Why is Wisconsin's Do Not Resuscitate Program so Successful?

The most likely reason for the success of Wisconsin's Do Not Resuscitate (DNR) program stems from specific legal and practical mechanisms designed to ensure patient autonomy and provide portability of end-of-life wishes across different care settings. 

Key factors contributing to the program's effectiveness include:

• A Standardized, Portable Order: Wisconsin law established a specific, universally recognized DNR order form and a corresponding patient identification bracelet. This system is crucial because traditional written advance directives are often not binding on emergency medical services (EMS) personnel (EMTs, paramedics, first responders) in an emergency. The bracelet provides immediate, visible notice to first responders, ensuring the patient's wishes are honored outside of a hospital or nursing home.
• Legal Protections for Providers: The system provides clear legal guidelines for emergency medical personnel, giving them the confidence to withhold CPR without fear of legal consequences if the patient is wearing the authorized identifier and has a valid order.
• Clarity and Specificity: The DNR order focuses specifically on the decision to forgo CPR, while still allowing emergency personnel to administer other non-CPR emergency care and comfort/supportive care. This clarity helps avoid confusion during high-stress situations.
• Accessibility and Continuity of Care: The system addresses the need for continuity of care as patients move between different locations (home, hospital, nursing home, during transport) where records might be unavailable. This consistency helps ensure patient decisions are respected regardless of location. 

What are some Wisconsin DNR guidelines?

Emergency Care Do Not Resuscitate Order, the key guidelines are:

Qualifying for a DNR Order

• The patient must be at least 18 years old.
• A licensed physician must determine that the patient has a qualifying medical condition, such as:
• A terminal condition.
• A condition where resuscitation would be unsuccessful in restoring function or repeated failure would occur shortly before death.
• A condition where resuscitation would cause significant physical pain or harm that outweighs the potential benefit. 

Legal Requirements

• The decision to have a DNR order must be voluntary and discussed with the patient's physician.
• The official Wisconsin Emergency Care Do Not Resuscitate Order form (F-44763) must be signed and dated by both the patient (or their legal representative, guardian, or healthcare agent) and the attending physician.
• The patient must be provided with information about resuscitation procedures and how to revoke the order.
• An original signed form, or a legible copy, is presumed to be valid. 

The DNR Bracelet

• A DNR bracelet is required for the order to be honored by emergency medical services (EMS) personnel outside of a hospital or other healthcare facility. A signed form alone is often insufficient for first responders.
• There are two approved types of bracelets:
• A free, plastic hospital-style band provided by the attending healthcare provider with the state seal and required information.
• A permanent metal bracelet available for a fee from an approved commercial vendor (currently StickyJ® Medical ID) that includes the patient's name and "Wisconsin Do-Not-Resuscitate-EMS".
• The bracelet must be intact and worn on the patient's wrist. 

Scope of Care

• EMS personnel must not perform CPR, including chest compressions, artificial ventilation, intubation, defibrillation, or related cardiac resuscitation medications.
• EMS personnel will provide comfort care and other medical treatments not related to resuscitation if needed, such as oxygen, pain relief, controlling bleeding, clearing a blocked airway (like the Heimlich maneuver), and emotional support.
• The patient's desire to be resuscitated at any time supersedes the written order or bracelet. They can revoke the order by removing the bracelet or verbally telling a healthcare provider they want resuscitation. 

To obtain the most current information, visit the Wisconsin Department of Health Website.