The Emergency Medical Services/"Do Not Resuscitate" (EMS/DNR) form can be downloaded by clicking this link: Download EMS/DNR Form.
In 1993, the Maryland Legislature enacted the Health Care Decision Act. One provision of the Act called upon the Maryland Institute for Emergency Medical Services Systems (MIEMSS) to work with the Board of Physician Quality Assurance (BPQA) and other key groups and individuals within the State to develop an Emergency Medical Services (EMS)/Do Not Resuscitate (DNR) Protocol. Under the Health Care Decisions Act, in addition to an advance directive, which has effect in clinical settings, a patient who wishes no resuscitation or only palliative care from EMS personnel in the event of incapacity, must also obtain an EMS/DNR Order. Additional information regarding the Health Care Decisions Act, Advance Directives and End of Life Care Decision-making can be found at http://www.oag.state.md.us/Healthpol/index.htm
In order to minimize the time it takes for EMS personnel to make the resuscitate/do not resuscitate decision, a standardized document has been developed that is readily recognizable throughout the State – the “MARYLAND EMERGENCY MEDICAL SERVICES (EMS)/DO NOT RESUSCITATE (DNR) ORDER.” It allows rapid identification of those patients who have chosen, either directly or through their legally authorized representatives, to no have attempts at resuscitation in the event of cardiac arrest (loss of palpable pulse) or respiratory arrest (loss of spontaneous respiration’s).
It also allows selection of one of two patient care options for care prior to arrest, either
A. Maximal (life-saving) care or
B. Supportive (comfort giving) care.
Based on which of the two Patient Care Options are selected on the EMS/DNR Order, the patient will, prior to arrest, receive either:
a) The full scope of restorative interventions permissible under statewide Maryland Medical Protocols, or
b) Palliative (comfort) care only as outlined in the EMS Palliative Care Protocol.
In either case, if a patient with an EMS/DNR Order arrests (loses a palpable pulse or stops breathing spontaneously), any further life-saving measures shall be withheld or withdrawn.
EMS personnel are authorized to initiate the EMS/DNR protocol when presented with an original EMS/DNR order, a copy of an EMS/DNR order, an EMS/DNR order from another state, a plastic EMS/DNR order bracelet, a Medic-Alert EMS/DNR bracelet or pendant, an oral DNR order from on-line medical direction, or an oral DNR order from an on-site physician. Other health care providers are also required follow an EMS/DNR order if a patient is in arrest.
In the absence of a valid EMS/DNR Order, patients calling for ambulance service who are unable to communicate their health care wishes, will receive the full scope of restorative interventions permissible under the statewide Maryland EMS medical Protocols, including if necessary, aggressive, life-saving resuscitation.
The Emergency Medical Services/"Do Not Resuscitate" (EMS/DNR) form can be downloaded by clicking this link: Download EMS/DNR Form. This EMS/DNR form has been developed with input from patients, their caregivers and the EMS community. We hope you find it useful. Plastic bracelets may still be ordered through MIEMSS at (410) 706-4367. Patients and caregivers without access to the internet may order forms through MIEMSS at (410) 706-4367. To schedule an in-service for your staff on the program, please contact Craig Coleman at (410) 706-3993. Patients may obtain metal EMS/DNR bracelets or necklaces by contacting Medic-Alert directly at (800) 432-5378.
Instructions for using an EMS/DNR Order
To issue an EMS/DNR Order:
- Complete the EMS/DNR form and, if they are to be used, the bracelet authorization form.
- Have the physician sign the “Physician Certification and Order” and initial ONLY ONE of the two options.
- If a vinyl bracelet is to be used, have the physician sign the bracelet inserts at the bottom of the EMS/DNR. If a metal bracelet or necklace is desired contact Medic Alert® at 1-800-432-5378. They will send you the application and information. They will require a copy of this order in order to process your request.
- If a vinyl bracelet will be used, be sure the insert has been completed and signed, tear the bracelet insert off of the original form, fold it, trim it along the dashed line, and insert it in the vinyl EMS/DNR bracelet that has been provided. The bracelet may be worn about the wrist, hung from a necklace, or pinned to clothing.
- The EMS/DNR Order form should be kept in a safe and readily available place and be retrieved for responding EMS personnel before their arrival.
- If a valid EMS/DNR Order is located after resuscitation has begun, EMS personnel may withdraw resuscitation. Ambulance personnel cannot honor specific instructions in advance directives that do not conform to the care selections in the “Physicians Order” (e.g. wants intubation but no CPR).
- An EMS/DNR Order may be revoked at any time by the patient’s request for resuscitation made directly to responding emergency medical services personnel OR by the physical cancellation or destruction of al l EMS/DNR Order forms, bracelets, and necklaces with the consent of the patient or the authorized decision maker signing the EMS/DNR Order. Destruction of an EMS/DNR Order, bracelet, or necklaces without consent carries penalties under the Health Care Decision Act.
- There is no expiration date for EMS/DNR Orders in Maryland. However, patients, their authorized decision makers, and attending physicians are encouraged to review the continuing need, desire, and qualification for an issued EMS/DNR Order at least annually.