A. This important document is a physician’s order or directive addressed to your emergency medical responders indicating the predetermined request by the patient (or the patient’s guardian or surrogate) to withhold CPR and other end-of-life resuscitative treatments once breathing and/or heart beat have ceased. It is the patient’s directive to be allowed to die without emergency intervention.

A. NO. “Living Wills” are a form of Advance Directive written by the patient. Because Living Will documents discuss the patient’s wishes under certain circumstances in the future, the New Jersey law requires emergency medical treatments to be rendered until such time as the document can be read and interpreted by a physician. Usually the patient will be transported to a hospital where a physician will determine what the patient’s wishes are and will determine any withholding of treatments based upon those wishes when there has been sufficient opportunity for a diagnosis and prognosis of the patient’s present condition.

NO. A person who has a DNR order will not be resuscitated in the event breathing and/or heart beat have stopped; however, they will be treated for all other medical emergencies.

A. NO. If you or a household member have a DNR order, you should feel free to call 9-1-1 in the event of a medical emergency. Once the emergency responders arrive at your home, they will assist you in handling any medical emergency in the appropriate manner. However, if the patient has died, they will not begin CPR or any other resuscitative efforts.

A. NO. It is a protocol developed as a statewide guideline for EMS in the event that a patient at home does not wish to be resuscitated at the time of death. The protocol has been supported and promoted through the appropriate State agencies as well as other professional groups and is a reflection of the most recent American Heart Association standards of care regarding end-of-life decision making and resuscitation. CPR and DNR are both standards of care promulgated through practice and protocol in the State of New Jersey.

A. Anybody can sue anyone for anything in our society. However, if a patient has a valid NJ Out-of-Hospital DNR order and you administer CPR you also run the risk of being sued for violation of the patient’s rights. This is perhaps a greater risk. These protocols and the OOH DNR form would provide you with a credible legal defense in the event someone did attempt to sue.

A. The patient’s physician controls the completion of the DNR order. While the possibility of “nefarious” dealings can never be 100% eradicated, the likelihood of a person using a document that is going to be seen, copied and entered into a medical record is minimal. Most patients with DNR orders are cared for in the home by family members who can provide identification. To date, no incident has surfaced anywhere nationwide indicating the fraudulent use of a DNR order to cause harm to someone.

A. NO. The bracelet in New Jersey is optional. You can have just the paper form (as many photocopies as needed), or you can have both the form and the bracelet. EMS will honor either the paper form or the bracelet. The bracelet is an orange and white striped plastic band (similar to hospital ID bands) marked with NJ EMS Alert – No CPR and contains the patient’s name and the name of the ordering physician. It is convenient for use on patients who may be transported often for treatments such as dialysis, and 10 Frequently Asked Q & A want the protection of their DNR order in all settings

A. YES. It is helpful to have the out-of-hospital DNR form to give to the EMS transport personnel who transport patients by ambulance from one health care setting to another. It is easily recognizable by EMS and protects the patient during the ambulance transport. It also serves as an alert to the receiving facility that the patient has a DNR order and, if he/she were admitted to a new facility, would require the DNR order to be re-written. Relying solely on verbal communication from the nursing home staff to EMS puts the patient at risk of having their wishes not followed

A. YES. DNR orders are not written conditioned upon the “cause” of death. DNR orders are written when CPR is considered to be inappropriate for the patient based upon the patient’s current underlying disease and condition. This underlying disease (such as cancer) remains the same regardless of the cause of death and warrants the honoring of a DNR order.

A. There are a variety of very reasonable and valid reasons why families of “dying” patients call “9-1-1”.

• (1) Families, even if educated by hospice caregivers about not calling 9-1-1 at the time of death, may panic at the time of the event. Remember, death does not occur instantaneously, but may manifest itself through symptoms such as difficulty breathing, seizure activity, and other sudden and disturbing precipitating events. When families call for help, they often don’t realize that the patient is actively dying.
• (2) It is critical to remember that “dying” patients who have DNR orders are still entitled to all other appropriate care. They may have a prognosis that will allow them to live for a year or more. During that time, they may suffer from a fall, bleeding, or any other acute reversible process that requires treatment. For comfort and palliation, the patient may need treatment and transport by EMS.

A. YES. New Jersey is not unique in developing a mechanism for the identification of DNR orders outside of medical facilities. Therefore, if a DNR identification from another state is presented to EMS in New Jersey with a request to honor it, and if there is no reason to believe that it is not valid, EMS personnel should honor the DNR in good faith.

A. YES. The New Jersey protocol for out-of-hospital DNR does not replace other mechanisms within health care facilities (hospitals and nursing homes) to identify patients who have DNR orders. Therefore, if a DNR order is presented to EMS by the health care facility on a different form with a request to withhold CPR, and if there is no reason to believe that the form is not valid, EMS personnel should honor the DNR order in good faith.

A. YES. There is no age restriction on the use of DNR orders. DNR orders may be appropriate for patients of any age who are near the end of life.

A. YES. In the long term care environment (institutionalized elderly care), an advanced practice nurse (APN) can sign DNR (and Do Not Hospitalize) orders, in consultation with the attending physician.

A. NO. A living will is important, but in order for your wishes for no resuscitation to be implemented, the physician must sign the DNR form.