Verbal do-not-resuscitate orders: A good policy for the prehospital care environment?

The majority of the 400 000 patients who suffer non-traumatic cardiac arrest in the USA each year do so in the out-of-hospital environment. Recently, the Los Angeles County Emergency Medical Service (EMS) implemented a new policy regarding verbal do-not resuscitate (DNR) orders. The policy gives surrogates of the patients with a cardiac arrest the right to verbally request EMS officers to ''forgo resuscitation''. The study was conducted to identify the prevalence of ''at-home'' cardiac arrests, written DNR orders and the availability of family members. This single-county study looked at 897 cardiac arrests of which 492 occurred in the home between August 2006 and January 2007; 102 patients (22%) in the study had ''unknown'' documented as the location for the cardiac arrest. Fifty five of the 492 patients who had at-home cardiac arrests had written DNR orders. Of the 55, 10 were resuscitated either because the DNR paperwork was not available or because the family had requested treatment. The study found written DNR orders were uncommon in the out-of-hospital environment, although patients were often resuscitated despite family members with DNR orders being present. The study concluded that some family members at the at-home arrest ''may be able to express the patient's wishes regarding end-of-life care''.