CPR on the Man With the Bracelet: Out-of-Hospital DNR Ambiguity
CPR on the Man With the Bracelet: Out-of-Hospital DNR Ambiguity - Medical Ethics clinical simulation case. A 74-year-old male pulled from a restaurant...
Age: 74 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 74-year-old male pulled from a restaurant choking on a piece of steak, now pulseless and apneic in the ED resuscitation bay. He wears a stainless steel medical ID bracelet engraved 'DNR — Patient W. Erikson'. No surrogate is present. No paper POLST form accompanies him. The EMS run sheet documents that paramedics initiated full resuscitation because authority of the bracelet could not be verified at the scene.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
When authority over an out-of-hospital DNR directive is ambiguous, the legal default is to RESUSCITATE — but a brief pause to read an engraved bracelet, contact EMS medical direction, and call a potential surrogate is mandatory and non-negotiable.
Documentary hierarchy for DNR: (1) alert patient with capacity, (2) valid POLST/MOLST form, (3) Healthcare Proxy document, (4) wearable identifiers (corroborative only), (5) verbal family statement (insufficient alone).
The four elements of decision-making capacity — understanding, appreciation, reasoning, and communication of a choice — must be assessed at the bedside, not assumed absent because of clinical instability.
A MOLST/POLST form is a binding physician order, not merely evidence of intent — once verified, it is honored without delay.
Default-to-resuscitation in cases of true ambiguity protects both the patient's potential wish to live and the clinician from liability for premature withdrawal.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.