Defibrillators: To be or not to be resuscited
 

There may be many Villagers who have living wills that request they not be resuscitated from apparent death. Should they, can they, be protected from being resuscitated in a non-institutionalized setting? Even some nursing homes ignore the request, for various reasons.

Picture that a person might be walking her dog, going for a brisk walk or pulling weeds in her front yard, in a neighborhood that is equipped with an AED. Some people who have AEDs in their neighborhoods have said they will try to resuscitate everyone, regardless of whether they contributed money or not.

Can a person who is "apparently dead" be protected from being resuscitated?
And what should happen if their request is not honored, as sometimes happens in nursing homes? And what about assisted living facilities?

A person has to either carry their DNR with them and/or have it in a visible location to have the medics not try and save them. If a person does not want to have lifesaving techniques and those around them know that, it is unlikely that 911 would be called. If you have nothing on you and you collapse, chances are someone will try CPR or call 911. DNR orders are posted in assisted livings and are followed, they must be shown t other paramedics and staff are to know where to look should an emergency occur.
And by the way, I cannot imagine an AED Program that does not respond because someone did not contribute!

I would have to say no. Unless that person is carrying around a signed DNR in their pocket or a family member has it on them and they are with the patient then no. Nothing will happen to the good Samaritans as long as they only do what they r trained to do.

If you have a DNR and you really want it to be followed why not buy a Medic Alert Bracelet and have it inscribed with your DNR request and wear it at ALL TIMES. JMO

Because if u just have a medic alert bracelet that won't stand up in court. A signed document must be presented at the time of need. Anyone can have DNR put on a bracelet. But if ur family doesn't agree with u and there is no signed document then everyone is up the creek without a paddle. So then CPR and AED is done

So I guess you need to have it tattooed on your chest so it won't be missed.

Notarized and signed too :a040:

So I'm wondering if there is anyone in The Villages that would be walking around and have a sudden heart attack that wouldn't want to saved. Now those people that are so ill that have a DNR I am thinking for the most part are either not out and about and if they are they are with a loved one that knows their wishes - so the chances of this being a problem are about as remote as the chance of a heart attack associated with electrical drilling or whatever was on the other web site. Why do we need to keep this going.

Only save those who have contributed? Oh my, I have NOW heard the epitimy of "scrooginess"!

Our neighborhood has several AEDs and I am one of those trained to use them. The call we would get to dispatch us to a help a neighbor comes from the county and neither they or I know have any way of knowing who contributed.

The good samaritan law covers anyone regardless of training or not. If you want to die then put a sign on your chest any time you leave the house stating that.

I'm a first responder with a key to nearby defibrillators. Our training is to go in and first of all start cpr with heart compressions and hold doing that until the AED or EMTs arrive. I can say with certainty that to stop me from doing that in a situation where a person is down would not be easy. There is no subtlety to my training.

In the scenario set by the OP where the person is up and about walking the dog?? Maybe if the person is clearly severely debilitated and has a bedside caregiver I could be restrained but in that case it's unlikely a call for defib would go out. Calls for defib are made only after a 911 call is screened for apparent heart attack victims.

My nieces husband said when he was on his ER rotation as an intern someone came in with Do Not Resuscitate tattooed on their chest. He said the D N and R were big letters with the rest of the word small so if you looked quick it said DNR and that a miniaturized copy of the document was in his wallet when they looked. The EMTs were giving CPR when they brought him in but the attending when he saw the card in the wallet instructed them to let him pass. However without the tattoo they never would have looked in the wallet. The patient had terminal cancer.

a dnr can be reversed by family.. and yes it happens more than you know...of course my kids know i would come back and hunt them down if they did not respect a dnr

IIRC, I remember a year or so ago there was a community in a mid Atlantic state that had voluntary participation in the fire dept. One of the houses that did not contribute was on fire and the trucks got there and it was determined they were not part of the "insured" group and they let the house burn. Later one of the officials commented that if they had saved the house then it would disincentivize the participants to pony up the cash to pay for the dept, as everyone would know they could get service in an emergency.

Amazing is the only response I can muster!

I know that if a life was on the line that no Villager who had CPR training would not step right in and do their best.

I don't understand why it would be unlikely? Suppose someone is out walking and falls to the ground. Anyone in the neighborhood might notice that and call 911. How can such a call be "screened" for heart attack if the caller has no idea why the person fell to the ground?

Also, remember, many Villagers have multiple health conditions. For example, a diabetic person could have cancer and coronary artery disease. And yet they might appear to be well when out walking.

The "spirit" of a living will as I understand it is to not keep a person alive who is in a "vegetable state". Reviving someone who has had an immediate heart attack is something entirely different.

That is why I have a living will (not to be kept alive as a vegetable for weeks) but being revived following a heart attack and hopefully have recovery I view as something different.

A living will keeps you off artifical life support systems for weeks and weeks. A Defibrillator is not an artificial life support machine.

If we try to imagine every situation and every health condition it would be impossible. But, in my opinion, it's quite possible that there are lots of people who could be out and about and not want to be saved. We live in a elderly retirement community where lots of people have multiple health issues. And they wouldn't necessarily be out with a loved one or caregiver.

For example, there's an elderly woman who shops at Aldi's every week. She arrives in her golf cart. She is as thin as a rail but appears to be physically fit. By the looks of her, I would guess she could be over one hundred years old. Perhaps 105+. I have never seen her with anyone. She's old but healthy enough to be out walking by her self. Should anyone try to resusitate her? Where would you draw the line?

We lived one place for a while that also had a "subscription" fire depatment. It was a requirement of the homeowners' insurance to have coverage, and the lender, but anyway... It was well known that if a house was on fire that wasn't a subscriber, the fire dept still put out the fire, but the homeowner was billed at a very high $/person-hour, and it was attached as a lien if not paid.

I suspect that the scenario psoted above is urban legend.

Not to get too far from the topic, as some one else mentioned, I doubt anyone would not be helped with the AED if the need was there, the 911 folks and local responders don't know who contributed...nor do they care.

But you are only imagining your own situation when there may be any number of situations that we can't imagine. Being in a vegetable state is not the only situation. For example, someone with incurable cancer may have a stroke or heart attack and not want to be brought back. More and more people have cancer that is treated as a chronic condition. They may have been fighting it for ten years, on and off. So, for that reason, they might not want to be brought back.

When my aunt was quite elderly (late eighties) she would go for walks by herself and you would never know that she had anything wrong with her. But she had kidney failure and needed kidney dialysis a couple times per week. If you don't know about kidney dialysis, it's a terrible way to live. Some elderly people stop the treatment knowing they will die without it. If she was out walking and had a heart attack, I'm sure she wouldn't have wanted to be saved.

:agree: Yes!

If you had read my reply to justjim, would you still have "agreed"? Not to mention my reply to Gomoho.

Before I replied, I did read your response to JJ. And yes, I would absolutely agree with Justjim.

Another thread that's akin to asking how many angels, dance on the head of a pin.

Unless one has a living will with this expressed wish, who would know what to do?

I would tend to think the most likely scenario would be if a person is already hospitalized and near death, their family members, would see their expressed wishes are carried out. I know I had asked my mother if she wanted to sign a DNR in the hospital, when she thought she was going to die.

Anything else, is purely hypothetical and speculative.

We could play the "what if game", but then we would be gone before the game finished. IMHO

Exactly.

I removed my posting - discussion would be going to much in details. Sorry:highfive:

All I can say is there are people out there to help people in their time of need. If you want all your scenarios answered then take a class on CPR and first aid. Basically if 911 is called and the patient is unconscious and not breathing or has no heart beat you start CPR and AED. You leave the DNR's and the living wills up to the ER Dr and the hospital staff. As far as the 911 dispatcher screening the calls for cardiac arrest, it is in the questions they are trained to ask. If they don't get sufficient answers to those question they err on the side of responding everyone. If your neighborhood has an AED, be thankful people care about each other enough to supply it and train to use it. Be kind to each other, neighbors.:D

Matzy, I spent 20 years doing it too. I agree with you. :BigApplause:

As a former career firefighter and Medic and NYS EMS Instructor for well over 20 years, I have done CPR and used an AED countless times.

Folks, it is simpler then many here are making it out to be. According to the Florida Department of Health Florida Department of Health

Florida's "Do Not Resuscitate Order" is state form 1896. Attached to the bottom of the Department of Health’s Form 1896 is a patient identification device, which may be removed from the form, laminated and can be worn on a chain around the neck, clipped to a key chain or to clothing/ bed, etc. so it can travel with the patient. It is equally as valid as the DNRO form and can be presented to emergency medical services when they arrive on scene and is designed to allow the patient to move between settings with one document.

So....if a person does not wish to be resuscitated, they would be wise to understand the DNRO, fill it out correctly, etc. You can do what it states above..wear it around your neck on a chain.

Anyone who has been properly trained in the use of an AED or CPR should and would check for this and comply. This is the surest way to have your wishes met.

Just a bracelet engraved with "DNR" would not work. If it did pity the fool who had those initials!

A first responder would need to see this official form or the bottom part of it to comply. Just having someone say "There is a DNR somewhere" does not cut it.

In real life if a family member is there screaming "Do CPR anyway!", then CPR is usually done. Should it be? Perhaps not, but I've been in those stressful situations...it is not fun. The chances of that happening here in The Villages is small.

Bottom line- if you want a DNR, wear the bottom part of the form around your neck. Nothing is foolproof or perfect, but that is most likely your best chance of having your wishes granted in public.

Hope that helps.

Frank

What DNR says is.....if I am in a condition not likely to survive I do not want to be resuscitated. It doesn't say don't resuscitate no matter what.
People seem to miss that point....look at the wording....this is an issue very often in caring for patients.
It typically applies to the terminally ill patient whose quality of life is so poor that they do not want their dying process to be reversed.
If you are at home and don't want someone to help you the best way is simply don't call anyone....but if you do call...you will most likely be helped and perhaps even saved.

FYI here is the Florida Law ref. DNR orders. Other states ARE now allowing a DNR bracelet.
Do not resuscitate order
Chapter 64E-2.031, Florida Administrative Code, is legislation regarding the Do Not Resuscitate Order (DNRO), form 1896 (revised December 2002), often referred to as the “yellow form” because it must be either the original on canary-yellow paper, or a copy made onto similar yellow-colored paper. It must be signed by an individual or the individual's health care representative and the individual's physician. While earlier forms will be recognized, it's recommended that patients obtain and complete this form. The Florida DNRO is recognized only in Florida. The bottom of the yellow form has a “patient identification device” that can be removed from the form, completed, and laminated to be carried by the individual. It is equally valid to the DNRO form 1896. The DNRO should be prominently displayed in the home. It is also advised that the patient identification device be displayed in a bracelet, for example, rather than in a wallet or purse, as emergency medical personnel aren't likely to have the time to look for the DNRO identification device before beginning resuscitation.

My wife is on an AED team and I suspect many others also reading this thread. If anything it will provide an opportunity for discussion at their AED future training meetings.

Personally, I believe the scenario just over complicates a process whose intent is providing emergency assistance and if I were an AED participant I would error in favor of saving someone because I can't help but believe that when faced with such a reality many more would welcome a little more living time than not and cannot envision a person you saved saying who asked you to intervene"

First of all a living will (or healthcare surrogate or healthcare proxy or ....) is very different from a valid, physician signed, DNR.

As stated above:
In the state of Florida there is a YELLOW DNR form. Yes it must be yellow and signed by both the patient (surrogate or POA, if patient is not competent) and a medical doctor. That and only that, or evidence thereof (the laminated id strip mentioned), stop a paramedic from performing life saving procedures.


In the hospital we MUST have a physician's order (different and distinct from the yellow sheet). The yellow sheet is only for use outside the hospital. Even many of the staff in the hospital need to be educated about DNR status. I know because it is one of things I need to do as charge nurse to insure that our patient's choices are being followed correctly and to the letter of the state law.

Thanks for the clarification
 

Russ, thanks for the clarification. Each State is a little bit different. :o

I've seen several drivers lately, who should have DNR
stamped on their drivers license............

DNR meaning Do Not Renew!!!!!!!:oops::loco::loco::loco::rant-rave::rant-rave::1rotfl:

Well, in that case, it's absolutely wrong to say that a DNR order is only for people in a vegetative state. Many people in nursing homes who are not in a vegetative state have DNR orders hanging at the foot of their bed.

And there's no law stating that you can't have this wherever you go.

Whether responders comply or not is anogher story. As far as I know, I don't think there's any penalty for disregarding a DNR order. Nursing homes have been known to do it when they are afraid that someone is about to die. In some cases they are afraid they might get in trouble if they don't call for an ambulance (if, for example, the person is having convulsions).

If you would go back and read all the previous posts, you will not find any comments from me suggesting that a person shouldn't need a DNR order.

I was mearly giving a few examples of why a non-institutionalized person might not want to be resusitated. If someone is out walking and doesn't want to be resusitated, they would absolutely need to have a DNR order with them.

Thanks, Frank, that was very helpful. This is for you:---->:eclipsee_gold_cup:

Thanks, the only question I have is: Are first (neighborhood) responders being taught to look for a DNR order and respect the person's wishes? Also, if a neighborhood hasn't had any calls for a while, you just have to hope that, in their excitement, they haven't forgotten what they were taught. For those who may be overly emotional, it's doubtful they will just sit there and do nothing, even if there is a DNR order in sight.

Another problem is: Villagers are not being told or reminded that they have the option to carry a DNRO with them. It has only come up now, on this board, because I more or less forced the issue. As there is a constant turnover of residents it should be featured in the Daily Sun at least once a year. But I don't believe they will ever do it, for obvious reasons: It's not a happy subject and will not promote new home sales to talk about such things.

So, for that reason, we should bring up this subject every so often, perhaps once a year? And perhaps someone here who has the experience might be kind enough to write a letter to the editor of the daily sun. That would be a big help so as to reach more people.