Communicating DNR orders to ambulance personnel.

To summarize, the MMA will provide a standard DNR form and guidelines for implementation in local communities. Local physicians, nursing home administrators, and ambulance service operators need to agree on an established set of guidelines that long-term care facilities, hospices, and private homes will follow to inform ambulance personnel of DNR orders. Ambulance medical directors should instruct ambulance staff on the proper implementation and use of DNR orders. The decision to write a DNR order rests with the attending physician, based on disclosure and consent of the patient, family, or proxies. Full implementation of a prehospital DNR system will reduce the suffering that patients and family members endure when inappropriate and unnecessary cardiopulmonary resuscitation is given by ambulance personnel. A similar program, administered by the county health department, has been successful in the west metropolitan Twin Cities area for the past five years. The model offered by the MMA to individual physicians and their medical societies may be modified to meet local needs. This community emergency medical services DNR program helps ensure the provision of appropriate ambulance service based on patients' individual needs and requests.