Make this page my home page
  1. Drag the home icon in this panel and drop it onto the "house icon" in the tool bar for the browser

  2. Select "Yes" from the popup window and you're done!

Customize your IMS Alliance Incident Command Boards
FireRescue1 - News, products and training resources

Print Comment RSS

Fire News in Focus
by Adam K. Thiel

Unpacking the no-CPR story

Given that the family and resident accepted in advance the facility's no-CPR policy, responders must honor that decision

By Adam K. Thiel

Editor's note: Chief Adam K. Thiel looks at the highly charged story of the nurse who cited company policy in refusing to perform CPR on a dying woman, and reminds us to be well-versed in the laws surrounding patient resuscitation in our jurisdictions. 

When I first heard this story, I had the same reaction as many other FireRescue1 readers: How could a (presumably trained) medical professional willingly refuse to do CPR on a dying patient?

Now, however, as I understand it from further media reports that both the patient and her family were aware of, and agreed with, the facility's stated no-CPR policy.

From my own experience as an EMS provider — and after losing my father and step-father to terminal illnesses, both of whom executed Do Not Resuscitate orders — I know how difficult it is to stand at the bedside and watch someone take their last breaths. But I also know that it's our duty, even beyond saving lives, to respect our patients' wishes regarding the type and level of treatment(s) they receive.

I think there are a few important lessons here:

First, of course, is making sure we have all the facts of a particular case before rushing to judgment. We've all been in situations where the facts aren't readily apparent to an outside observer and we probably all (myself included) can use a reminder on that score.

Second, for those of us who are EMS providers at any level — including, as this story demonstrates, just CPR-trained — it's important to understand our state's specific laws, regulations and standard of care for addressing patients' advance directives, DNR orders, hospice practices, etc. These can be emotionally charged and difficult situations; it's vital to know what you can, and can't, do to provide care without violating the patients' wishes.

Third, as hard as it is, we probably should think about what our own wishes might be if placed in such a situation; and ensure the proper communication is accomplished (in advance) with our families and care providers.

Stay safe.
 

About the author

With more than two decades in the field, Chief Adam K. Thiel — FireRescue1's editorial advisor — is an active fire chief in the National Capital Region and a former state fire director for the Commonwealth of Virginia. Chief Thiel's operational experience includes serving with distinction in four states as a chief officer, incident commander, company officer, hazardous materials team leader, paramedic, technical rescuer, structural/wildland firefighter and rescue diver. He also directly participated in response and recovery efforts for several major disasters including the 9/11 terrorist attacks, Tropical Storm Gaston and Hurricane Isabel.



Comments
The comments below are member-generated and do not necessarily reflect the opinions of FireRescue1.com or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser.
Chris Redding Chris Redding Wednesday, March 06, 2013 4:09:18 PM I knew from the beginning that there was more to this story.
Matthew George Matthew George Wednesday, March 06, 2013 5:03:15 PM Chief Thiel, Thank you for your comments on this incident - it's certainly something I'm glad to see is getting national attention and thoughtful commentary. As an EMS provider, I'm sure you'll agree with me that it is widely considered best practice and the law to resuscitate a cardiac arrest patient if two conditions are met. First, no obvious signs of irreversible death are present. Since this patient had a witnessed arrest, this was clearly not the case. Second, a DNR order must not be present. The only way a healthcare provider can legally withhold CPR is being presented with a signed, notorized and original DNR order in most states. As has been reported widely, the patient did NOT have a DNR and the facility was aware that the patient did not have a DNR. A no-CPR policy in a facility where there were multiple nurses standing around looking at the patient on the floor is irresponsible, and in the opinion of many health care lawyers, illegal. If your firemen were traveling in a fire department vehicle to a convention out of state, and came upon a serious accident, I'm sure none would hesitate to render assistance until the proper local authorities took over. I'm sure their first thought would not be "am I allowed to render assistance" but would rather be "we need to help". Similarly, a nurse is responsible to provide a basic life saving technique taught to folks as young as 10 years old until the paramedics can arrive. CPR is a basic skill and justifying the nurses actions by stating that there are "complicated legal issues" when the nurse was aware that there was not a DNR present may be a bit off base. Respectfully, Matthew George FP-C, NREMT-P, CCP, Instructor.
Alan Hanson Alan Hanson Thursday, March 07, 2013 7:03:23 AM A few years ago my mother-in-law who had a DNR in place went into cardiac arrest at her home. The fire department arrived, and even being told by the physician and with documents present, the firefighter/paramedic revived her. The hard part was having to watch the suffering of the family while we watched her die over the next few hours honoring the DNR. Thank you for your article.
Brian Blackburn Brian Blackburn Sunday, March 10, 2013 5:51:37 PM I agree 100% with Mr. George and his post eloquently conveys my sentiments. I personally feel the home should loose their accreditation and the nurse be stripped of her certifications. I have come across accidents that were not within my area and always given aid until the local authorities arrived because during all our training and at the end we took the oath for our positions it was instilled into us that we would always help those who needed assistance no mater where we were or what we are doing. Now, that being said a DNR does supersede our normal processes so long as it filled out correctly and that is the word I want to emphasize, because if it is not then normal treatment processes are back in play.

Communications and Interoperability
Communications and Interoperability

Sponsored by

Connect with FireRescue1

Mobile Apps Facebook Twitter Google+

Get the #1 Fire eNewsletter

Fire Newsletter Sign up for our FREE email roundup of the top news, tips, columns, videos and more, sent 3 times weekly
Enter Email
See Sample