These Conversations Aren't Black and White: DNR, Advanced Directives, and the Intersection with EMS

Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers

These challenging scenarios represent opportunities to provide truly patient-centered care at life's most vulnerable moments. By combining your medical expertise with thoughtful communication, you can help ensure patients' wishes are honored while supporting families through difficult transitions. In this episode we dive into the complex ethical and legal dilemmas faced by EMS providers when arriving on scenes involving Do Not Resuscitate (DNR) and goals of care forms. With special guest Dr. Daniel Markwalter, an emergency physician and hospice/palliative care expert, the discussion touches on understanding the importance of these forms, the challenges of making decisions without clear directives, and strategies for effective communication with family members when they suddenly disagree with the form. This episode provides valuable insights and practical advice for EMS professionals who can be faced with these sometimes challenging scenarios. 00:00 Introduction: The Ethical Dilemma in EMS 00:49 Sponsor Message: The Recess Tailor 01:53 Case Study: Evening Shift Dilemma 03:33 Expert Insights: Dr. Daniel Mark Walter 04:40 Understanding Hospice and DNR 09:48 Advanced Directives and Code Status 19:20 Challenges with Comfort Care and Advanced Directives 26:19 Aligning Medical Knowledge with Patient Goals 28:34 Understanding Goals of Care 29:03 Respecting Autonomy in Medical Decisions 30:02 Effective Communication with Families 31:45 Navigating Family Overrides in Critical Moments 32:36 Legal Aspects of Surrogate Decision Making 36:00 Exploring Illness Understanding and Prognosis 45:46 Symptom Management in Palliative Care 49:43 Final Thoughts and Summary
Resources

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Gear We Like

• Good Stethoscope - https://amzn.to/3YJJrf2
• Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn
• Notepad for taking notes on calls - https://amzn.to/3Z1X21J
• Sunglasses - https://frontline-optics.com/discount/EMSCAST15
• Books we recommend -
  • The Dichotomy of Leadership - https://amzn.to/4fiCAjN
  • Extreme Ownership - https://amzn.to/3O1FWfa
  • Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf
  • Thinking Fast and Slow - https://amzn.to/4fiJG85
  • A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back - https://amzn.to/3YJJrf2

Guest/Cast/Crew information-
Guest- Daniel Markwalter, MD
Host- Ross Orpet, Will Berry
Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com