Living Wills and pre-hospital lifesaving care

Mirarchi, F.L., Kalantzis, S., Hunter, D., McCracken, E., and Kisiel, T. (2009).
Triad II: Do living wills have an impact on pre-hospital lifesaving care?
The Journal of Emergency Medicine 36 (2), 105-115.

This is posted on behalf of Bobbie Fiore:

There is confusion regarding the interpretation of living wills and DNR especially
in the pre-hospital setting. A three part study done at Hamot Hospital, Erie, Pa
addressed this issue. The Realistic Interpretation of Advanced Directives I or
TRAID I study included EMS, doctors, and nurses who reviewed a living will and then were asked the code status. The results indicated that 89% of EMS, 79% of nurses, and 64% of doctors were incorrect in stating the code status as DNR.
.
TRIAD II used only paramedics and EMS participants. They were given clinical
information and a living will and then told the patient’s condition had changed.
They were given options for intubation, no intubation, defib, no defib or
call for medical direction. Many surveyed chose to delay their responses
feeling that the living will meant DNR.

It is being recommended that an out-of-the-hospital DNR be obtained from
a health care provider. It was also interesting to note that there have
been recommendations to consider the elimination of living wills.