Why are advance directives not honored by CFRs in pre-hospital settings?

Advance directives, such as Do Not Resuscitate (DNR) orders, are important legal documents that outline a patient's wishes regarding medical treatment in critical situations. In the pre-hospital setting, certified first responders (CFRs) typically do not honor these directives because they are not considered legally binding in these environments. The primary reason is that CFRs operate under a strict protocol that emphasizes saving lives and providing immediate care, which often involves CPR and the use of a defibrillator in cases of cardiac arrest.

In many jurisdictions, pre-hospital providers must act according to the laws and regulations applicable to emergency medical services, which often prioritize patient resuscitation unless an advanced directive is appropriately verified and recognized. This can lead to confusion on the scene regarding the patient's wishes, as CFRs are trained to respond to emergencies and may not have immediate access to documentation or the authority to interpret advance directives in the moment.

In essence, the policies governing emergency care often focus on a standardized approach to resuscitation in order to provide consistent and immediate care, making it difficult to incorporate advance directives without clear enforcement guidelines that may not be present in pre-hospital scenarios.