Recently, a Do Not Resuscitate Confirmation (DNRC) Information Bulletin
was posted to provide direction for the Fire Service with respect to the
implementation of the new DNRC Form.
To further support the implementation process, additional responses to recently
posed questions regarding the use of the new Form have been provided. These
questions have been asked by EMS system stakeholders and are supplementary to
the Frequently Asked Questions included in
Appendix 1.
Would you ensure that all stakeholders are provided access to the attached
Supplemental Frequently Asked Questions.
Training Bulletin
Do Not Resuscitate Confirmation (DNRC) Form
Supplemental Frequently Asked Questions
Questions 1 – 19 can be found in Appendix 1 of the DNRC Information Bulletin
- Have all health system stakeholders been
notified about the new DNR Standard and DNR Confirmation Form?
All health system stakeholder groups – including Long-Term Care facilities,
hospitals, palliative care groups, physicians, nurses and paramedics have been
notified by their respective associations or governing bodies through the DNR
Task Force regarding the upcoming implementation of the revised DNR Standard and
DNR Confirmation Form, effective Feb. 1, 2008.
In addition, fire services across the province have been advised of the revised
Standard and Form. The Office of the Fire Marshal has issued a communiqué
and posted firefighter-specific training materials on their website.
Ministry staff and stakeholder representatives continue to work together to
enhance the provision of information on this important change.
- The Training Bulletin makes reference to
“Do Not Resuscitate Orders” and “Treatment Plans”. What is the difference
between the two?
A Do Not Resuscitate order is specific direction given by a physician not to
resuscitate a patient in the event that the patient experiences a respiratory or
cardiorespiratory arrest. A DNR order by a physician may be made in
advance and included in a patient’s current Treatment Plan or it may be made at
the time of the event. A Treatment Plan outlines the ongoing management
and care of a patient. A Treatment Plan is routinely developed in a
process which involves health care professionals, the patient and their family.
A patient’s Treatment Plan may change to include a no CPR request when the
patient or their substitute decision-maker requests that it be included.
The DNR Confirmation Form, when completed and signed by a medical doctor (M.D.),
Registered Nurse (R.N.), Registered Nurse in the Extended Class [R.N. (EC)] or
Registered Practical Nurse (R.P.N.) will confirm that the existing plan of care
as documented in the patient’s Treatment Plan does not include CPR.
- Do paramedics/firefighters need to
“confirm” that an individual who identifies themselves as the patient’s
substitute decision-maker (SDM) - is legally authorized to give or refuse
consent?
Confirmation of SDM status is not required by paramedics/firefighters. If
there is any confusion or doubt about the identity or authority of the SDM,
paramedics/firefighters will initiate resuscitation on a patient who has
experiences respiratory or cardiorespiratory arrest.
- Does the DNR Confirmation Form direct
the practice of volunteer firefighters?
Firefighters - both full time and volunteer - are managed by the municipalities
in Ontario and their fire departments, each of which may have their own policies
and procedures to direct their practice in regard to the DNR Standard.
Each fire department adopting the DNR Standard should develop a standard
operating procedure (SOP) incorporating the DNR Confirmation Form.
- Can the DNR Confirmation Form be
completed for a patient of any age, or is there a minimum age requirement?
Patients of any age may have “no CPR” or “DNR” as part of their current
treatment plan. Paramedics can accept and honour a DNR Confirmation Form
for any patient, regardless of their age, if the form has been completed and
signed by a Health Care Provider as defined within the DNR Standard.
- Can firefighters cancel the ambulance
response if they arrive on scene and are presented with a Valid DNR Confirmation
Form?
No. Ambulance Communications Officers will not cancel or modify the
priority of an ambulance response. Paramedics must respond even if they
have been advised of the existence of a DNR Confirmation Form. On arrival
at the scene, paramedics will need to follow the appropriate On-Scene Directives
within the DNR Standard.
- Does the DNR Confirmation Form direct
the practice of First Response Team members?
The DNR Confirmation Form only relates to the patient care practices of
paramedics and firefighters. If a firefighter is employed as part of a
First Response Team to provide medical response, the firefighter will follow the
standard operating procedures of the First Response Team in regards to the DNR
Confirmation Form.
- Some police services are not aware of
the revised DNR Standard. How are they going to be notified of the
implementation of this Standard?
The Ontario Provincial Police (OPP) are revising operational policy to
accommodate the new DNR Confirmation Form. As well, the Public Safety
Division of the Ministry of Community Safety and Correctional Services will be
issuing a memorandum to all Municipal Police Chiefs regarding the revised DNR
Standard and new DNR Confirmation Form - and will be encouraged to liaise with
the local EMS providers and local Fire Chiefs to discuss and coordinate efforts,
where applicable.
