You’ve probably heard of an Advance Directive (also known as a “Medical Directive” or “Directive to Physicians”) or a DNR (Do-Not-Resuscitate Order), which allow you to decide in advance what, if any, life-sustaining measures you prefer if you become incapacitated or are faced with a life-threatening illness or condition. But there is another document, called an Out-of-Hospital DNR, that gives you similar control over how much medical treatment you receive if you find yourself outside the immediate care of a physician.
What is an Out-of-Hospital DNR?
An Out-of-Hospital DNR (OOH DNR) is a legal form authorized by the Texas Administrative Code that instructs emergency medical professionals not to start or continue the following life-saving procedures if you are unconscious and unable to make decisions on your own:
- Cardiopulmonary resuscitation (CPR: chest compressions and airway)
- Advanced airway management (clearing the airway, usually with a breathing tube)
- Artificial ventilation (machine or procedure to restore breathing)
- Defibrillation (electrical shock to the heart with a defibrillator machine)
- Transcutaneous cardiac pacing (electrical impulses to the heart using electrodes attached to the skin)
Importantly, however, EMS is allowed to provide treatment and pain medicine to make you more comfortable.
As its name suggests, the Out-of-Hospital DNR only applies if you are not in a hospital or in the presence of a treating physician, so it basically applies wherever you are – at home, at the grocery store, etc. – and specifically in the following places:
- Long-term care facilities
- In-patient hospice facilities
- Private homes
- Hospital outpatient or emergency departments
- Doctors’ offices
- Vehicles during transport
Is an Out-of-Hospital DNR Necessary if I Already Have a Medical Directive?
A Medical Directive tells your doctor to withhold or withdraw certain life-saving treatments if your doctor certifies that your condition is terminal or irreversible. However, if you want a DNR to provide instructions to EMS when your doctor is not available, you should execute a DNR order.
You can revoke your Out-of-Hospital DNR at any time by destroying it. You can also tell EMS at the scene that you’ve changed your mind or tell your doctor that you want to revoke it. It is not in effect if you are pregnant. If you revoke your Out-of-Hospital DNR, you should inform your doctor and ask that it be noted in your medical record.
How Do I Get My Out-of-Hospital DNR?
Thankfully, the OOH DNR is available in Texas for free. English and Spanish versions of the form, along with instructions on how to complete it, are available online at: https://www.hhs.texas.gov/regulations/forms/advance-directives/out-hospital-do-not-resuscitate-ooh-dnr-order.
You shouldn’t need an attorney to help you complete the form, but we are happy to advise you if you have any questions.
Obtaining an Out-of-Hospital DNR for a Loved One
If your loved one is incapacitated and unable to give consent to the execution of an OOH DNR, one can be issued for them by:
- Their legal guardian
- Their agent under a Medical Power of Attorney
- Their doctor, if they have a Medical Directive
- The following relatives, in order of priority:
- Their spouse
- Their adult children
- Their parents, or
- Their nearest living relative
If none of the above are available, your loved one’s doctor can issue an Out-of-Hospital DNR with the consent of another doctor who is not involved in their treatment and/or is a member of a hospital’s medical ethics committee.
Where Should I Keep My Out-of-Hospital DNR After it is Signed?
Remember, to be useful in an emergency, your original Out-of-Hospital DNR must be readily available to emergency medical professionals, so it should be kept where EMS technicians or loved ones can find it easily. For individuals who live with conditions or illnesses that make the DNR’s necessity more likely, identification bracelets or necklaces can be used to prove the existence of the DNR. But in Texas, a plastic bracelet must display the words “Texas” and “Do Not Resuscitate” (or the shape of the State of Texas and the word “STOP” over the shape) – or, if metal, the bracelet or necklace must display the words “Texas Do Not Resuscitate–OOH.” The following organizations can be of assistance with these DNR accessories.
Texas Medical Association
ATTN: DNR
401 W. 15th Street
Austin, TX 78701
Telephone order line: 512-370-1306
MedicAlert Foundation, Inc.
2323 Colorado Ave.
Turlock, CA 95382
888-755-1448
American Medical Identifications, Inc.
949 Wakefield, Suite 100
Houston, TX 77018
800-363-5985
