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Medical Orders for Life Sustaining Treatment - Professionals

Frequently Asked Questions (FAQs)

NYSDOH Bureau of EMS (BEMS) 

Due to the significant change in procedures and decision-making standards set forth in the Family Health Care Decisions Act (FHCDA), the legal requirements to withhold and/or withdraw life-sustaining treatment have changed.  As a result, these changes are integrated into the MOLST process.  This has raised many questions among EMS professionals.

These MOLST FAQs are included in the NYSDOH BEMS Policy Statement 11-02 - March 2, 1011 (Supersedes/Updates 99-10, 08-07, 10-05).

 

What should I do if I am uncertain how to proceed?

Contact Medical Control

What do I do if the patient has both a nonhospital DNR order and a MOLST form?  Which do I honor?

If the forms have different orders, you should follow the form that has the most recently dated authorization.  In all instances you should follow the DNI instructions on the MOLST form if the form is signed by a physician, as the nonhospital DNR order does not provide this advice.

What if the old MOLST form was signed prior to June 1, 2010, the date the Family Health Care Decisions Act became effective?

You may honor the previous versions of the form as if it were authorized after the statutory effective date.

Does the MOLST law allow EMS to honor other advance directives?

The law does not expand the ability of EMS personnel to honor advance directives such as a Health Care Proxy or Living Will.

What procedures are, and are not, performed if the patient presents a DNR?

Do not resuscitate (DNR) means, for the patient in cardiac or respiratory arrest (i.e., when the patient has no pulse and/or is not breathing), NO chest compressions, ventilation, defibrillation, endotracheal intubation, or medications.  If the patient is NOT in cardiac or respiratory arrest, full treatment for all injuries, pain, difficult or insufficient breathing, hemorrhage and/or other medical conditions must be provided, unless Section E of the MOLST form provides different instructions.  Relief of choking caused by a foreign body is usually appropriate, although if breathing has stopped, ventilation should not be assisted.

CPR must be initiated if no Out of Hospital or facility DNR is presented.  If a DNR order is presented after CPR has been started, stop CPR.

What documentation is required for a patient with DNR order?

Prehospital care providers should attach a copy of the Out of Hospital DNR form, MOLST form, hospital DNR order and/or copy of the patient's chart to the patient care report, along with all other usual documentation.  It should be noted on the patient care report that a written DNR order was present including the name of the physician, date signed and other appropriate information.

If the cardiac/respiratory arrest occurred during transport, the DNR form should accompany the patient so that it may be incorporated into the medical record at the receiving facility.

Patients who are identified as dead at the scene need not be transported by ambulance; however, local EMS agencies should consider transportation for DNR patients who collapse in public locations.  In these cases it may be necessary to transport the individual to a hospital without resuscitative measures in order to move the body to a location that provides privacy.  Local policies need to be coordinated with the Medical Examiner/Coroner and law enforcement.

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