded at: www.health.ny.gov/forms/doh-3474.pdf . While it should be reviewed every ninety days, as long as it remains posted it is considered in effect. Neither a living will or a health care proxy can take the place of the Out of Hospital Do Not Resuscitate.
Understandably, not all families are interested in having such a form in the home. And often, even with the form present, in a moment of panic a family member will chose to have a spouse or parent resuscitated. Nevertheless, for those families who are intent on limiting further treatment this document is essential.