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Something that we have to take into consideration with resuscitation is advanced decision or DNRs, do not resuscitate orders. These orders tend to be placed on patients who are terminally ill, things like cancers and stuff that cannot be cured, where the patient has reached the end of their actual medical treatment, and have made a decision themselves, in consultation with a doctor, with their family and nursing staff that when their time comes, they do not want to be put through the rigours of being resuscitated.

The DNR form itself is normally a red form that is signed by the GP, the nursing staff and the person themselves whilst they are compos mentis; in other words, while they can make that decision, a piece of paper in place, so whenever their time comes, we know their actions and we know what they want us to do. They must always be taken into consideration.

The DNR or advanced decisions must be in front of the clinician at the time of cardiac arrest or death, so we must be able to have it easy at hand and the patient's family must be able to present it to you before you start resuscitation. If they cannot present it, do not have it at hand, or there is any confusion, you have a duty to look after that patient, they are your duty of care so you must start the resuscitation as you would with anybody until presented with the DNR, because some people may not have it, it may not be completed, it may not actually be the family's wish. So, please be careful, DNRs are there for a reason, they are there to keep you and the patient safe, but it has to be presented to you. So if somebody just tells you there is a DNR in place, then, unfortunately, you got to ask them to go and fetch it so that you can see it and read it. If in doubt, carry out the resuscitation.

The DNRs are a very, very effective and proper way for somebody who has had a terminal illness to end their life. Do not panic over it, but if in doubt, carry out resuscitation. And finally, remember DNRs, if they are not present or you are not sure about your actions or if you are in the street and something happens, remember that it is very, very unlikely you are going to get into any trouble at all from resuscitating or attempting to resuscitate somebody, so do not hold back. Until further assistance arrives, or your paramedic, or you can actually get the emergency services on the phone to confirm that you should stop, it is always better to err on the side of caution and start the resuscitation until somebody with more qualifications, with more experience, and with more knowledge than yourself to actually take over from you. Nobody will hold you to account for trying.