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Azza  
#1 Posted : 10 January 2018 20:36:20(UTC)
Rank: Forum user
Azza

An employee has indicated that whilst at work if an incident occurs they do not want to be resuscitated. Does anyone have any guidance on this? My understanding is you can only request not to be resuscitated when in the care of the NHS.
Roundtuit  
#2 Posted : 10 January 2018 21:47:12(UTC)
Rank: Super forum user
Roundtuit

DNR can only apply where a medical professional is in possession of all the facts including the existence of a "living will" (a prior registered legal declaration by the individual regarding their care and treatment).

Consider the more likely scenarios such as your employee is knocked down on a public highway / collapses in a public space - any ambulance called would as a matter of course commence resuscitation as consent has to be presumed, even someone repeating "let me die" has to be treated.

They are completely free to wear an SOS talisman or similar with their wishes/contact/will details BUT this should not affect either the activity of your First Aiders or the timely calling of the Ambulance service.

We can and do change our minds over time and forget to update records.

Edited by user 10 January 2018 21:48:30(UTC)  | Reason: FFS

thanks 2 users thanked Roundtuit for this useful post.
Azza on 11/01/2018(UTC), lorna on 11/01/2018(UTC)
Kate  
#3 Posted : 11 January 2018 12:35:56(UTC)
Rank: Super forum user
Kate

I have come across people saying they don't want to have a defibrillator used on them and asking for a note to made to prevent first aiders from doing this.  In both cases the reason was that they had a pacemaker and wrongly believed that defibrillation would for this reason be a danger to them.

In this case does the person have a reason for their request and could it also be based on a misconception?

stevedm  
#4 Posted : 31 January 2018 16:54:13(UTC)
Rank: Super forum user
stevedm

Guidance notes and model forms from the Resus Council link below:

https://www.resus.org.uk/dnacpr/do-not-attempt-cpr-model-forms/

It can only be signed by a Doctor and anyone who is aware must respect those rights no matter how hard it is but only when they are in sight of the original form.

Please also ensure that you and your first adiers have signed confidentiality as the information is medical in confidence and if the person doesn't wish it sharing with the first aiders..it is a tough one but needs to be handled with sympathy and understanding.

Roundtuit  
#5 Posted : 31 January 2018 22:37:38(UTC)
Rank: Super forum user
Roundtuit

A very interesting link - would it pass "the man on the Clapham omnibus test" here I am not sure, this is one of those specialist areas where the general public has very little awareness.

So there is a form, signed by a doctor, that the employee has allowed its existence known to First Aiders - what about the rest of the employees? The mental scarring that will occur as they watch a supposed First Responder do nothing for their work colleague (possibly family member), someone they expect to do everything possible to maintain life until the emergency services arrive.

It is not common today but we used to have protocols on communication in the event of an incident as fathers/sons/daughters/uncles/wives... all worked at the same firm. One accident and suddenly half the town was at the door asking what had happened - and this was in the days before mobile phones and social media.

Now we have baying mobs set-off by miss-information on social meida running vigilante - are you really willing to expose a First Aider to something they cannot defend due to signing confidentiallity?

First-Aid is First-Aid, medical decisions are for medical practitioners, individuals wishes are for medical practitioners - even then the family may choose to fight medical or the individuals opinion in the high court and beyond

Back when I held my FAAW it was never a consideration of wishes - "is there any further danger to the casualty or myself...A..B...C...continue CPR until relieved or casualty handed over"

stevedm  
#6 Posted : 01 February 2018 13:31:18(UTC)
Rank: Super forum user
stevedm

If you have not actually been put in this position then it is best not to comment...the information provided is from a credible source and provuded just for that.  Not to make some moral statement on the whys and wherfores...

It is rare that this information would or indeed should be bandied about in the workplace hence the confidentiality statement...but to compare this to the general reasonableness test is...well.. just not reasonable...  Everyone has the right to have thier own wishes and feelings respected...it is hard for everyone faced with this challenge day in and day out...I know I have been there...both first hand and dealing with the aftermath effect on staff...

Roundtuit  
#7 Posted : 01 February 2018 22:42:40(UTC)
Rank: Super forum user
Roundtuit

Have... and will....

This is a discussion forum and I suggest the general public expect First Aiders provide and not withold treatment.

Not long ago we even had suggestion of adopting a law similar to Frances "M'Aidez" how would that sit with an individuals wishes?

There are enough problems getting volunteers without adding to the pressure by potentially asking them to stand down from their good intentions and training to watch a coleague die (I still carry the mental scars from one such selfish individual - thanks for dragging the memories back up)

LeanneD  
#8 Posted : 02 February 2018 14:18:46(UTC)
Rank: Forum user
LeanneD

Originally Posted by: stevedm Go to Quoted Post

If you have not actually been put in this position then it is best not to comment...the information provided is from a credible source and provuded just for that.  Not to make some moral statement on the whys and wherfores...

It is rare that this information would or indeed should be bandied about in the workplace hence the confidentiality statement...but to compare this to the general reasonableness test is...well.. just not reasonable...  Everyone has the right to have thier own wishes and feelings respected...it is hard for everyone faced with this challenge day in and day out...I know I have been there...both first hand and dealing with the aftermath effect on staff...

have to say i agree with Roundtuit.  This sort of action is for medical professionals only and it should remain that way.  First aiders are there to treat someone until a medical professional (if required) takes over.  they are volunteers and to place the resposibility of someone's life in their hands is a ridiculous ask of them.  If, once the casualty is taken to a hospital and they are aware of the DNR or advanced life protocol or what ever it is called these days then medical professionals, with the right training and information, can make the call on wether to stop treatment or not.

We have 40 first aiders where i work and any one of those could treat someone with one of these agreements so that is 40 people that would need to know confidential informtion about it.  Whilst we expect and demand a level of integrity and hope that they would not disclose that information to anyone, you can never control information once it is out. 

I get the point that roundtuit makes about the wider workforce not understanding why no one did anything.  After the event is too late to tell them they didnt want to receive treatment.  The reputational damage is already done.

This is an agreement between the individual and the medical professionals and it should remain as such.

thanks 3 users thanked LeanneD for this useful post.
jodieclark1510 on 02/02/2018(UTC), toe on 03/02/2018(UTC), lorna on 16/02/2018(UTC)
LeanneD  
#9 Posted : 15 February 2018 14:00:49(UTC)
Rank: Forum user
LeanneD

Originally Posted by: stevedm Go to Quoted Post

Guidance notes and model forms from the Resus Council link below:

https://www.resus.org.uk/dnacpr/do-not-attempt-cpr-model-forms/

It can only be signed by a Doctor and anyone who is aware must respect those rights no matter how hard it is but only when they are in sight of the original form.

Please also ensure that you and your first adiers have signed confidentiality as the information is medical in confidence and if the person doesn't wish it sharing with the first aiders..it is a tough one but needs to be handled with sympathy and understanding.

I may be wrong (and often am, but every opportunity is a learning opportunity - right?!) but from reading through the information in the link you posted, it is all aimed at healthcare providers and not first aiders at work.  I couldnt find any information on there that related to the workplace.  I think it is potentially quite dangerous to advocate completing forms in the workplace that are intended for healthcare providers only.

Charlie Brown  
#10 Posted : 15 February 2018 15:59:02(UTC)
Rank: Forum user
Charlie Brown

If I was the first aider I would go ahead and resuscitate and let them sue me later. This is for 2 reasons, firstly, good luck with getting blood from a stone so to speak and secondly, I don't want to live with the thoughts that I could possibly have saved a life and didn't.

BTW, has there ever been a case where someone was sued for resuscitation?

Edited by user 15 February 2018 16:01:55(UTC)  | Reason: dyslexic

thanks 1 user thanked Charlie Brown for this useful post.
lorna on 16/02/2018(UTC)
AFletcher  
#11 Posted : 16 February 2018 12:45:42(UTC)
Rank: New forum user
AFletcher

If a GP has issued a DNR order for an individual that wish must be respected and the order adhered to when the original document (not a copy) is carried on that person (i.e. it cannot be in their locker / car etc.)

A DNR order is reviewed periodically by their GP (the review period timescale is also decided by the GP).

This information is confidential, but an individual's wishes (although may not be condoned by the majority of people) does need to be respected and the information relayed to the First Aiders along with a confidentialilty agreement.

There is however a very large grey area, in that a person may collapse from respiratory failure (their heart is beating but they cannot maintain breathing). Providing "rescue breaths" is not CPR per se, it is simply helping to maintain oxygenated blood in the sytem. However during respiratory failure their heartbeat may be weak and/or sporadic, but there is a pulse. Therefore it would be quite feasible that a First Aider assesses the casualty; assumes they are in cardiac arrest and due to the DNR order does not provide treatment when rescue breaths may actually prevent the death of the person.

In my opinion unless a defibrillator (or ECG used by medical professionals) can be properly secured to the patient's chest and there is no heart output detected could you have justifiable grounds to uphold the DNR order, otherwise relatives could feasibly argue that you did not categorically know the person was in respiratory arrest or cardiac arrest when treatment was withheld.

Edited by user 16 February 2018 12:47:41(UTC)  | Reason: Typo

Roundtuit  
#12 Posted : 16 February 2018 13:53:14(UTC)
Rank: Super forum user
Roundtuit

Well that was a quick change of stance compared to Wednesday http://forum.iosh.co.uk/posts/t126294-Do-not-resuscitate-order-request when you were looking for information

You start from a position of upholding individuals wishes and end with opinion advocating application of medical (not First Aid) techniques

Resuscitate - verb - "to revieve from apparent death or from unconciousness"

A Kurdziel  
#13 Posted : 16 February 2018 14:01:31(UTC)
Rank: Super forum user
A Kurdziel

I am not convinced by this.

People who help out by using a defibrillator or a first aider cannot be expected to go through someone’s pockets etc to find out if they have DNR order.  Any indication that they may “get into trouble” for using a defibrillator on someone that does not want resuscitation is, in my opinion dangerous.  I believe that in the UK it is not possible to sue for “unwanted life” which could be defined as is being kept alive when you want to die but by drawing attention to this you might be putting the cat amongst the pigeons. If we find a situation where people legally have to check whether someone has a DNR before using a defibrillator, then I would recommend getting rid of them as there is no legal requirement to have them.

Note I said IF this is the case. Do not think that it is and that DNR only apply to people in hospital who are undergoing medical treatment not to first aiders or even first responders.

AFletcher  
#14 Posted : 16 February 2018 14:21:22(UTC)
Rank: New forum user
AFletcher

I appreciate there is a change in perspective given the fact that further information has been received.

It is potentially a very difficult area to navigate, as in one hand the respect of a person's wishes should be of most importance. But in the days of litigation and social media whereby every action can be broadcast in seconds around the globe, it can make decisions very difficult.

In nursing homes (which aren't staffed by nursing staff or doctors) have DNR in place; how is that any different to a warehousing environment or office? If an individual has a DNR order, does it make a difference depending on the location where they collapse?

Paramedics and health professionals will check for a DNR order, sometimes it is indicated by a wrist band / or even a lanyard worn underneath clothing with the DNRO actually mounted within a plastic wallet. It's meant to be easily obtained information, not a frisk search of every individual in case one is in place.

A Kurdziel  
#15 Posted : 16 February 2018 14:58:27(UTC)
Rank: Super forum user
A Kurdziel

The situation in a nursing home is very different to that in another workplace or where a member of the public is in trouble.  In a nursing home the employer has a specific duty of care to the residents and as part of the duty of care they are expect to have access to their medical records; something like a DNR will be noted. A general employer will only have the most basic medical information about their employees and a first aider will not be expected to be privy to this.

You state the patient must carry be carrying the original DNR: not a realistic prospect and if you do find on their person how do you ascertain that it applies to them- remember in many first aid situations you are helping a complete stranger. The DNR may belong to somebody, else be a draft etc. How do you ascertain a person’s identity quickly? Having talked about relying on needing to see the original DNR (signed and sealed by the GP- how do you know it’s their bone fide GP?)  You then mention wrist bands and bracelets. Is there a standard DNR band that first aiders are trained recognise indicating people have a DNR order? Meanwhile while they are going through this palaver we are losing time when we could be saving a life- golden minutes and all that.

Defibrillators are placed in easy to access locations so that they can be used by someone with minimal or even no training. Would you stop them from having a go?

thanks 1 user thanked A Kurdziel for this useful post.
AFletcher on 16/02/2018(UTC)
Roundtuit  
#16 Posted : 16 February 2018 14:59:44(UTC)
Rank: Super forum user
Roundtuit

Nursing/convalescence home, respite, hospice, hospital call it what you want the residents/patients are not at work and there will be a care protocol in place for the individual (including DNR when applicable) so yes it does matter where the casualty arises.

This post has been discussing whether First Aiders at Work be informed about, and should act upon DNR - twice now you have concluded the involvement of medically qualified professions

thanks 2 users thanked Roundtuit for this useful post.
A Kurdziel on 16/02/2018(UTC), AFletcher on 16/02/2018(UTC)
LeanneD  
#17 Posted : 16 February 2018 15:02:16(UTC)
Rank: Forum user
LeanneD

Originally Posted by: AFletcher Go to Quoted Post

If a GP has issued a DNR order for an individual that wish must be respected and the order adhered to when the original document (not a copy) is carried on that person (i.e. it cannot be in their locker / car etc.)

A DNR order is reviewed periodically by their GP (the review period timescale is also decided by the GP).

This information is confidential, but an individual's wishes (although may not be condoned by the majority of people) does need to be respected and the information relayed to the First Aiders along with a confidentialilty agreement.

There is however a very large grey area, in that a person may collapse from respiratory failure (their heart is beating but they cannot maintain breathing). Providing "rescue breaths" is not CPR per se, it is simply helping to maintain oxygenated blood in the sytem. However during respiratory failure their heartbeat may be weak and/or sporadic, but there is a pulse. Therefore it would be quite feasible that a First Aider assesses the casualty; assumes they are in cardiac arrest and due to the DNR order does not provide treatment when rescue breaths may actually prevent the death of the person.

In my opinion unless a defibrillator (or ECG used by medical professionals) can be properly secured to the patient's chest and there is no heart output detected could you have justifiable grounds to uphold the DNR order, otherwise relatives could feasibly argue that you did not categorically know the person was in respiratory arrest or cardiac arrest when treatment was withheld.

Can i ask where this information is from.  Is it from specific guidance for first aiders?  In my opinion first aiders are in no position to determine if someone is in cardiac arrest or not and simply treat the symptoms they are presented with undil medical professionals take over.

I dont think that this is an issue of wether or not individuals wishes are condoned, it is about the responsibility of diagnosing and interpreting a DNR situation which i believe is far beyond the remit of a first aider.

thanks 4 users thanked LeanneD for this useful post.
A Kurdziel on 16/02/2018(UTC), jodieclark1510 on 16/02/2018(UTC), AFletcher on 16/02/2018(UTC), Charlie Brown on 16/02/2018(UTC)
AFletcher  
#18 Posted : 16 February 2018 15:45:57(UTC)
Rank: New forum user
AFletcher

Originally Posted by: Roundtuit Go to Quoted Post

Nursing/convalescence home, respite, hospice, hospital call it what you want the residents/patients are not at work and there will be a care protocol in place for the individual (including DNR when applicable) so yes it does matter where the casualty arises.

This post has been discussing whether First Aiders at Work be informed about, and should act upon DNR - twice now you have concluded the involvement of medically qualified professions

Good points there. I stand corrected, they are most definitely not employees and will have specified (and detailed) medical records.

AFletcher  
#19 Posted : 16 February 2018 15:53:34(UTC)
Rank: New forum user
AFletcher

Originally Posted by: LeanneD Go to Quoted Post
Originally Posted by: AFletcher Go to Quoted Post

If a GP has issued a DNR order for an individual that wish must be respected and the order adhered to when the original document (not a copy) is carried on that person (i.e. it cannot be in their locker / car etc.)

A DNR order is reviewed periodically by their GP (the review period timescale is also decided by the GP).

This information is confidential, but an individual's wishes (although may not be condoned by the majority of people) does need to be respected and the information relayed to the First Aiders along with a confidentialilty agreement.

There is however a very large grey area, in that a person may collapse from respiratory failure (their heart is beating but they cannot maintain breathing). Providing "rescue breaths" is not CPR per se, it is simply helping to maintain oxygenated blood in the sytem. However during respiratory failure their heartbeat may be weak and/or sporadic, but there is a pulse. Therefore it would be quite feasible that a First Aider assesses the casualty; assumes they are in cardiac arrest and due to the DNR order does not provide treatment when rescue breaths may actually prevent the death of the person.

In my opinion unless a defibrillator (or ECG used by medical professionals) can be properly secured to the patient's chest and there is no heart output detected could you have justifiable grounds to uphold the DNR order, otherwise relatives could feasibly argue that you did not categorically know the person was in respiratory arrest or cardiac arrest when treatment was withheld.

Can i ask where this information is from.  Is it from specific guidance for first aiders?  In my opinion first aiders are in no position to determine if someone is in cardiac arrest or not and simply treat the symptoms they are presented with undil medical professionals take over.

I dont think that this is an issue of wether or not individuals wishes are condoned, it is about the responsibility of diagnosing and interpreting a DNR situation which i believe is far beyond the remit of a first aider.

The information has come from a medical source in regards to the respect of a patients wishes, however, as stated, First Aiders are not "medical professionals" so is probably a nul point.

If First Aiders work on a patient and then paramedics decide not to continue due to a DNR, I assume (perhaps wrongly?) that the onus entirely falls upon the professional medicals as the First Aider(s) have done all they can in terms of preservation of life.

Charlie Brown  
#20 Posted : 16 February 2018 17:27:50(UTC)
Rank: Forum user
Charlie Brown

I still would rescusitate and the paramedics can decide what they want to after. If I am ever in the position I am not going to bother looking in anyones pocket for a start and I am not having something like that screwing with my nut, it is screwed enough already.

Originally Posted by: AFletcher Go to Quoted Post

If a GP has issued a DNR order for an individual that wish must be respected and the order adhered to when the original document (not a copy) is carried on that person (i.e. it cannot be in their locker / car etc.)

A DNR order is reviewed periodically by their GP (the review period timescale is also decided by the GP).

This information is confidential, but an individual's wishes (although may not be condoned by the majority of people) does need to be respected and the information relayed to the First Aiders along with a confidentialilty agreement.

There is however a very large grey area, in that a person may collapse from respiratory failure (their heart is beating but they cannot maintain breathing). Providing "rescue breaths" is not CPR per se, it is simply helping to maintain oxygenated blood in the sytem. However during respiratory failure their heartbeat may be weak and/or sporadic, but there is a pulse. Therefore it would be quite feasible that a First Aider assesses the casualty; assumes they are in cardiac arrest and due to the DNR order does not provide treatment when rescue breaths may actually prevent the death of the person.

In my opinion unless a defibrillator (or ECG used by medical professionals) can be properly secured to the patient's chest and there is no heart output detected could you have justifiable grounds to uphold the DNR order, otherwise relatives could feasibly argue that you did not categorically know the person was in respiratory arrest or cardiac arrest when treatment was withheld.

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