That makes complete sense and is probably the law in all 50 states.

A living will is a legal document that basically creates a precedent for the removal of life support mechanisms in the event of an unlikely recovery. I wouldn't want an EMS guy making that decision on the scene. It is a medical decision to be made by a MD (usually two separate docs) after complete and final diagnosis and all the initial resuscitation has been performed.

Completely different than a DNR. IT is a document that prevents the use of advanced resuscitation methods. It has nothing to do with a terminal prognosis or medical diagnosis at all. It is a preemptive call made by the patient.

I know you know these things surgcric, it just seemed that the definitions were unclear in that last post. I wanted to make sure everyone understood. I would have a living will if going to war or even at home (I have one now), but as someone with a future I would never get a DNR. For the non-terminal, a DNR might be necessary if you have religious reasons or have no real interest in continuing to live if an accident occurs. Hope that helps explain why EMT's can't enforce one but follow the other.

Is this (living will) a fairly recent thing? I don't recall having the option.

Terry

Terry-

Just a guess, but they didn't have them back then b/c they didn't have the technology and medical capability that far forward in the combat zone. They couldn't perform the advanced care necessary to keep you alive in the first place if wounded that severely.
Interested to hear others thoughts on why?

The stone tablets were too heavy to carry.

NDD:

I got your "stone tablets", hangin!:D

Terry

(hypothetically) On a SF team, I would alter that a little. I would have discussed my DNR wishes
with the 18D and TS. One of them could make the call as to whether there was ANY real chance to save me based on the extent of my injuries and the likelyhood for quick evac. He would also be informed that if I had a very low chance of survival then to make the decision NOT to risk my teamates or himself just to to save me if the danger still exists. I would ask the same of them that I would my family.

A little different than what I would do in the civy world.

**quoting myself.. now that is arrogant:p

Actually quite to the contrary.

A few years back, maybe 4 or so, a case was taken to the State Supreme Court after an EMS crew provided ALS care to an individual involved in a MVA who had a Living Will. It was ruled without the care given by the EMS crew the PT would have died at the scene but instead is now quad.

The crew was cleared, but there was much talk about changing the Living Wills here to read just as a pre-hospital DNR does for EMS. There is a difference between a DNR and a pre-hospital DNR BTW. Also not all states have legislation that support pre-hosp DNR's. With a valid PH-DNR we can provide supportive care only (ie: O2, IV, Pain meds, NTG, ASA, etc.) This this mean no advanced airway, drug therapy other than noted, and no CPR.

If I am not mistaken it is still being debated by the state legislature. I will check on that and get back with you. There are states however that do recognize Living Wills in the pre-hospital setting.

DNR's here can only be issued for terminal illnesses (ie: terminal cancer, ESRD, and so-on.)

In 1995, an act was passed to amend Title 44 by adding Chapter 78, the Emergency Medical Services Do Not Resuscitate Act (EMS DNR Act). This act allows EMS personnel to honor written DNR orders on the adult terminally ill patient.

The living will I'm refering to is one that would take place in a hospital setting. As a single soldier (like I was at the time) would need if I took a hit and was in a coma with not much of a chance of recovery.

Basically it said I did not want to be kept in a coma for 134 years and DNR if it came to saving my life.

I do not have a living will at this moment, I do however have a personal physician that can and will make those decisions if I were to ever end up in that sort of situation.;)

Team Sergeant

Its not like that, its not the patients decision. That decision is made by the PL or leadership. If you get wounded with me, you are no longer in the CofC, you are now a door bundle that needs to be moved or left, as the circumstances warrant. Your personal wishes mean shit. Its not romantic "Go on Jimmy, save yourself!" stuff. Basically its very simple, your body is USG property. Somebody signed for your ass. And we have to bring you back or have a damn good explanation as to why not.

That's why there are triage categories and different classes of medevac.

Thank you James. I was ignorant to those issues in some states.

I stand corrected.. mental note: never travel to that backwards state of SC. LOL

TS-
How much life insurance does HH6 have you carrying nowadays? LOL You may want to write that one out.... J/K Team Sergeant

I wasn't trying to be hollywood NDD. Don't portray me to be a 15 yr old neighborhood Rambo. I am going to mil.com and dredgin up some kids to come here so you can get this frustration from lack of sleep out of your system. ;)

I reread it, it does sound that way. That was not the spirit it was written in.

Look hear!

You live in Mississippi for God's sake. That is one of the most archaic states for pre-hospital care in the union. Hell, medics have to call online med control for an order for an IV... they are still in the "Rampart! This is Squad 51" days.

We are leading the way here.

Field Crics; RSI; 12-lead EKGs; thrombolitics in the field for CVA and AMI; etc...

LOL - I know. But you said you would "discuss it with the TS and medic" - there's nothing to discuss reference the field.

If we're together and you've got a pulse, we carry you until we can't carry anymore and then we stack magazines unless we have to leave you to do the mission. Those decisions are made by the leadership. Mission, Men, Equipment. DNR as somebody said is a doctor's decision after trying everything.

Besides, I'd rather fight than run any day. Having a patient gives me an excuse to quit running. :D

I agree with NDD completely. While I would not hesitate to leave a body, I would not leave someone with a pulse. This isn’t Hollywood, we’re not actors. The bullets and blood are real so are the tough decisions.

While it’s not a smart to engage a Special Forces A-Team, it’s dumber to corner one.

Team Sergeant

Quote of the Year! Bravo! Author! Author!

Besides all this, I never met a patient with a pulse I couldn't save. Yes, Virginia, I'm that good.

I have one simple goal when medicking - turn my patient over to the surgeons in better shape than he was when I originally found him.

I can imagine the conversation - "Redleg 26, bring it in danger close, NOW!"

"Well, he did sign a living will"

"Watch the left flank, no the left...DAMN Bravos!"

"To hell with the living will, watch this! Who's O Neg? Give the clacker to Bao/Hadji/Juan and get over here now!"

"CAS in 5!"

"JESUS Doc, what are you doing to him?"

LOL

Truth is, I probably wouldn't even know who the patient was, mcuh less remember who wanted what. Probably a defense mechanism, but I tend to block identities and treat the wound, not the person, in the field.

I've had people come up later "Hi, remember me?"
"I've never met you, go away."
"But, I named my kid after you!"
"I don't know you."
"Shrapnel wound left forearm, Honduras, '88."
"Oh yeah, how'd that work out for you?"

I'm much nicer in a clinical setting.

LOL