Chesapeake Fire Department Advance Health Care Directives PDF

Policy 503 Chesapeake Fire Department Policy Manual Copyright Lexipol, LLC 2023/03/29, All Rights Reserved.Published with permission by Chesapeake Fire Department Advance Health Care Directives - 1 Advance Health Care Directives 503.1 PURPOSE AND SCOPE This policy identifies the circumstan...

Policy 503 Chesapeake Fire Department Policy Manual Copyright Lexipol, LLC 2023/03/29, All Rights Reserved.Published with permission by Chesapeake Fire Department Advance Health Care Directives - 1 Advance Health Care Directives 503.1 PURPOSE AND SCOPE This policy identifies the circumstances and types of documents required for department Emergency Medical Services (EMS) members to withhold or withdraw resuscitative or life- sustaining measures based on the Virginia Health Care Decisions Act (Va. Code § 54.1-2981 et seq.; 12 VAC 5-66-10 et seq.). Nothing in this policy should be interpreted to limit EMS members from relieving an airway obstruction. 503.1.1 DEFINITIONS Definitions related to this policy include (Va. Code § 54.1-2982; Va. Code § 54.1-2987.1; 12 VAC 5-66-10): Advance directive - Either a witnessed, written document, voluntarily executed by the declarant in accordance with the requirements of Virginia law, or a witnessed oral statement, made by the declarant subsequent to the time he/she is diagnosed as suffering from a terminal condition and in accordance with the provisions of the Virginia Health Care Decisions Act. A living will is not considered a medical advance directive and cannot be honored by EMS personnel. Agent - An adult appointed by the declarant under an advance directive to make health care decisions for the declarant. Alternate Durable Do Not Resuscitate (DDNR) jewelry (also known as DDNR bracelet or necklace) - Uniquely designed and identifiable bracelets and necklaces that are available only from a vendor approved by the Virginia Department of Health’s Office of EMS that can be used to validate a DDNR or serve in place of a DDNR. Declarant - An adult who makes an advance directive while he/she is capable of making and communicating an informed decision. Durable Do Not Resuscitate Order (DDNR Order) - A written physician's order, issued pursuant to Virginia law, to withhold CPR from a particular patient in the event of cardiac or respiratory arrest. CPR includes cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of cardiac resuscitative medications and related procedures. Pursuant to Virginia law, a DDNR Order is not and shall not be construed as an advance directive. For the purposes of this policy, DDNR Orders completed on the current or previous yellow forms approved by the Virginia Department of Health, or copies thereof, are considered valid. This includes a DDNR reasonably believed to have been lawfully executed in another state. Other Do Not Resuscitate Order (Other DNR Order) - An order, including a Physician Orders for Scope of Treatment (POST) form, in accordance with applicable policies and procedures of a health care facility, which is to be honored when the patient is in that health care facility, currently admitted to a hospital or is in transit from that health care facility. Other DNR Orders include the Chesapeake Fire Department Policy Manual Advance Health Care Directives Copyright Lexipol, LLC 2023/03/29, All Rights Reserved.Published with permission by Chesapeake Fire Department Advance Health Care Directives - 2 same information as DDNR Orders except that the signature of the patient or person authorized to consent for the patient does not need to be included on the order. Other DNR Orders are also valid for patients receiving hospice or health services at home. Palliative care - The total care of patients who are not responsive to curative treatment, designed to achieve the highest quality of life possible. Physician Orders for Scope of Treatment (POST) form - A form available statewide that allows an individual to express his/her desires concerning resuscitation and various resuscitation modalities. 503.2 POLICY It is the policy of the Chesapeake Fire Department that EMS members honor DDNR Orders, Alternate DDNR jewelry and Other DNR Orders to withhold or withdraw resuscitative measures (12 VAC 5-66-80). 503.3 PROCEDURES The following guidelines should be used by members who are presented with or encounter a DDNR Order, Alternate DDNR jewelry or Other DNR Order (12 VAC 5-66-80): (a) Members shall perform routine patient assessment and resuscitation or intervention until a valid DDNR Order, Alternate DDNR jewelry or Other DNR Order can be confirmed, as follows: 1. Determine the presence of a DDNR Order, Alternate DDNR jewelry or Other DNR Order. 2. Determine that the DDNR Order, Alternate DDNR jewelry or Other DNR Order is not altered. 3. Verify, through driver's license or other identification with a photograph and signature, or by positive identification by either a family member or other person who knows the patient, that the patient in question is the one for whom the DDNR Order, Alternate DDNR jewelry or Other DNR Order was issued. 4. If the DDNR Order, Alternate DDNR jewelry or Other DNR Order is intact, unaltered and verified as issued for the patient, EMS members may consider it valid. (b) All do-not-resuscitate patients should receive non-resuscitation-related palliative care and other comfort measures, as would any other person. (c) A DDNR Order, Alternate DDNR jewelry or Other DNR Order shall be disregarded if the patient requests resuscitative measures. (d) When EMS members honor a DDNR Order, they should note on the Pre-Hospital Patient Care Report (PPCR) that a DDNR Order or Other DNR Order was presented Chesapeake Fire Department Policy Manual Advance Health Care Directives Copyright Lexipol, LLC 2023/03/29, All Rights Reserved.Published with permission by Chesapeake Fire Department Advance Health Care Directives - 3 or Alternate DDNR jewelry was observed and honored, and shall document the circumstances surrounding the order on a PPCR. (e) Base hospital or Medical Director contact should be made, the base hospital physician consulted and resuscitation initiated: 1. If there are any questions concerning the validity of the DDNR Order, Alternate DDNR jewelry or Other DNR Order. 2. If a DDNR Order, Alternate DDNR jewelry or Other DNR Order is incomplete, altered or not signed. 3. When a document other than those noted in this policy is presented. 4. Any time EMS members have concerns or require assistance. (f) All do-not-resuscitate patients who are in cardiopulmonary arrest should not be transported. EMS members shall contact local law enforcement and/or the coroner’s office to report the death and should support family members on-scene, as appropriate. (g) All do-not-resuscitate patients who decline transport to the hospital, including patients for whom transport is declined on their behalf, should not be transported. EMS members should make reasonable efforts to preserve the patient’s privacy, dignity and comfort before leaving the scene. (h) If a do-not-resuscitate patient is transported to a hospital, the following shall apply: 1. A valid DDNR Order, Alternate DDNR jewelry or Other DNR Order shall be honored during transport of the patient. 2. The DDNR Order, Alternate DDNR jewelry or Other DNR Order shall accompany the patient. 3. The attorney-in-fact or health care agent (if applicable) should accompany the patient to the hospital.