Medical Orders for Life Sustaining Treatment (MOLST)

[WAS967 97]

Linky to the MOLST website: www.compassionandsupport.org

To: All Regional EMS Agencies

All 911 Receiving Hospitals

Fr: Katherine O’Connor, BS, EMT-P, Regional EMS Office

Re: Medical Orders for Life Sustaining Treatment (MOLST)

Date: July 24, 2008

The Regional EMS Office has been advised by the New York State Department of Health Bureau of EMS (NYSDOH BEMS) that on July 7, 2008, the Governor signed Chapter 197 of the Laws of 2008 which allows for the use of the Medical Orders for Life Sustaining Treatment (MOLST) form through out the state. The law is effective immediately.

This new law makes permanent and statewide a program that was begun as a pilot study in Monroe and Onondaga counties 3 years ago. The MOLST form is used by seriously ill patients with advanced chronic illness to document decisions regarding end of life care, including medical orders related to prohibition or limitation of care provided by EMS.

Some key points to know about the MOLST form:

· It is distributed as a BRIGHT PINK, cardstock, multi-page form, but it can be photocopied.

· It may replace a NYS non-hospital Do Not Resuscitate (DNR) form.

· The NYS non-hospital DNR form is still valid.

· It provides orders limiting or preventing ALS care (i.e. intubation, IVs)

· It also includes information to be used in other health care settings such as the hospital (i.e. placement of feeding tubes, etc).

While the MOLST form and process is supported by the NYSDOH, it is not a DOH program. For additional information, please visit the MOLST Training Center at www.compassionandsupport.org . It is expected that an updated EMS page will developed to address the expanded training needs of EMS providers since passage of this legislation. Also, the NYSDOH BEMS is preparing a policy statement discussing this law and the use of the MOLST form that will be disseminated to all regions and agencies. Once the BEMS policy is finalized, it will be made available on the department’s website and will include a link to the MOLST site.

A sample copy of the MOLST form has been posted on the Regional EMS website, www.wremsco.org , along with a link to the MOLST website. Additional information regarding updated EMS training will be shared as it becomes available.

Any questions regarding this announcement, please contact the Regional EMS Office at 914-231-1616.

Katherine O'Connor, BS, EMT-P/CIC

Program Specialist, EMS Division

Program Coordinator, REMSCO

Westchester County Department of Emergency Services

Westchester Regional EMS Office

4 Dana Rd., Valhalla, NY 10595

T(914) 231-1685 / F(914) 813-4160

koc1@westchestergov.com

Edited July 24, 2008 by WAS967

[JetPhoto 626]

O'boy, some addition they added.

[Guest alsfirefighter]

Not for nothing..but its about damn time. I never understood for the life of me why EMS was (well I have some ideas, but to me you don't 'not' do something for a select few who can't get it) excluded (left in a grey area) in such matters for such a long amount of time. People should be able to make decisions of what they feel in their condition is a dignified way to die and what they do not want to endure in their final days.

[20y2 43]

Not for nothing..but its about damn time. I never understood for the life of me why EMS was (well I have some ideas, but to me you don't 'not' do something for a select few who can't get it) excluded (left in a grey area) in such matters for such a long amount of time. People should be able to make decisions of what they feel in their condition is a dignified way to die and what they do not want to endure in their final days.

Amen.

[NWFDMedic 58]

Not for nothing..but its about damn time. I never understood for the life of me why EMS was (well I have some ideas, but to me you don't 'not' do something for a select few who can't get it) excluded (left in a grey area) in such matters for such a long amount of time. People should be able to make decisions of what they feel in their condition is a dignified way to die and what they do not want to endure in their final days.

I can't agree more. I can just imagine if my family wasn't a little more understanding of situations and called 911 for either of my ailing paternal grandparents. My grandfather wanted to die at home; he had given up the fight after his third stroke and we were able to respect his wishes. My grandmother was in a nursing home with terminal lung cancer, had refused to sustain her own life, and had made all of her final wishes known, yet my father and I still nearly had a fistfight with the nursing home staff because apparently a patient that dies in the facility looks bad for their records.

[traumajunky 5]

Working in a system that was part of the study I found the paperwork very useful... I think it was one of the smarter things NYS has done for EMS.

[joetnymedic 43]

I remember when I first became an EMT many moons ago and DNR's were started in CT. Patients family had the paperwork and back then being somewhat green, I may not have agreed with it back then, I rode the call in and just gave the patient O2 and made them as comfortable as possible to the hospital - that was when Meriden actually had 2 hospitals West and East Campus - Now they have midstate. Anyways, they had a floor for terminal patients on I think the 7th floor. We patched in to the ER told them what we had and they told us to just take the patient up there. It was actually pretty nice and peaceful up there like a hospice floor. Family got to spend time with the patient before they expired and say their goodbyes. Now after working EMS and in an ER as well as some family issues, I'm all for a DNR. Bad thing in CT is that in CT (not sure if it's still true - Izzy correct me if I'm wrong) but even if the patient has a valid DNR, they code and the family says work them you have to work them, which pretty much defeats the whole purpose. My Father, 3 years ago was a DNR, he coded at rehab, they had a DNR, but couldn't find it right away, AMR worked him as well as East Haven Fire. They got him to the hospital who also had his DNR on file but the ER doc said sorry he's tubed and now it has to stay in for 24 hours. This was clearly against my Dads wishes. He wound up having two more massive MI's While our family was all with him and they came in and defibbed him. I finally got pissed off enough to open my mouth and say hey, enough this is not what he wanted. We took turns sitting with him and sleeping for the next 2 days. Talking to him telling him it was gonna be ok now. The doctor came in the last day at 11:15am and said they were taking him to hospice, by noon he crossed. He picked the DNR for 2 reasons. 1. In 1999 my Mom died from an intracrainal bleed caused by someone dropping the ball and not checking her coumadin levels, but thats neither here nor there. they talked she just wanted to go, so he honored her wishes. for 6 years he missed her everyday and I mean bad, he did the DNR because he didn't want to end up dependent and more so because he wanted to be with her. They pulled the tube, gave him some O2, pumped him full of morphine and he went comfortably in his sleep. Not sure about you guys, but if I know I'm going and there's any way I might be a save but screwed up for the rest of my life or a veg, let me go. One of my old partners was transporting someone to the hosiptal when someone blew a light and t-boned the rig and flipped it which wasnt exactly easy as it was a medium duty. this is a guy that was fun to be around and work with, a guy who busted his a** to make the academy and to get through it and did. The Dream came true for him. But it didn't last but days. everyone did everything they could for him to save him - that was in 1999 - to date he is now in a colorado nursing home with a severe brainstem injury, with a treach, gets turned rolled moved from the bed to a chair cant talk, plus alot of other stuff. this is a friend and I will always love the hell out of him and feel sorry for him.but I cant see or even understand how it could feel like that, a prisoner in your own body. Sorry guys something real bad like that happends, if it gets to the end of my run with this hep c and the cirrhosis, put my down. I do not want to suffer like that. So there it is the whole nut from all sides. Sorry if I went on and on babbling. but I wanted to make sure I got my point accross. Who knows maybe it's this new trial drug they have me on - lol

Joe

Joe