Q: At a recent safety meeting, we were discussing the proper response to an employee experiencing a stroke or heart attack at work. Someone explained that a member of their work team has a Do Not Resuscitate (DNR) order in his medical record. Does the DNR mean we would have to withhold emergency medical care and allow him to die? Our safety team members include some who have been trained in CPR and the use of an onsite AED (automated external defibrillator).
A: In the event of a workplace medical emergency, always provide immediate care by administering first aid or calling 911.
While it is important to understand and respect an employee's decision to forego certain life-sustaining medical care, it is not your safety staff's or others' responsibility to make such significant life-or-death decisions.
DNR patients are to be provided medical care by emergency medical service providers as directed by the patient's attending physician but recognizing the limitations of the DNR order.
Under Connecticut law, a DNR order reflects an individual's decision to forego resuscitation if their heart or breathing stops or slows to dangerous levels. Only a Connecticut licensed physician can issue a DNR order.
Outside of a healthcare setting, the only valid indication of a DNR order recognized by Emergency Medical Services (EMS) providers is a DNR bracelet, which can be obtained exclusively through a physician via the Connecticut College of Emergency Physicians and the Connecticut Department of Public Health. It cannot be ordered directly by a patient or other individual.
A DNR bracelet must be worn on the person's wrist or ankle (DNR necklaces are not legally valid in Connecticut) and must display the patient's and attending physician's name.
The DNR order refers to certain specific forms of medical intervention or care: cardiopulmonary resuscitation, including chest compressions; defibrillation; or breathing or ventilation by any assistive or mechanical means, including but not limited to mouth-to-mouth, mouth-to-mask, bag-valve mask, endotracheal tube, or ventilator. All other medical care should be provided as determined necessary by the appropriate healthcare professionals.
To gain a better understanding of and respect for an employee's DNR status, it would be valuable to meet with your local EMS provider and discuss the scope of employees' roles (those with or without CPR training) and EMS and attending physician responsibilities.
Getting better acquainted with your local EMS provider would be worthwhile in any case for a variety of other workplace safety reasons.