The SCDHEC DNR form and authorizing statute do read, in part,:

“This notice is to inform all emergency medical personnel who may be called to render assistance to that he/she has a terminal condition which has been diagnosed by me and has
specifically requested that no resuscitative efforts including artificial stimulation of the cardiopulmonary system by electrical, mechanical, or manual means be made in the event of cardiopulmonary arrest.”

Those last two words are very important. The authorizing statute defines cardiac arrest as “the cessation of a functional heartbeat.” Additionally, and separately, the authorizing statute also defines “Respiratory Arrest (Pulmonary Arrest) means the cessation of functional breathing.”

In other words, the SC DNR applies if your patient is in Respiratory Arrest AND/OR Cardiac Arrest, as defined.

You are also correct that advance directives and living wills have no direct authority over our treatment. However, I would say that if you are presented with an advance directive or living will by a family member or spouse on-scene that it may be prudent to contact your On-line Medical Control Physician, explain the situation and patient condition, and allow the OLMC to advise you as whether to abide by the advance directive or living will or to follow your protocols. Whatever they advise, document fully.

In my experience (and probably yours too), families call 911 even when there is a valid DNR order because they are scared-both for themselves and their loved one. In these situations we should not be judgmental. We should educate the family members as to what treatments we must withhold and what treatments we can perform. We can do a lot of good in these situations by alleviating some of the fear and providing emotional support.

I would agree that education on DNR orders could and should be improved. Typically the patient was educated properly by the signing physician, however other family members may not fully understand what that form truly means. In these instances it falls on us to be that educator.

Thanks for your comment, and stay safe out there.

PS, I am also a Paramedic in SC.