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Comfort Care DNR protocol

When a patient is in a non-hospital setting, Emergency Medical Technicians (EMTs) are required to provide emergency medical care and to transport patients to appropriate health care facilities. Emergency Medical Services (EMS) personnel are required by law to provide treatment to the fullest extent possible, subject to their level of training.
Comfort Care DNR Order Verification Protocol (Comfort and Care DNR)
  1. The Comfort Care DNR is designed to allow EMTs and first responders to honor a DNR order in an out-of-hospital setting.
  2. Before 1999, when Massachusetts implemented its Comfort Care DNR protocol, there was no mechanism to enable EMT’s and other first responders to recognize DNR orders in a non-hospital setting. So EMT personnel were always obligated to perform full resuscitation measures when they encountered a patient unable to convey directions regarding medical treatment.
  3. The Comfort Care DNR protocol provides for a statewide, uniform DNR verification protocol.
  4. The purpose of the Comfort Care DNR is to: (a) provide a verification of DNR orders to enable EMTs and first responders to honor DNR orders, (b) clarify the role and responsibilities of EMTs and first responders at the scene and/or during transport of patients who have a valid current DNR order, (c) avoid resuscitation of patients who have a current and valid DNR, (d) provide for palliative/comfort care measures for patients with a current Comfort Care DNR order verification form.
  5. Comfort Care DNR order verification forms must be completed and signed by the patient’s physician, authorized Physician’s Assistant or Nurse Practitioner.
  6. The patient must post the Comfort Care DNR where any EMT or first responder can easily find it. (Usually the patient’s refrigerator, or taped to the patients bedroom door. The Department of Public Health stopped issuing Comfort Care DNR bracelets in 2007, but the Department’s approved form contains bracelet inserts that can be used in generic wrist bracelets.
  7. The Comfort Care DNR Order Verification form can be accessed by anyone, in downloadable format from the Massachusetts Department of Public Health/Office of Emergency Medical Services website, at: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/oems/comfort-care/public-health-oems-comfort-care-verification.html. But the form must be fully completed and signed by the attending physician, authorized nurse practitioner or authorized physician assistant as proscribed by the regulations.

Comfort Care Order (CCO-DNR) program Plus MOLST

EMS Comfort Care Order Do Not Resuscitate Program | doh

Comfort Care - Do Not Resuscitate
Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate
(CCO-DNR) program allows patients diagnosed with a specific medical or
terminal condition to express their wishes regarding end of life
resuscitation in the pre or post-hospital setting.

The program requires that a patient’s attending physician certify and sign a Comfort Care Order
(CCO) that states the patient (adult or child) has a specific medical
or terminal condition. The patient, or his or her authorized decision
maker or surrogate, must also consent and sign the CCO (verbal orders
are not valid). The physician then places a Comfort Care bracelet on the

Resources | Novant Health | Choices and Champions

Resources | Novant Health | Choices and Champions
Novant Health is a integrated system of physician practices, hospitals, outpatient centers, and more – each element committed to delivering a remarkable healthcare experience for you and your family. Code Comfort is for patients with a DNR order who desire comfort measures. Use of the order set will promote comfort for patients at risk for symptom crisis nearing end of life. Code Comfort Order Set Code Comfort Policy (draft)