Do EMTs Need Access to Advance Directives in the Field?
Every state in the US offers advance directives for citizens
By Michael Cayes
Mooring Tech, Inc.
This article is provided by Mooring Tech, Inc. and does not necessarily reflect the opinions of EMS1.
The American Heart Association estimated in a study from 2011 that nearly 383,000 people suffer cardiac arrest each year. Another study from the Netherlands in 2013 showed that only 18.6% of patients over the age of 70 made it out of the hospital after suffering cardiac arrest. That percentage grew steadily smaller as patients aged, with only an 11.6% survival rate for cardiac arrest patients at age 90. Cardiac arrest is not a heart attack; there is often no warning, and there may not be a history of heart trouble observed before the incident happens. It is instant, and so is the halt in the flow of oxygenated blood to the brain and organs. Without CPR, the chances of spontaneous circulation are less than 40%.
To this end, every state in the U.S. offers advance directives for citizens, the most common of these being a Do Not Resuscitate (DNR) form. A DNR allows patients to make informed decisions about the level of health care they wish to receive in the event of an emergency such as cardiac arrest. DNR forms must be signed by the patient’s primary care physician, and they must be presented to emergency responders at the scene to be recognized. Even if the patient’s family is aware of, and in agreement with, the patient’s wishes emergency medical professionals are legally required to perform CPR. Meaning that for a person who has taken the time to create an advanced directive, they are obligated to carry that directive around with them, or their wishes will be ignored until they reach the hospital. If the patient lives, they are left with the expenses and emotional trauma of treatment; if they don’t, the cost of unnecessary health care is left to the family. Understandably, this is a hot-button ethical issue for medical responders; so many of them have been faced with choosing between honoring patient’s wishes and their own legal obligations.
There is a group called the U.S. Living Will Registry that has been in operation since 1996. The goal of the registry is to maintain a database of advance directives, organ donor information, and emergency contact information. This database is updated annually and managed by one source, the Living Will Registry. Now that an estimated 30% of ambulances equip some form of mounted laptops or rugged tablets, it would be a good time to test the use of the Living Will Registry in the field. Some tablets especially, such as the Panasonic ToughPad line, run Windows 8 and top-of-the-line processors. Accessing information would be fast and hopefully easy since the tablets are extremely portable. In a perfect world, people would carry their own information all the time on their person or mobile device. Until we get there, the next best thing is find efficient ways to help EMT’s bridge the gap.