A patient signed a DNI but was found unconcious by EMS and was intubated.?

Question

Now that we know the patients wishes, what do we do? Patient is still intubated now.
I think withholding treatment is the same as withdrawal- meaning we should extubate. But does anyone know where to find medical ethics sources that would answer this question?

Answer 1

Are we talking prehospitally?

Paramedics can extubate, but that's a pretty rare thing for them to do. If the patient didn't have the DNI order present at the time of the rescucitation attempt, then the paramedics didn't do anything wrong by intubating. The paramedic has to see the signed DNI order, not just be told that it exists. If I were the responding paramedic, I'd contact on line med control and find out what the MD would rather have me do . That's one of the great things about being a medic-if you have any questions, you can always call med control :)

If the patient is in the hospital, you can always contact the hospital's ethics board, and find out how they feel on the issue.

I don't know if this helps, but in this DNR protocols, there's a line in there about discontinuing rescuscitation once the DNR order has been found: http://www.hawaii.gov/health/family-child-health/ems/pdf/dnrinfopacket.pdf

I agree, if a signed and valid DNR order is found after the resuscitation attempt, the right thing to do would be to extubate (or at least quit any further actions, such as ventilation). That's just my opinion, though.

Answer 2

It might depend on state laws. I do not believe that in Colorado, EMTs are allowed to extubate a patient once they have been successfully intubated. I would personally transport the pt. to the hospital and let the Dr. decide how to proceed. Also, the Dr. has better insurance than your ambulance company does, if the family then decides that they didn't really want the pt. extubated. You might want to ask your physician advisor/medical director about your agency and state's protocols in this situation.

Answer 3

Is the patient's family around. If so talk to them, if not you do have the patients wishes. The person probably signed the DNI because they have a disease which will not improve. Even if you don't agree, that was their wish, i think it should be followed.