Emergency medical services professionals sometimes respond to calls from patients who are suffering from life-threatening conditions. When a patient’s heart stops while under EMS care, EMS personnel need to be mindful of the options Nevada grants its citizens to choose whether to be revived. Nevada recognizes two formal ways an individual can secure a medical order to not be resuscitated: the Provider Order for Life-Sustaining Treatment (POLST) and the Out-of-Hospital Do Not Resuscitate (DNR) order.
What is POLST?
The POLST program allows people who are extremely frail or suffering from terminal illnesses to make choices about the types of medical care they receive at the end of life. Nevada’s POLST statute, NRS 449.691 et seq., went into effect in 2013. A patient’s physician or other healthcare provider provides the POLST form, which to be valid must be signed by the physician and the patient or the patient’s legal representative. The Nevada Division of Public and Behavioral Health recommends that the POLST form be printed on hot pink paper to help it stand out. Patients are supposed to place their POLST form either near their refrigerator or next to their bed so EMS workers can find them quickly.
Nevada POLST, a non-profit established to assist with the implementation of POLST in the state, provides good resources for EMS professionals to understand how the program affects them.
Do-Not-Resuscitate (DNR) orders
Unlike POLST, a patient does not need to be faced with a terminal illness or at the end life to obtain a DNR order. In fact, some individuals opt to have a standing DNR order as a personal preference. Like a POLST, a medically binding DNR order is obtained by completing a Do-Not-Resuscitate Identification Application, which must be signed by the patient’s physician and the patient or the patient’s legal representative. Upon receipt of a validly executed form, the state issues the patient an identification card that puts healthcare providers on notice of the patient’s DNR choice. Both a copy of the signed form and the ID card serve as binding medical orders. Some patients opt to wear bracelets or other distinct jewelry with DNR alerts printed on them.
EMS personnel must follow specific guidelines with respect to treatments given to DNR patients.
Are EMS personnel legally liable for compliance with a POLST or DNR order?
Provided they are aware of it, EMS personnel are legally required to comply with a patient’s validly signed POLST or DNR order. NRS 449.695, NRS 450B.550. As such, it is best to ask the patient or the patient’s family or representatives if the patient has a POLST or DNR order, or if the patient is alone to check for a POLST form in the patient’s home or a DNR ID card in the patient’s wallet or purse. Personnel will not be held liable for complying with a POLST or DNR order, or providing care in violation of either if instructed to do so in another valid advance directive, or if the patient or a patient representative authorizes the treatment. NRS 449.6948, NRS 450B.540. EMS professionals should note that in the event a patient has both a POLST and a DNR, the document that was signed most recently must be followed.
An EMS professional cannot refuse to honor a DNR or POLST. In either case, the patient must be transferred to another EMS provider or physician who is willing to honor the patient’s preferences. NRS 449.695, NRS 450B.550.
GGRM serves the Las Vegas EMS community
Greenman Goldberg Raby Martinez is proud of its long history of service to Las Vegas first responders, including our city’s EMS personnel. We are happy to answer your questions about how patient POLST and DNR orders affect your legal obligations. To speak to an attorney, reach out to us today at 702-388-4476, or contact us through our website.