Emergency Medical Service - Do Not Resuscitate Program

The Virginia General Assembly passed a law requiring the Emergency Medical Service (EMS) personnel to follow Do Not Resuscitate (DNR) orders for terminally ill individuals. Subsequently the Virginia State Department of Health issued the rules and regulations for this law which took effect July 1, 1992. Here is a brief overview of these rules.

What constitutes a Do Not Resuscitate Order and how is it obtained?

  • A DNR order is written on a special form which is printed on distinctive security paper and numbered sequentially.  The regulations state that the order is considered valid when it has (1) the attending physician's signed statement regarding the patient's terminal condition, and his Do Not Resuscitate determination set forth in the Order Form, and (2) the patient's signed directives, or a designated agent's or authorized decision maker's signature, if applicable.  The EMS/DNR Order Form is effective for one year from the date it is written.  The bottom portion of the form can be detached and inserted into a special EMS/DNR plastic bracelet for the patient to wear.
Forms and bracelets are available to physicians through local health departments and hospitals.  An EMS/DNR Order may only be issued by the attending physician for a patient diagnosed as having a terminal condition.

How is "terminal condition" defined?
  • The regulations describe "terminal condition" as a "condition caused by injury, disease or illness from which, to a reasonable degree of medical probability, a patient cannot recover and (i) the patient's death is imminent or (ii) the patient is in a persistent vegetative state."
When the EMS personnel are summoned to a person's home because of cardiac or respiratory arrest, how will they determine whether the person has a DNR order?
  • The rescue personnel will look for the original DNR Order Form in one of four places:  on the back of the door leading to the patient's bedroom; on the patient's bedside table; on the refrigerator; or in the patient's wallet.  A valid (intact, unaltered, current) EMS/DNR Bracelet will be honored in lieu of the Order Form.  The personnel will verify that the patient is the one for whom the DNR was issued.

What treatment will be provided to, or withheld or withdrawn from
a person during this process?
  • Until the patient's EMS/DNR Order status is established, the EMS personnel are to perform routine patient assessment and resuscitation or intervention.
If the EMS personnel have any doubt about the validity of an EMS/DNR order, they will resuscitate the patient.
  • If the order is verified, cardiopulmonary resuscitation (CPR), endotracheal intubation, artificial ventilation, defibrillation, and cardiac resuscitation medications will be withheld or withdrawn.

Will a patient with a valid DNR order receive any care?
  • Yes.  The emergency personnel will take measures to provide "comfort care" and to alleviate pain.  These measures include airway opening, suction, oxygen, pain medications, control of bleeding, positioning the patient for greater comfort, and being supportive to the patient and family.

Can the EMS/DNR Order be revoked?
  • Yes.  This order may be revoked at any time by the patient, the attending physician, or the patient's designated agent or authorized decision maker.  The patient may verbally express the desire to cancel it, may physically destroy the order form or bracelet, or direct someone else to do so.
For further information about the EMS/DNR Program, contact your physician, or the Office of Emergency Medical Services, Virginia Department of Health, 1538 East Parham Road, Richmond, VA 23228; 804-371-3500.


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