End-of-Life Care Planning
Preparing for end-of-life care requires discussion and documentation. The EMS Agency has provided tools for this deeply personal and sometimes difficult decision.
Two forms are provided here - the Do Not Resuscitate (DNR) form and the Physician Orders for Life- Sustaining Treatment (POLST) form.
In general, the emergency medical services system is designed to provide invasive, life-prolonging treatment, rather than treatment aimed at enhancing quality of life. Some individuals do not want invasive treatment. These forms allow for your preferences to be honored as closely as possible.
For additional information: Coalition of Compassionate Care of California
Do Not Resuscitate (DNR)
Historically, EMS systems have focused on resuscitation of those individuals in sudden cardiac arrest, when the heart or breathing stops. Individuals who have decided that they do not want life-sustaining efforts taken in this situation can make their DNR wishes known.
The Prehospital Do Not Resuscitate DNR form has been developed by the California Emergency Medical Services Authority, in concert with the California Medical Association and emergency medical services (EMS) providers, for the purpose of instructing EMS personnel regarding a patient's decision to forego resuscitative measures in the event of cardiopulmonary arrest. Resuscitative measures to be withheld include chest compressions, assisted ventilation (breathing), endotracheal intubation, defibrillation and cardiotonic drugs (drugs that stimulate the heart).
The form does not affect the provision of other emergency medical care. If the person is not in cardiac or respiratory arrest, we will provide the appropriate medical treatment for any and all injuries, pain, difficult or shortness of breath, hemorrhage and/or any other medical conditions.
If you have decided that you do not want resuscitative measures performed should your heart or breathing stop -follow the instructions for completion on the form.
- Do Not Resuscitate Form (PDF)
- California EMS Authority Do Not Resuscitate - Frequently Asked Questions and Answers
Physician Orders for Life-Sustaining Treatment (POLST)
POLST is a form that states what kind of medical treatment patients want toward the end of their lives. Printed on bright pink paper, and signed by both a doctor and patient, POLST helps give seriously ill patients more control over their end-of-life care. The POLST form complements an advance directive. A POLST form allows for a DNR decision but also covers situation, allowing for comfort-focused treatment or selective treatment. This form is most frequently used in extended care facilities.
- Information for Patients & Families
- POLST Form (PDF)
- Information for Health Care Providers
- Quick Reference Guide on POLST in Nursing Homes (PDF)
- Training for EMS Providers (MS-PowerPoint)
- Do Not Resuscitate (DNR) Orders and Physicians Orders for Life Sustaining Treatment (POLST) in the Prehospital Setting - EMS Policy 20 (PDF)