Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.23 - Disclosures to patient requesting out-of-hospital DNR order

Current through Register Vol. 54, No. 28, July 13, 2024
When a patient qualified under §
											1051.11(a) 
						(relating to patient qualifications to request and revoke out-of-hospital DNR
						order) requests an out-of-hospital DNR order, the attending physician shall
						disclose the following information to the patient before issuing an
						out-of-hospital DNR order for the patient:
(1) The diagnosed condition is a terminal
					 condition.
(2) An out-of-hospital
					 DNR order directs an EMS provider to withhold providing CPR to the patient in
					 the event of the patient's cardiac or respiratory arrest.
(3) The attending physician may also issue an
					 out-of-hospital DNR bracelet or necklace for the patient, and that the necklace
					 and bracelet also direct an EMS provider to withhold providing CPR in the event
					 of the patient's cardiac or respiratory arrest.
(4) An out-of-hospital DNR order, bracelet or
					 necklace requested by a patient is effective only when the patient possesses
					 and displays the order, bracelet or necklace.
(5) An out-of-hospital DNR order is not
					 effective when the patient is in a hospital, unless an EMS provider has been
					 dispatched to provide EMS to the patient in the hospital, but it may be
					 possible for a DNR order to be issued for the patient in a hospital in
					 accordance with other procedures.
(6) The patient may revoke the
					 out-of-hospital DNR order; the patient may do so without the physician's
					 approval or knowledge; revocation may be accomplished by destroying or not
					 displaying the order, bracelet or necklace, or by conveying the decision to
					 revoke the out-of-hospital DNR order verbally or otherwise at the time the
					 patient experiences respiratory or cardiac arrest; and neither the patient's
					 physical nor mental condition will be considered to void the patient's decision
					 to revoke the out-of-hospital DNR order if that decision is clearly
					 communicated in some manner.
(7)
					 The possibility exists that the EMS provider may administer CPR in the event of
					 the patient's cardiac or respiratory arrest if an EMS provider is uncertain
					 regarding the validity or applicability of the out-of-hospital DNR order,
					 bracelet or necklace.
(8) An EMS
					 provider who complies with the patient's out-of-hospital DNR order may provide
					 other medical interventions to the patient to provide comfort or alleviate
					 pain.
(9) The physician will make
					 every reasonable effort to contact the patient to ask the patient to return the
					 out-of-hospital DNR order, bracelet and necklace to the physician, for
					 destruction by the physician, if the physician discovers that the diagnosis of
					 the terminal condition was in error.
(10) If the patient is female, there are
					 additional procedures that an EMS provider will need to follow to implement an
					 out-of-hospital DNR order if the patient is pregnant at the time of cardiac or
					 respiratory arrest. If the patient is pregnant or requests information
					 regarding the additional procedures, the physician shall explain the
					 requirements of §
											1051.61 (relating to pregnant
					 patients).
This section cited in 28 Pa. Code §
													1051.24 (relating to disclosures
						  to surrogate requesting out-of-hospital DNR order); and 28 Pa. Code §
													1051.25 (relating to disclosures
						  to patient when surrogate requests out-of-hospital DNR
						  order).