A do-not-resuscitate order or a POLST form tells responders that the patient does not want CPR if the heart stops. The team must confirm the document quickly, respect the patient's wishes and focus on comfort and support for the family.
Key symptoms
- Unresponsive patient with no breathing and no pulse
- Often a known terminal or serious chronic illness
- Family or caregivers present with a DNR form or bracelet
What you find on exam
- Confirm cardiac arrest: no pulse and no breathing
- Check the patient's identity matches the document
- Look for obvious signs of death or a valid DNR, POLST or bracelet
Tests
- Read the order: signed, valid in your state, and what it covers
- Contact medical control if the document is unclear
- Document the time and the order details
Treatment basics
- Do not start CPR when a valid DNR order is present
- Start CPR if the order is missing, unclear or the patient revoked it
- Stop resuscitation if a valid order appears during CPR
- Support the family, explain what is happening and follow death procedures
Red flags
- Document is missing, unsigned or does not match the patient
- Family members disagree about the patient's wishes
- Arrest from trauma or suspected foul play
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021); AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.