Yeah, I've set up some remote classes but especially with young guys getting trained I'd like to have someone travel for in person. The local FD/EMS is a good idea, thanks.Originally Posted by RoyGBiv
Yeah, I've set up some remote classes but especially with young guys getting trained I'd like to have someone travel for in person. The local FD/EMS is a good idea, thanks.
Sorry for the confusion. I realized that I got my categories mixed up. The patients who have permanent multisystem organ failure prior to arrest need a goals of care discussion; patients with single system or reversible multisystem failure should get a full court press…at least until they declare themselves.
I like my rifles like my women - short, light, fast, brown, and suppressed.
Good reference to class listings from another member. Keep in mind that many, probably most STB classes are never listed or uploaded to the STB website for one reason or another. A course does not need to do such to be an official STB event and issue a certificate. Best POCs will be local FD, EMS, emergency management agency, or hospital training/education division.
الدهون القاع الفتيات لك جعل العالم هزاز جولة الذهاب
If you are considering end of life instructions, I encourage considering these forms and/or taking them to your estate planning attorney.
https://www.nrlc.org/medethics/willtolive/states/
After speaking with estate planning attorneys and seeing the forms that they use, I found the above-linked forms to be much more carefully thought out, and they are what I used for my wife and myself.
It is very rare that I would recommend using a free online form rather than the form you would get from your attorney. In this instance, the free forms linked above are the best you will find.
Any legal information I may post is general information, and is not legal advice. Such information may or may not apply to your specific situation. I am not your attorney unless an attorney-client relationship is separately and privately established.
Caveat emptor: states frequently use standardized forms for end of life instructions which, by law, must be used. Any other form may be invalid, and providers may be legally obligated to provide full resuscitative care against your/your family's wishes until the correct form with the correct signatures is presented in person.
"Are you ready? Okay. Let's roll."- Last words of Todd Beamer
These forms start with a presumption of providing care, and then provide opportunities to include exceptions. They are also have different forms for each state. Of course, check with an estate planning attorney in your state if you have questions. I can confirm that the Pennsylvania forms meet all requirements in Pennsylvania.
This is outside my practice area but the usual case I read about is a hospital denying care against the family's wishes.
Any legal information I may post is general information, and is not legal advice. Such information may or may not apply to your specific situation. I am not your attorney unless an attorney-client relationship is separately and privately established.
Totally, don't mean to discount the usefulness of planning ahead. I felt the need to mention these because it's something we frequently dealt with at my last job as an EMS chief. We had two standardized forms from the state. One being the DNR, the other being a green end of life care instructions form which offered more nuance than a simple DNR. Ex: give me free flowing O2, but no intubation and no compressions. That sort of thing.
Anyways, hand drawn legal agreements that people did themselves using free online legal form generators/templates were invalid. It led to a lot of confrontation with family members. They could be useful for presenting to a doctor (who was also required to sign off) or for establishing a legal backstop for the POA concerning the patient's wishes if other family members wanted to sue them after the fact, but were 100% legally invalid in compelling medical providers.
"Are you ready? Okay. Let's roll."- Last words of Todd Beamer
Having completed the correct forms is one thing, having them available when needed is another. I've spent a decent amount of time teaching, and thus talking to, local EMTs. I now recommend to all of my patients who have advanced directives or POLST forms to affix that paperwork to their fridges with magnets.
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We had a relative who was very healthy all his life until he was 75, and he had his first "cardiac event", which was some sort of AFIB related thing. A few months later, he took his wife to the grocery store and his heart stopped while he waited in the car. A customer coming out saw him flop around in the car and did CPR until the FD got there, just a couple of minutes as they are like a quarter mile away. They used the paddles on him and got his heart started again. He was put on meds and was OK until about 4 years later, when the exact same thing happened at the same store! They shocked him the first time, and he woke up and said, "I feel terrible!", then his heart stopped again, and he got shocked, opened his eyes and said, "Wow, that's better! I feel pretty good now!". He was drama free until he was 85. Then one day his wife got up and found him, holding the paper in his hand, sitting on the front porch looking as peaceful as he could be. He had been dead about 2 hours. He must have felt OK until the end, he fed the dog, made coffee, and had the stove turned on so it would be ready for his wife when she got up, usually a couple of hours later than he did. If not for CPR, he would have died 10 years prematurely.
What is being discussed on this page generally deals with distinguishing Do Not Resuscitate (DNR) form/order, Medical Orders for Scope of Treatment (MOST) form, and living wills. While it is true that each state has variations of these forms, their requirements, and what they entail, there are broad similarities across most states for at least 2 of these forms (DNR and living will).
The most basic and fortunately commonly encountered form in pre-hospital circles is the DNR. This always signifies that you do not want CPR in the event of cardiac arrest, but there is growing ambiguity in many states around intubation in the event of respiratory arrest or failure. Some medical professionals are moving to create sub-categories such as DNR-I for intubation, DNR total, etc. Personally, I have and continue to approach the DNR to mean no CPR, intubation, unsynchronized shocks, or ACLS for cardiac or respiratory arrest. Patients with DNR orders still receive other aggressive and invasive care such as antibiotics, vasopressors, non-invasive ventilation, etc. and can still be admitted to intensive care units.
The MOST form in many states has options for DNR as well as many other levels of care such as only comfort measures, limited trials of IV fluids, limited trials of invasive feeding, etc. These forms are geared towards chronically ill people who are expected to frequently rely on the healthcare system. They are often people with advanced dementia, heart failure, or cirrhosis who wish to have care limitations known when they cannot communicate for themselves.
The last category is a living will. These vary from state to state and often accompany a separate healthcare power of attorney. They generally outline a person’s philosophy to end of life care or situations involving devastating illness without the detail and specificity of a MOST form. They are created by you and your lawyer and are often signed in front of a notary. For example, there is often language such as, “If my physician determines my condition to be incurable, I do not wish to be kept alive for prolonged periods by artificial means.” As you can imagine, there is some ambiguity with these documents that largely depends on the opinions of the medical team. What is incurable? What is prolonged? Etc.
Generally speaking, the legal protections provided by these various documents depend on the circumstances and what a similarly trained individual would do in that situation. For example, there is actually legal exposure if you perform CPR on a person wearing a DNR bracelet with a DNR golden form taped to their refrigerator behind you. Probably the best way to eliminate confusion and honor a loved one’s end of life wishes is to refrain from using the EMS system on those who you know are expected to die soon and who do not want aggressive measures. Plenty of people die peacefully without a bunch of strangers standing in their living room whose turnout gear smells like last week’s barbecue. Their death is typically not an emergency.
I like my rifles like my women - short, light, fast, brown, and suppressed.
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