Table 2 EMS provider interpretation of POLST for treatment interventions and transportation
Case and POLST | Paramedic Interpretation and Treatments Selected | |||
|---|---|---|---|---|
Case # 1: A 95-year-old female with dementia lives with her family is more confused than her baseline. She has foul smelling diapers and a chronic pressure sacral ulcer. Vital Signs P, 105; RR 12; SaO2, 97%; T, 39 C; BP, 90/50 POLST Selection: DNR/DNAR, Selective Treatment Correct minimum: IV normal saline AND transport to the hospital | Comfort Focused | Selective Treatment | Full Treatment | |
# of Respondents: | 0 | 117 (99%) | 1 (1%) | |
Advanced Airway | 1 (1%) | 0 | ||
Bag Valve Mask | 43 (36%) | 1 (1%) | ||
NIPPV | 36 (31%) | 1 (1%) | ||
Supplemental oxygen | 76 (64%) | 1 (1%) | ||
IV normal saline | 112 (95%) | 0 | ||
IV Fentanyl | 49 (42%) | 1 (1%) | ||
Naloxone | 23 (19%) | 1 (1%) | ||
Contact Base Physician | 27 (23%) | 1 (1%) | ||
Transport the patient to the hospital | 112 (95%) | 1 (1%) | ||
Non-transport, Assess & Refer | 1 (1%) | 0 | ||
Non-transport, Refusal of Service | 3 (3) | 0 | ||
Non-transport, AMA | 5 (4%) | 0 | ||
Case #2: A 43-year-old female with metastatic ovarian cancer on hospice feels very short of breath because of fluid that has accumulated in her lungs. Vital Signs P, 115; RR, 30; SaO2, 86% 2L home oxygen; T, 37 C; BP, 130/70. She states that she wants help with her symptoms, but does not want to go to the hospital POLST Selection: DNR/DNAR, Comfort Focused Treatment Correct minimum: Non-transport | Comfort Focused | Selective Treatment | Full Treatment | |
# of Respondents: | 113 (96%) | 2 (2%) | 3 (3%) | |
Advanced Airway | 1 (1%) | 0 | 0 | |
Bag Valve Mask | 14 (12%) | 0 | 0 | |
NIPPV | 29 (25%) | 1 (1%) | 1 (1%) | |
Supplemental oxygen | 101 (86%) | 1 (1%) | 3 (3%) | |
IV normal saline | 22 (19%) | 1 | 0 | |
IV Fentanyl | 39 (33%) | 0 | 0 | |
Naloxone | 7 (6%) | 0 | 0 | |
Contact Base Physician | 73 (62%) | 1 (1%) | 1 (1%) | |
Transport the patient to the hospital | 12 (10%) | 1 (1%) | 0 | |
Non-transport, Assess & Refer | 22 (19%) | 0 | 0 | |
Non-transport, Refusal of Service | 19 (16%) | 0 | 0 | |
Non-transport, AMA | 68 (58%) | 1 (1%) | 2 (2%) | |
Case #3: A 87-year-old male with advanced dementia, on apixaban for atrial fibrillation hits his head at his nursing facility and now has a scalp hematoma. He is awake and talking and to staff at his mental status baseline. Vital Signs P, 75; RR, 12; SaO2, 99%; T, 37 C; BP, 115/75 POLST Selection: DNR/DNAR, Full Treatment Correct minimum: Transport to the hospital | Comfort Focused | Selective Treatment | Full Treatment | |
# of Respondents: | 0 | 0 | 118 (100%) | |
Advanced Airway | 25 (21%) | |||
Bag Valve Mask | 26 (22%) | |||
NIPPV | 25 (21%) | |||
Supplemental oxygen | 35 (30%) | |||
IV normal saline | 49 (42%) | |||
IV Fentanyl | 33 (28%) | |||
Naloxone | 23 (19%) | |||
Contact Base Physician | 30 (25%) | |||
Transport the patient to the hospital | 115 (97%) | |||
Non-transport, Assess & Refer | 3 (3%) | |||
Non-transport, Refusal of Service | 3 (3%) | |||
Non-transport, AMA | 5 (4%) | |||
Case #4: A 72-year-old woman with advanced COPD feels short of breath and has increased work of breathing. Vital Signs P 125; RR, 32; SaO2, 79% on 4L; T, 37C; BP, 138/75. Her husband and health care surrogate states that she does not want continuous positive airway pressure (CPAP) but does want to go to the hospital POLST Selection: DNR/DNAR, Selective Treatment—Request transport to hospital only if comfort needs cannot be met in current location Correct minimum: Supplemental oxygen, Transport to the hospital | Comfort Focused | Selective Treatment | Full Treatment | |
# of Respondents: | 1 (1%) | 117 (99%) | 0 | |
Advanced Airway | 0 | 0 (0%) | ||
Bag Valve Mask | 0 | 39 (33%) | ||
NIPPV | 0 | 9 (8%) | ||
Supplemental oxygen | 1 (1%) | 106 (90%) | ||
IV normal saline | 0 | 49 (42%) | ||
IV Fentanyl | 0 | 21 (18%) | ||
Naloxone | 0 | 11 (9%) | ||
Contact Base Physician | 0 | 30 (25%) | ||
Transport the patient to the hospital | 1 (1%) | 101 (86%) | ||
Non-transport, Assess & Refer | 0 | 3 (3%) | ||
Non-transport, Refusal of Service | 0 | 2 (2%) | ||
Non-transport, AMA | 0 | 7 (6%) | ||
Scenario 5: A 101-year-old man fell at home and was unable to get up independently or with the help of his wife, so she called 911 for assistance. Vital Signs P 85; RR 14; SaO2 96% RA; T 37C; BP 110/75. He has no physical complaints and does not want to go to the hospital POLST Selection: DNR/DNAR, Selective Treatment—Request transport to hospital only if comfort needs cannot be met in current location Correct minimum: Non-transport | Comfort Focused | Selective Treatment | Full Treatment | |
# of Respondents: | 1 (1%) | 115 (97%) | 2 (2%) | |
Advanced Airway | 0 | 0 | 0 | |
Bag Valve Mask | 0 | 11 (9%) | 1 (1%) | |
NIPPV | 0 | 7 (6%) | 0 | |
Supplemental oxygen | 0 | 15 (13%) | 1 | |
IV normal saline | 0 | 15 (13%) | 1 | |
IV Fentanyl | 0 | 13 (11%) | 0 | |
Naloxone | 0 | 8 (7%) | 0 | |
Contact Base Physician | 0 | 29 (25%) | 0 | |
Transport the patient to the hospital | 0 | 13 (11%) | 1 (1%) | |
Non-transport, Assess & Refer | 1 (1%) | 30 (25%) | 0 | |
Non-transport, Refusal of Service | 0 | 51 (43%) | 1 (1%) | |
Non-transport, AMA | 0 | 51 (43%) | 1 (1%) | |
Scenario 6: A 43-year-old male with pancreatic cancer on hospice feels very short of breath because of fluid that has accumulated in his lungs. Vital Signs P, 115; RR, 30; SaO2, 86% 2L home oxygen; T, 37 C; BP, 130/70. He states that he wants help with his symptoms, but does not want to go to the hospital POLST Selection: DNR/DNAR, Comfort focused Correct minimum: Non-transport | Comfort Focused | Selective Treatment | Full Treatment | |
# of Respondents: | 115 (97%) | 2 (2%) | 1 (1%) | |
Advanced Airway | 0 | 0 | 0 | |
Bag Valve Mask | 10 (8%) | 0 | 0 | |
NIPPV | 27 (23%) | 2 | 0 | |
Supplemental oxygen | 93 (79%) | 1 | 1 | |
IV normal saline | 15 (13%) | 0 | 0 | |
IV Fentanyl | 24 (20%) | 1 (1%) | 0 | |
Naloxone | 4 (3%) | 0 | 0 | |
Contact Base Physician | 68 (58%) | 1 | 0 | |
Transport the patient to the hospital | 8 (7%) | 1 (1%) | 1 (1%) | |
Non-transport, Assess & Refer | 19 (16%) | 0 | 0 | |
Non-transport, Refusal of Service | 16 (14%) | 0 | 1 (1%) | |
Non-transport, AMA | 68 (58%) | 1 (1%) | 1 (1%) | |