Treating the person with a POLST in crisis
Purpose of POLST
To provide a mechanism to
communicate patient preferences for
end-of-life treatment across
treatment settings
Patient
Primary Care
Provider
Care facility
Emergency
Medical
Services
Hospital
Clinic/Specialist
POLST Basics

What do you look for first?
 Patient name
 MD/DO/PA or NP signature
○ Is there a T/O or V/O (verbal orders) signed by
an RN? --these are ok!
 Date signed

If the above criteria are not met, the
form is not a valid medical order
Onto the orders

Section A: Cardiopulmonary Resuscitation
 When does section A apply?
○ ONLY when the patient is NOT breathing AND
is pulseless.
Section A POLST-isms
“Until they die, it doesn’t apply”
“Once they’re dead, go ahead”
Section B: Medical Interventions

When does section B apply?
 When the patient still has a PULSE and/or is still BREATHING
Section B POLST-isms
“Heart’s got a beat? See Section B for how to treat!”
“Is the patient still breathing? Then interventions they’ll be receiving”
Section B: Comfort Measures Only
Do: any intervention that will help keep the
patient comfortable
 Do: Try to resolve care concerns that are
manageable by the providers on scene

 If the issue becomes larger, consider calling
OLMC

Consider transporting only when the
patient cannot be kept comfortable at their
primary location
 Does
not mean do not treat!
Section B: Limited Additional
Interventions
Do simple, minimally invasive
interventions
 Avoid intubation
 Do: Transport if there is a simple
medical intervention that can be
provided by the ED or hospital

Section B: Full Treatment
Treat
as per your
standard of care for that
particular condition!
Scenario 1:

EMS arrives at the home of a 78yom c/o
SOB, GCS 15. Pt’s son is on scene and
presents you with a POLST that is signed
by the physician but bears no patient
signature. PMH: COPD, HTN

Can you follow the orders?

Form states DNR, Limited Additional
Interventions
Which order is most relevant in the
patients’ current medical state?
 What treatments would you consider?

Scenario 2: POLST & the CA pt
Arrive on scene of a 52 year old woman,
thin and ill- appearing with metastatic
breast cancer. She is c/o new onset
nausea and pain in her jaw.
 What else do you need to know?
 Before seeing a POLST form what
treatments are you considering?

Scenario 2: 12-lead results
Kern, Morton MD “The Different Presentations of Acute STEMI: What Problems Should the
Cath Lab Look For?” 12/30/10; www.cathlabdigest.com
Now what?

Do you transport?
 Would your decision to transport change if
you were able to control the patient’s pain on
scene?

If you decide to transport where do you
transport to?
 What info should you relay to the receiving
hospital besides that this is a STEMI
patient?
Quiz time!

Can you follow POLST orders that are
from a different state than Oregon?
 Yes! (Question… contact OLMC)

Are copies of POLST form ok??
 Yes!
Scenario #3






72yom, general malaise who stated “I just
don’t feel right.”
What is the first thing you need to find out?
The patient is awake and c/o CP & SOB.
Monitor shows V-tach
Treatments?
You decide you’d like to cardiovert
 What do you explain to the patient?

Cardiovert asystole
 Now what?
Quiz time!

When do you consider using CPAP on
the patient with a POLST order of CMO?
 The patient has to be alert enough to
cooperate in order to try CPAP.
 Is it helping?
○ Yes—then this is a comfort measure
○ No—then take it off, and try something else
Scenario 4: I’ve fallen and I can’t get
up!
88 year old woman falls at care facility.
GCS13. BP 94/70, P 96; unstable pelvis.
 RN on scene hands you POLST form:
DNR, CMO

Does the POLST form influence your
decision to transport?
 Does it change the destination?

It’s easy!
When should I call?
 Elderly, frail patients
 Terminally ill patients
 Chronic, progressive illness patients
 If someone states there may be a POLST but cannot
provide a copy
 If you are not certain the POLST for you have is
current
What is the Oregon POLST Registry?
Secure electronic database of
POLST forms.
 Owned by the state of
Oregon, operated by the
Emergency Communication
Center at OHSU and available
statewide.
 Emergency medical
professionals treating a
patient can access POLST
orders if the original POLST
form cannot be immediately
located.

How do I access the POLST Registry?
For emergent needs
•
–
Call the POLST Registry EMS
Hotline*
State: “This is <your name & title>
from<Agency name>, with a POLST
form request”
Provide some of the following patient identifiers, as requested
by the Registry Hotline staff:
•Full name
•Date of Birth
•Gender
•Last 4 SSN
•POLST Registry ID #
•Home address/residential
care facility address
•City, County, or zip code
*this number is available for EMS, ED and acute care hospital unit use ONLY.
It is not for public distribution or dissemination
Do I need to have all those identifiers?
 NO!

If possible, start with these identifiers
 Registry ID
○ This may be present in a person’s personal effects on a
bright pink sticker (example right)
 Date of Birth
 First and last name
 Hotline
staff may request additional
identifiers to confirm the identity of a patient
What information will be provided?
•
The Registry staff can verbally relay:
• Section A and B orders
• Date the form was signed
• Patient’s POLST Registry ID
•
THE STAFF ARE NOT MEDICAL
PROVIDERS, AND CANNOT
INTERPRET POLST ORDERS
• If you need guidance, contact On-Line
Medical Control
Transporting?

Let us know! We will
fax a copy of the
POLST to your
destination hospital
What do I document?

Verbal orders relayed
 Example: DNR; Limited additional interventions
Date the form was signed
 POLST Registry ID

You can always call the business office and request a copy
of the POLST for your chart. Calls received after hours
will be faxed the next business day
The Oregon POLST Registry Office

EMS Contact Jenny Cook, Oregon POLST Registry
Liaison
 Call for any non-urgent questions, or educational
information or onsite training requests.
Phone: 503-494-1230
 Toll free: 877-367-7657
 Fax: 503-418-2161
 E-mail: polstreg@ohsu.edu
 Website: www.orpolstregistry.org
