Comfort Care DNR protocol

When a patient is in a non-hospital setting, Emergency Medical
Technicians (EMTs) are required to provide emergency medical care and to
transport patients to appropriate health care facilities. Emergency
Medical Services (EMS) personnel are required by law to provide
treatment to the fullest extent possible, subject to their level of
training.

Comfort Care DNR Order Verification Protocol (Comfort and Care DNR)

1. The Comfort Care DNR is designed to allow EMTs and first responders to honor a DNR order in an out-of-hospital setting.


2. Before 1999, when Massachusetts implemented its Comfort Care DNR
   protocol, there was no mechanism to enable EMT’s and other first
   responders to recognize DNR orders in a non-hospital setting. So EMT
   personnel were always obligated to perform full resuscitation measures
   when they encountered a patient unable to convey directions regarding
   medical treatment.


3. The Comfort Care DNR protocol provides for a statewide, uniform DNR verification protocol.


4. The purpose of the Comfort Care DNR is to: (a) provide a
   verification of DNR orders to enable EMTs and first responders to honor
   DNR orders, (b) clarify the role and responsibilities of EMTs and first
   responders at the scene and/or during transport of patients who have a
   valid current DNR order, (c) avoid resuscitation of patients who have a
   current and valid DNR, (d) provide for palliative/comfort care measures
   for patients with a current Comfort Care DNR order verification form.


5. Comfort Care DNR order verification forms must be completed and
   signed by the patient’s physician, authorized Physician’s Assistant or
   Nurse Practitioner.


6. The patient must post the Comfort Care DNR where any EMT or first
   responder can easily find it. (Usually the patient’s refrigerator, or
   taped to the patients bedroom door. The Department of Public Health
   stopped issuing Comfort Care DNR bracelets in 2007, but the Department’s
   approved form contains bracelet inserts that can be used in generic
   wrist bracelets.


7. The Comfort Care DNR Order Verification form can be accessed by
   anyone, in downloadable format from the Massachusetts Department of
   Public Health/Office of Emergency Medical Services website, at:
   http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/oems/comfort-care/public-health-oems-comfort-care-verification.html.
   But the form must be fully completed and signed by the attending
   physician, authorized nurse practitioner or authorized physician
   assistant as proscribed by the regulations.