Here's an overview of each document and how they might affect prehospital care:
Living Will: A living will is a legal document that allows individuals to express their preferences regarding medical treatment in advance, particularly in situations where they may become incapacitated and unable to communicate their wishes.
EMS providers should review a patient's living will if available to understand their preferences regarding life-sustaining treatment, resuscitation, and other medical interventions.
If a patient has a living will indicating their desire to refuse certain treatments, EMS providers must respect these wishes within the legal framework of their jurisdiction.
Durable Power of Attorney (DPOA): A durable power of attorney for healthcare (or healthcare proxy) is a legal document in which a person designates another individual to make healthcare decisions on their behalf if they become unable to do so themselves.
EMS providers should be aware of the presence of a DPOA and consult with the designated proxy if necessary to make medical decisions in the absence of the patient's capacity to do so.
Do Not Resuscitate (DNR) Order: A DNR order is a medical directive indicating that a patient does not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
EMS providers must honor valid DNR orders, which typically must be signed by a physician and/or meet specific legal requirements in the jurisdiction.
In the absence of a valid DNR order, EMS providers are generally obligated to initiate resuscitative measures unless there is clear evidence of futility or the patient's wishes are otherwise known and legally documented.
Do Not Intubate (DNI) Order: A DNI order is a medical directive indicating that a patient does not wish to be intubated or mechanically ventilated.
EMS providers should be aware of the presence of a DNI order and respect the patient's wishes accordingly.
It's essential to differentiate between DNR and DNI orders, as a patient may have one without the other, depending on their preferences and medical condition.
Physician's Orders for Life-Sustaining Treatment (POLST): POLST is a medical order form that outlines a patient's preferences for life-sustaining treatment, including CPR, intubation, and other interventions.
EMS providers should review the POLST form if available to understand the patient's preferences for treatment in emergency situations.
POLST forms are often used for patients with serious illnesses or frailty and are intended to guide medical treatment across various healthcare settings, including prehospital care.
In summary, EMS providers must be familiar with these legal documents and their implications for prehospital care. Respecting patients' wishes as expressed in these documents while adhering to legal and ethical standards is paramount in delivering patient-centered care.
Collaboration with healthcare proxies, family members, and other healthcare professionals may be necessary to ensure that the patient's preferences are honored appropriately.
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