By Merri Rudd, appeared May 19, 2005, Albuquerque Journal, Business Outlook
Reprinted with permission

• Editor's note: This column may not be quoted or reproduced in whole or part without express written permission of the author.
  
  Q: Thank you for your column about health care directives in the Albuquerque Journal. We have completed the advance health-care directive forms. We also would like information on where to obtain the "do not resuscitate" form. J.G., Albuquerque
  
  I assume you mean Emergency Medical Service Do Not Resuscitate (EMS-DNR) Orders? EMS personnel are EMTs or paramedics who come in the ambulance when you call 911.
  
  Prior to 1994, when you called 911 and the ambulance arrived, EMS personnel would resuscitate you. Even if the person you had appointed as your health care agent was present and displayed your health care power of attorney, resuscitation was the rule.
  
  In 1994, the Department of Health first issued EMS-DNR regulations that allowed a person to decline EMS treatment. If you have signed the appropriate forms, EMS personnel should honor your wish not to be resuscitated. To state your wishes, you can do one of two things.
  First, you and your doctor can sign an EMS-DNR Order, which directs EMS personnel not to resuscitate you under certain medical conditions. If you are unable to consent to such an order, your health care decision-maker and doctor can sign one for you if that is what you would have wanted.
  
  You have the option of wearing a bracelet that indicates you have an EMS DNR Order. You may revoke the EMS-DNR Order at any time.
  
  Second, you can sign a health care power of attorney (POA) that designates an agent to make health care decisions for you and states that you wish to be DNR. The agent needs to know how you feel about resuscitation.
  
  The regulations state, "EMS personnel shall follow EMS DNR Orders or durable powers of attorney when encountering persons in pre-hospital settings." Pre-hospital settings are places such as a home, ambulance, or long-term care facility.
  
  EMS personnel must first verify your identity and the existence of a current Order or POA. If EMS personnel cannot find the EMS-DNR Order or POA, they will resuscitate you. Make sure the Order or POA is evident--at your bedside, on the refrigerator door, or other visible location. Tell your family and friends you have the documents and tell them where to find the original documents. The regulations do not say whether EMS personnel can accept photocopies of the documents.
  
  Although the EMS-DNR regulations allow EMS personnel to honor either an EMS-DNR Order or a durable power of attorney, the reality is that EMS personnel are trained to recognize the EMS-DNR Order. If you have strong feelings about EMS-DNR, make sure you create an EMS-DNR Order, as well as a power of attorney for health care. If you have both documents, the EMS regulations state that the EMS-DNR Order prevails for EMS treatment only.
  
  If you want to be resuscitated in emergency situations, instruct your health care decision-maker about your wishes and do not ask your doctor for an EMS DNR Order.
  
  For in-hospital situations, a DNR Order can be created by informing your doctor, who should indicate your DNR wishes in your medical chart.
  
  The EMS Bureau provides one free EMS DNR Order per person. Send a note requesting the EMS DNR Order to: EMS Bureau, New Mexico Department of Health, 2500 Cerrillos Road, Santa Fe, New Mexico 87505. Groups can obtain multiple copies for a small fee. A packet of 10 forms costs $5.00; 50 forms cost $20.00; and 100 forms cost $30.00.
  
  
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