Liverpool Care Pathway – A DNR Directive For Paramedics And First Aiders

Paramedics will be told of a patient's end-of-life wishes, under Department of Health plans to extend the use of electronic medical records.

First Aiders train to become First Aiders to make a difference. With first aid knowledge you can be the difference between life and death.

The most life-threatening condition a first aider may be called to deal with is a casualty that is not breathing.

If a person does not respond to the sound of your voice or to gentle pressure applied to their body, it is likely they are unconscious.

You should then check for a response. Gently shake their shoulders.

Check breathing. If they are not breathing commence cardiopulmonary resuscitation ( CPR). Cardiopulmonary resuscitation (CPR) is a technique whereby oxygen is pumped around the body using a combination of chest compressions and rescue breaths.

WAIT! Check first to see if there is a living will directive to DNR!

The Mail Online reports:

Do Not Resuscitate: Paramedics to get access to patients' end-of-life wishes

 CLAIRE BATES writes -

Paramedics will be told of a patient's end-of-life wishes, under Department of Health plans to extend the use of electronic medical records.

It comes a year after a ministerial review into Summary Care Records, which are being drawn up for every patient in England unless they have 'opted out' using a special form.

The computer database has been set up to give GPs, hospital doctors and paramedics immediate information about patients, such as allergies and medications they are taking.

However, now patients with serious illnesses are being encouraged to add extra information about their conditions in consultation with a GP to make it easier for doctors and nurses to treat them in an emergency.

This could include whether they want to be resuscitated and if they wish to die at home.

The scheme is backed by a number of charities as well as Health Minister Simon Burns, who said: 'Some seriously ill patients have added information about their end of life wishes to their record, helping to ensure that their wishes, typically to die at home, are respected.

'This is because information about their wishes can be shared with everyone including, most critically, out-of-hours doctors and paramedics, involved in their care.

He added that some patients had added 'do not resuscitate' requests to their records, which had saved them and their loved ones 'needless distress.'

'This is hugely encouraging, offering the prospect of making sure that many more patients' wishes for a dignified death at home are honoured,' he told the Daily Telegraph.

WHO CAN ACCESS MY SUMMARY CARE RECORD?

According to the NHS, people who can see your records...

Need to be involved with your care

Need to have an NHS Smartcard with a chip and passcode 

Should only look at the information they need to do their job

Should have their details recorded – who they are and if they have added or changed information

However, they admit there is always a small risk when information is held on computers, that confidentiality could be breached.

Patients can only opt-out of the system if they fill in a form when informed their record is being drawn up. You can ask to have it deleted later on but this may not always be possible.

Jim Petter, Director of Professional Standards at the College of Paramedics, told Mail Online that any improvements to the current situation would be welcome.

'At the moment very ill patients can have a Do Not Resuscitate order,' he said.

'But these can vary from a handwritten note to a legal document from a solicitor. 

'Paramedics are often entering a very intense situation and have to balance trying to verify the document with the need to start treatment quickly if the evidence doesn’t stack up. 

'This decision often needs to be made in minutes and you can often have upset relatives with their own opinions too.

'At the moment in the absence of firm written evidence that the patient does not wish to be resuscitated we would go ahead and treat them.

'Anything that could standardise and verify a person’s end-of-life wishes is laudable.'

However he was wary about how such a complex national system could be implemented.

'The processes and systems would need to be very well-defined,' he said.

'We would need to see evidence in the record of a patient's discussion with their GP about their decision not to be resuscitated - preferably on a headed document and with the GP’s contact details.

'It's not clear how paramedics would get access to the Summary Care Records as we cannot see them on the ambulance computer at the moment.

‘I would also want to know who would be responsible for keeping the record accurate and up to date?

'At the moment I feel a print out kept with the patient would be the safest option. I can imagine a situation where there are two patients with the same name at a nursing home. Mistakes can be made.’

Meanwhile a number of charities have backed the move to allow patients to add extra information to their records. One example is that patients with asthma would no longer need to repeat their medical history while struggling to breathe.

Neil Churchill, Chief Executive Officer of Asthma UK, said: 'Summary care records are a vital step forward in delivering safe and effective patient care.'

A spokesman for the Muscular Dystrophy Campaign said they knew about incidences where a patient's health had suffered because doctors were unfamiliar with the rare condition. One patient who had entered hospital able to walk was left wheelchair-bound because of inappropriate care.

Nic Bungay, Director of Campaigns for the charity, said: 'We see the great potential for Summary Care Records to support staff across the NHS in dealing with rare conditions.

'We encourage patients to take ownership over the records.'

To make Advance Directives available to all medical operatives including paramedics - who would only be involved in an emergency call situation in any case - is both precarious and hazardous such that it borders on folly. If there is injury which will result in certain brain incapacity… should the paramedic then determine to proceed with a DNR directive? Is the extent of any resultant brain incapacity determinable in the situation? Delay will certainly compound any risk but will the paramedic, in the knowledge of the DNR directive on file, still risk resuscitation knowing that prosecution may result if this is disobeyed?

The right to life and the desire to preserve life has been overtaken by the right to death and the desire to promote death as a desirable alternative option.