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EMS

Value of MOLST

Key Points

S – Signs and Symptoms

A – Allergies

M – Medication(s)

P – Pertinent past medical history

L – Last oral intake

E – Events leading up to contacting 911

D – Do you have advance directives (i.e. a health care proxy and/or living will) or medical orders (i.e. non-hospital DNR or MOLST)?

Education

MOLST EMS training is specifically designed to provide an overview of the MOLST Program and MOLST Comprehension for First Responders and EMS Personnel.

With the upcoming changes in NYS Public Health Law effective May 28, 2018, MOLST EMS training is being revised by members of the MOLST Statewide Implementation Team in partnership with Cypherworx and the University of Rochester Division of Prehospital Medicine.

Please check back for updated training opportunities

NYSDOH Bureau of EMS (BEMS) Policy Statement and Briefings

The NYSDOH Bureau of EMS issues periodic policy statements and memos about cardiopulmonary resuscitation and life-sustaining treatment. The most recent is pertinent for current practice.

Policy Statement

Briefings

MOLST Implementation

Resources

EMS Frequently Asked Questions

Expand all questions (useful for CTRL+F Search)

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What should I do if I am uncertain how to proceed?

Contact Medical Control.

What do I do if the patient has both a nonhospital DNR order and a MOLST form? Which do I honor?

If the forms have different orders, you should follow the form that has the most recently dated authorization. In all instances you should follow the DNI instructions on the MOLST form if the form is signed by a physician, as the nonhospital DNR order does not provide this advice.

What if the old MOLST form was signed prior to June 1, 2010, the date the Family Health Care Decisions Act became effective?

You may honor the previous versions of the form as if it were authorized after the statutory effective date.

Does the new MOLST law allow EMS to honor other advance directives?

The law does not expand the ability of EMS personnel to honor advance directives such as a Health Care Proxy or Living Will. MOLST is not an advance directive – it is a medical order.

What procedures are, and are not, performed if the patient presents a DNR?

Do not resuscitate (DNR) means, for the patient in cardiac or respiratory arrest (i.e., when the patient has no pulse and/or is not breathing), NO chest compressions, ventilation, defibrillation, endotracheal intubation, or medications.

If the patient is NOT in cardiac or respiratory arrest, full treatment for all injuries, pain, difficult or insufficient breathing, hemorrhage and/or other medical conditions must be provided, unless Section E of the MOLST form provides different instructions. Relief of choking caused by a foreign body is usually appropriate, although if breathing has stopped, ventilation should not be assisted.

CPR must be initiated if no Out of Hospital or facility DNR is presented. If a DNR order is presented after CPR has been started, stop CPR.

What documentation is required for a patient with a DNR order?

Prehospital care providers should attach a copy of the Out of Hospital DNR form, MOLST form, hospital DNR order and/or copy of the patient’s chart to the patient care report, along with all other usual documentation. It should be noted on the patient care report that a written DNR order was present including the name of the physician, date signed and other appropriate information.

If the cardiac/respiratory arrest occurred during transport, the DNR form should accompany the patient so that it may be incorporated into the medical record at the receiving facility.

Patients who are identified as dead at the scene need not be transported by ambulance; however, local EMS agencies should consider transportation for DNR patients who collapse in public locations. In these cases it may be necessary to transport the individual to a hospital without resuscitative measures in order to move the body to a location that provides privacy. Local policies need to be coordinated with the Medical Examiner/Coroner and law enforcement.

 

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