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 › MEDICAL COMMAND PHYSICIAN RESPONSIBILITIES › Section 1051.81 - Medical command physician responsibilities

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Compliance with out-of-hospital
					 DNR order
. If a medical command physician is in contact with a
					 prehospital practitioner when the prehospital practitioner is attending to a
					 patient in cardiac or respiratory arrest and the prehospital practitioner is
					 made aware of an out-of-hospital DNR order for the patient by examining an
					 out-of-hospital DNR order, bracelet or necklace, the medical command physician
					 shall honor the out-of-hospital DNR order. If appropriate, the medical command
					 physician shall direct the prehospital practitioner to provide other medical
					 interventions within the practitioner's scope of practice to provide comfort to
					 the patient and alleviate the patient's pain, unless the prehospital
					 practitioner is otherwise directed by the patient.
(b)
Prehospital practitioner
					 uncertainty
. If a medical command physician is in contact with a
					 prehospital practitioner when the prehospital practitioner is attending to a
					 patient in cardiac or respiratory arrest and the prehospital practitioner
					 communicates uncertainty as to whether an out-of-hospital DNR order for the
					 patient has been revoked, the medical command physician shall ask the
					 prehospital practitioner to explain the reason for the uncertainty. Based upon
					 the information provided, the medical command physician shall make a good faith
					 assessment of whether the described circumstances constitute a revocation, and
					 then direct the prehospital practitioner to withdraw or continue CPR based upon
					 whether the physician determines that the out-of-hospital DNR order has been
					 revoked or not revoked.
(c)
Pregnant patient
. If a medical command physician is in contact
					 with a prehospital practitioner when the prehospital practitioner is attending
					 to a pregnant patient in cardiac or respiratory arrest, and the prehospital
					 practitioner is made aware of an out-of-hospital DNR order for the pregnant
					 patient by examining an out-of-hospital DNR order, bracelet or necklace for the
					 patient, and apprises the medical command physician of the out-of-hospital DNR
					 order, the medical command physician shall direct the prehospital practitioner
					 to ignore the out-of-hospital DNR order unless the medical command physician
					 has knowledge that the patient's attending physician and a second physician who
					 is an obstetrician had examined the patient, and both certified in the
					 patient's medical record that, to a reasonable degree of medical certainty,
					 life-sustaining treatment, nutrition, hydration and CPR will have one of the
					 following consequences:
(1) They will not
					 maintain the pregnant patient in such a way as to permit the continuing
					 development and live birth of the unborn child.
(2) They will be physically harmful to the
					 pregnant patient.
(3) They will
					 cause pain to the pregnant patient which cannot be alleviated by
					 medication.