In the vast majority of emergency situations, first responders are called on to do everything in their power to keep people alive. However, complications arise when paramedics respond to a situation where the person is dying and has very specific end-of-life wishes, such as a "do not resuscitate" order.
This professional conflict is the focus of a recent study led by Deborah Waldrop, a professor at the University at Buffalo School of Social Work. Waldrop examined the role of first responders who answer end-of-life calls.
Emergency response at end-of-life
According to a press release, Waldrop interviewed paramedics and emergency medical technicians in Western New York to gain perspective on the largely unknown intersection between emergency care and end-of-life care. She reported that while most responders are not trained in end-of-life care, they do more of it than they are given credit for.
Though they have not received training, the study found that most responders have found ways to navigate the situations, including verbally walking the family through the process during their loved one's last moments. However, a major problem arises when there are no medical orders or the orders cannot be found. Without an official document, the responders are obligated to take life-saving measures and transport the patient to a hospital, even if the family says otherwise.
"It's why the end-of-life conversation needs to happen at the time of a life-limiting diagnosis or when something changes on the trajectory of that illness and why those documents have to be in a prominent place," Waldrop said in a statement. "In the heat of the moment, families don't want to be shuffling through files."
The study reported that in general, first responders expressed the desire for more training in how to handle these situations.
Steps to aid the process
Waldrop recommended that families make sure to openly discuss a terminal loved one's wishes with medical professionals and caretakers and place any official medical orders in a prominent location such as on the refrigerator door so that it can be easily given to emergency responders.
"It's someone's life that may end differently than they intended if we fail to take these steps," Waldrop said. "Those memories don't easily go away."
According to the U.S. National Library of Medicine, patients can request a DNR order from their doctor, who must either honor the request or refer the recipient to a doctor who will. Standard forms may also be found at the state Department of Health. Family cannot override a DNR order once it is written by the physician, but if a person has not made an order and is no longer able to communicate the desire, a family member can make the decision in certain situations.
The California Emergency Medical Services Authority recommended that people wear a DNR medallion if they are worried that responders will not see the authorized form.