36-3251

36-3251. Prehospital medical care directives;
form; effect; definition

A. Notwithstanding any law or a health care directive to the contrary, a person may
execute a prehospital medical care directive that, in the event of cardiac or respiratory
arrest, directs the withholding of cardiopulmonary resuscitation by emergency medical
system and hospital emergency department personnel. For the purposes of this article,
"cardiopulmonary resuscitation" includes cardiac compression, endotracheal intubation and
other advanced airway management, artificial ventilation, defibrillation, administration
of advanced cardiac life support drugs and related emergency medical procedures.
Authorization for the withholding of cardiopulmonary resuscitation does not include the
withholding of other medical interventions, such as intravenous fluids, oxygen or other
therapies deemed necessary to provide comfort care or to alleviate pain.

B. A prehospital medical care directive shall be printed on an orange background
and may be used in either letter or wallet size. The directive shall be in the following
form:

Prehospital Medical Care Directive

(side one)

In the event of cardiac or respiratory arrest, I refuse any
resuscitation measures including cardiac compression, endotracheal intubation
and other advanced airway management, artificial ventilation, defibrillation,
administration of advanced cardiac life support drugs and related emergency
medical procedures.

Patient: __________________________ date: ______________

(Signature or mark)

Attach recent photograph here or provide all of the following
information below:

Date of birth ______ sex ____

Eye color ________ hair color ______ race ______

Hospice program (if any) ________________________________

Name and telephone number of patient's physician ________

_________________________________________________________

(side two)

I have explained this form and its consequences to the signer and
obtained assurance that the signer understands that death may result from any
refused care listed above.

________________________________ date __________

(Licensed health care provider)

I was present when this was signed (or marked). The patient then
appeared to be of sound mind and free from duress.

________________________________ date ___________

(Witness)

C. A person who has a valid prehospital medical care directive pursuant to this
section may wear an identifying bracelet on either the wrist or the ankle. The bracelet
shall be substantially similar to identification bracelets worn in hospitals. The
bracelet shall be on an orange background and state the following in bold type:

Do Not Resuscitate

Patient: _________________________________________

Patient's physician: _____________________________

D. If the person has designated an agent to make health care decisions under
section 36-3221 or has been appointed a guardian for health care decisions pursuant to
title 14, that agent or guardian shall sign if the person is no longer competent to do
so.

E. A prehospital medical care directive is effective until it is revoked or
superseded by a new document.

F. Emergency medical system and hospital emergency department personnel who make a
good faith effort to identify the patient and who rely on an apparently genuine directive
or a photocopy of a directive on orange paper are immune from liability to the same
extent and under the same conditions as prescribed in section 36-3205. If a person has
any doubt as to the validity of a directive or the medical situation, that person shall
proceed with resuscitative efforts as otherwise required by law. Emergency medical system
personnel are not required to accept or interpret medical care directives that do not
meet the requirements of this section.

G. In the absence of a physician, a person without vital signs who is not
resuscitated pursuant to a prehospital medical care directive may be pronounced dead by
any peace officer of this state, a professional nurse licensed pursuant to title 32,
chapter 15 or an emergency medical technician certified pursuant to this title.

H. This section does not apply to situations involving mass casualties or to
medical emergencies involving children and disabled adults in public or private schools
that are not licensed health care institutions as defined in section 36-401.

I. After being notified of a death by emergency medical system personnel, the
person's physician or the county medical examiner is then responsible for signing the
death certificate.

J. The office of emergency medical services in the department of health services
shall print prehospital medical care directive forms and make them available to the
public. The department may charge a fee that covers the department's costs to prepare the
form. The department and its employees are immune from civil liability for issuing
prehospital medical care directive forms that meet the requirements of this section. A
person may use a form that is not prepared by the department of health services if that
form meets the requirements of this section. If an organization distributes a prehospital
medical care directive form that meets the requirements of this section, that
organization and its employees are also immune from civil liability.

K. Any prehospital medical care directive prepared before April 24, 1994 is valid
if it was valid at the time it was prepared.

L. For the purposes of this section, "emergency medical system personnel" includes
emergency medical technicians at all levels who are certified by the department of health
services and medical personnel who are licensed by this state and who are operating
outside of an acute care hospital under the direction of an emergency medical system
agency recognized by the department of health services.