An EMT is called to a residence for an elderly patient who is experiencing severe respiratory distress. The patient's family presents a document titled 'Do Not Resuscitate (DNR) Order' that appears valid and signed by a physician. However, the EMT observes that the DNR order specifies 'Do Not Intubate' but does NOT explicitly state 'Do Not Administer Oxygen' or 'Do Not Transport.' What is the EMT's MOST appropriate course of action regarding oxygen administration and transport?
- AWithhold oxygen and transport the patient only if their condition deteriorates to cardiac arrest.
- BAdminister oxygen as needed and transport the patient, respecting the 'Do Not Intubate' order.
- CDo not administer oxygen or transport the patient, as the DNR implies comfort care only.
- DContact medical direction immediately for clarification before providing any care.
Show answer & explanationAnswer & explanation
Correct answer: B. Administer oxygen as needed and transport the patient, respecting the 'Do Not Intubate' order.
A DNR order only applies to resuscitation efforts explicitly stated within it. Unless specifically prohibited, EMTs should provide all other indicated medical care, including oxygen administration and transport, to alleviate suffering and address the patient's current distress. 'Do Not Intubate' does not equate to 'Do Not Treat' or 'Do Not Transport.'
Why the other options are wrong
- A. Withholding oxygen or delaying transport based on a limited DNR is incorrect; the DNR does not prohibit these interventions.
- C. This is an incorrect interpretation of a DNR order. A DNR does not imply withholding all care; it only restricts specifically listed interventions.
- D. While contacting medical direction is always an option if unsure, in this clear scenario, the EMT should proceed with non-prohibited care to alleviate distress.
DNR Scope of Care
A Do Not Resuscitate (DNR) order only prohibits specific life-sustaining interventions explicitly listed, such as CPR or intubation, and does not preclude other medical care aimed at comfort or symptom relief.
- DNRs are specific; if an intervention isn't listed, it's generally permitted.
- Patients with DNRs still receive comfort care, oxygen, pain management, and transport.
- EMTs should err on the side of providing care if the DNR is ambiguous or incomplete regarding certain interventions.
Memory trick: DNR means NO to some, YES to comfort, and transport if not forbidden.