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Pandora
02-15-2004, 15:43
Is there such a thing as having a DNR (Do Not Resuscitate) order in your personnel records in the Forces as you might have on your medical files in the civilian world?

Topic close to home, and it occurred to me just now that as Special Forces members you may not have that choice as an option, even in the case of long term illnesses that may be debilitating or incurable, as long as you are still on the Government payroll.

Team Sergeant
02-15-2004, 16:34
I did when I went off to Desert Storm. I filled out a living will just for that reason.

The Team Sergeant

Pandora
02-15-2004, 16:39
Relieved that you guys get the choice.


Thanks for the response.

Team Sergeant
02-15-2004, 16:44
I didn’t want my family having to make those decisions had something happened to me.
It’s a good feeling knowing I’ve relived them of that burden. Hope that helped.

TS

NousDefionsDoc
02-15-2004, 17:07
We wouldn't do it anyway, it causes delays in dividing up the gear.

Pandora
02-15-2004, 20:25
The pragmatist in me is saying, "Good point."

The rest of me is headed straight to hell and laughing. (No disrespect meant, just an appreciation for Dark Humor).

Great contrast you've raised, NDD. "Dividing up the gear," in the SF world makes sense and is such a necessary reality check that is so far removed from petty battles over Aunt Mabel's roll-top desk.

I'll pre-qualify my next question by stating I am pro-euthanasia in many medical circumstances. With that on the table, do you think the Hippocratic Oath should be adhered to 100% faithfully in the field?

NousDefionsDoc
02-15-2004, 20:45
Which part?:D

Pandora
02-15-2004, 22:25
You're a med-head, you dissect it. :D

Pandora
02-15-2004, 22:37
Subjective selections:


Classic:
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.




Contemporary:
I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.




I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.


I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.




If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

NousDefionsDoc
02-15-2004, 22:43
I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and the warmth, sympathy and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say 'I know not,' nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with the care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, or a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability.

My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body, as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

NousDefionsDoc
02-15-2004, 22:45
yeah, although I didn't take it, I'm ok with it.

Being an SF medic, this is my favorite part:
But it may also be within my power to take a life

Pandora
02-15-2004, 23:02
Mine, as well.

I am also partial to:

I will remember that I do not treat a fever chart, or a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability.

Guy
02-16-2004, 08:20
Originally posted by NousDefionsDoc
But it may also be within my power to take a life

LOLs...that reminds me of something I said:

"I'm a SHOOTER first! I'll come get you however, it does neither one of us any good...If I run out there and get hit also".

NousDefionsDoc
02-16-2004, 10:52
Originally posted by Guy
LOLs...that reminds me of something I said:

"I'm a SHOOTER first! I'll come get you however, it does neither one of us any good...If I run out there and get hit also".

Exactly

Surgicalcric
02-16-2004, 11:00
Originally posted by Team Sergeant
I did when I went off to Desert Storm. I filled out a living will just for that reason.

The Team Sergeant

Do you have one now Team Sergeant?

Also for anyone else interested in them, in the civilian world, you need to check with your state Dept of Health or whomever regulates EMS. Some states do not recognize Living Wills as a valid order for EMS. DNR's are though, but are only authorized here in SC for persons with a terminal illness.

Just some FYI.

Sacamuelas
02-16-2004, 11:14
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.

CPTAUSRET
02-16-2004, 11:14
Originally posted by Team Sergeant
I did when I went off to Desert Storm. I filled out a living will just for that reason.

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

Terry

Sacamuelas
02-16-2004, 11:22
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?

NousDefionsDoc
02-16-2004, 11:24
Originally posted by Sacamuelas
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.

CPTAUSRET
02-16-2004, 11:37
Originally posted by NousDefionsDoc
The stone tablets were too heavy to carry.

NDD:

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

Terry

Sacamuelas
02-16-2004, 11:38
Originally posted by Sacamuelas
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.

(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

Surgicalcric
02-16-2004, 11:44
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.

Team Sergeant
02-16-2004, 11:44
Originally posted by Surgicalcric
Do you have one now Team Sergeant?

Also for anyone else interested in them, in the civilian world, you need to check with your state Dept of Health or whomever regulates EMS. Some states do not recognize Living Wills as a valid order for EMS. DNR's are though, but are only authorized here in SC for persons with a terminal illness.

Just some FYI.

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

NousDefionsDoc
02-16-2004, 11:47
Originally posted by Sacamuelas
(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

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.

Sacamuelas
02-16-2004, 11:50
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

Sacamuelas
02-16-2004, 11:57
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.

Surgicalcric
02-16-2004, 12:03
Originally posted by Sacamuelas
...I stand corrected.. mental note: never travel to that backwards state of SC. LOL



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...

NousDefionsDoc
02-16-2004, 12:06
Originally posted by Sacamuelas
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.

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

Team Sergeant
02-16-2004, 12:49
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

NousDefionsDoc
02-16-2004, 13:05
Originally posted by Team Sergeant

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

Sacamuelas
02-16-2004, 13:11
Originally posted by NousDefionsDoc
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

UHHH... who is being Hollywood in this thread? LOL ;)

NousDefionsDoc
02-16-2004, 13:15
Where's Holleywood?:D

NousDefionsDoc
02-16-2004, 13:17
Are you picking on me today?

Sacamuelas
02-16-2004, 13:19
Decided to edit to maintain professionalism. Will send my humor via PM.

Doc T
02-16-2004, 19:43
in my profession living wills are a blessing. Not all living wills deal with "if you have no chance of survival"...lots deal with scenerios instead and are much more "user friendly" for hte physician because it is rare that we know you have NO chance of survival.

multiple scenerios like
~if you were quadraplegic
~if you were in a vegetative state
~if you would not be able to live independently

and talk about
~withdrawal of ventilator assistance
~withdrawal of all nutrition and IV assistance
~withdrawal of all support

its an awful thing to discuss with a 50 year olds family what they think they're loved one would want us to do never the less a 18 year old's...

I abide by living wills...lots of physician's do not and will do what they think is best regardless of the patient's wishes once they are unable to consent or refuse...its the nature of trying to do everything you can. Just be sure to talk to your spouse, next in line to make decisions because a living will or DNR will mean nothing if your proxy says... no...he signed that but had changed his mind since he wrote it....then we are forced to do what the proxy tells us the patient would have wanted.

and fyi...DNR means just that ...do not resuscitate...meaning NO CPR in case of arrest...at least for most hospitals that is what it means... it does not imply withdrawal of support or failure to treat at all.

doc t.