All certified/licensed medical providers (EMT/Paramedic) of iCare Ambulance operate under the Denver Metro EMS Protocols and under the supervision of our Medical Director. Providers MUST always operate within their respective scope of practice as defined in the protocols.

The current version of the Denver Metro EMS Protocols is available on all ambulance smartphones or online at https://www.dmemsmd.org/protocols

Medical Director: Jeff Beckman, MD

For complex issues, contact Dr. Beckman at 303-905-1601

For routine medical direction, contact:

Swedish Medical Center

303-761-8721

Advanced Directives/DNR/MOST/POA

Advanced Directive:

A legal document (as a living will) signed by a competent person to provide guidance for medical and health-care decisions (as the termination of life support or organ donation) in the event the person becomes incompetent to make such decisions.

Do Not Resuscitate (DNR):

A legal order written either in the hospital or on a legal form to respect the wishes of a patient not to undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing.

Medical Orders for Scope of Treatment (MOST):

A MOST form is a doctor’s order that helps a person keep control over medical care at the end of life. Like a Colorado CPR Directive, the form tells emergency medical personnel and other health care providers whether or not to administer CPR in the event of a medical emergency. A MOST form may be used in addition to, or instead of, a CPR Directive.

Durable Power of Attorney (POA):

A legal document that allows an individual to appoint someone else (proxy) to make medical or health care decisions, in the event the individual becomes unable to make and/or communicate such decisions personally.

ACLS guidelines are very clear; their intent is to prolong life, not delay death.  For any patient who is at the very end of his or her life, with a known end-stage illness (brain cancer, for example), it may not make sense to initiate a resuscitation.  A medical history that suggests that a resuscitation attempt will be futile is just as important as other factors when deciding whether an attempt is warranted, such as down time.

Many people believe that communicating their wishes to a family member is sufficient to avoid an out-of-hospital resuscitation attempt.  Carefully consider what the family has to tell you about the wishes of their elderly family member, even if there is nothing in writing.

IF THERE IS EVER ANY QUESTION, CALL MEDICAL CONTROL!

Considerations:

A Colorado CPR directive that has been taken out by a patient, and co-signed by a physician, may only be revoked by the patient.  To be clear, a family member may not revoke it, a medical durable power of attorney may not revoke it.  (Unless, it is the medical durable power of attorney who took out the CPR directive in the first place.)  Interestingly, many EMS providers will not listen to family who are asking that a family member not be worked, however, are quick to allow family to illegally override a CPR directive.

Any copy of the CPR directive is just as valid as the original.  Patients may also be wearing a bracelet that signals their wishes.

There are a variety of ways that the patient may signal to you, the EMS provider, about what they want done if they are in cardiac arrest.  However, a majority of EMS providers are unfamiliar with some newer advance directives, including the MOST form, the Allow Natural Death request, and 5-wishes.  All forms are legally recognized in Colorado, as well as non-standard formats for the patient communicating his or her wishes