Some time in the next six months, Ohioans may be able to purchase state-approved bracelets and necklaces declaring they prefer a natural death to the life-supporting machines of modern medicine.

The state Health Department is calling the program “DNR (Do Not Resuscitate) Comfort Care and has begun the process of adopting a statewide protocol that tells health-care professionals - especially those in emergency medicine - what to do if someone doesn’t want to be revived by artificial means.

“Basically, these things will let people know that you’ve decided you don’t want to go out of this world with somebody pounding on your chest,” said Dr. David Romano, an emergency-room physician in Beaver Creek.

Romano has served on a 25-member Ohio Health Department committee that drafted the rules - now scheduled for a public hearing April 5 in Columbus - authorizing the ID tags and cards.

“We wanted to come up with something simple that explains, ‘When my heart stops, when I quit breathing, I don’t want anything else,’ ” said Romano. “That’s so the paramedics and the doctors and nurses can recognize this person and respect their wishes.”

For example, “comfort care” patients might get painkilling medication and oxygen from a mask while they die.

But they would not receive an artitlcial breathing tube, nor could they be hooked up to a respirator.

Or, if a patient chose “comfort care arrest,” he or she would get full medical care until the heart and lungs stopped. Then, no effort would be made to bring the patient back to life.

According to the protocol, cardiac arrest means “absence of a palpable pulse.” Respiratory arrest is defined as “absence of spontaneous respirations or presence of agonal [death pangs] breathing.”

The do-not-resuscitate jewelry is being designed to resemble a soldier’s dog tag or hospital wrist-band: It is intended to be easy to find and offer paramedics and doctors simple instructions about a patient’s end-of-life choice.

Also being prepared are state-issued wallet identification cards that show the bearer does not want any type of technological life support.

Pete Van Runkle, a lawyer with the Ohio Health Care Association, a trade group for nursing homes, said the intent of the rules is to eliminate confusion.

“There was nothing in the law that spoke to how a person could specifically refuse CPR,” said Van Runkle, who was part of the Health Department committee. “Only time will tell if this actually works.”

State lawmakers ordered the Health Department to draft the rules last year because then often was no quick and precise way to sort out whether people had signed living wills spelling out their wishes, or where the will was located.

“What happens now is you can have split families,” explained Romano, the emergency room physician. “You’ve got three family memben who tell you, ‘Don’t do anything.’ And two will say, ‘Do something.’ You’ve got a family argument going on in the living room or the emergency room.

There may be a living will somewhere, nobody knows where,” Romano said. “You’d be surprised how
many times that happens.”

Scott Highley, assistant fire chief in Worthington and a member of the state Emergency Services Board, said it has been standard practice for rescue personnel in Ohio to resuscitate people even if there was a living will on file somewhere. The Emergency Services Board governs the rules and training of emergency medical technicians.

“It has been a big problem area because of the confusion,” Highley said. “The EMTs would go out and do their work because they hadn’t been notified the patient didn’t want it. The routine has been: Sorry folks, we can’t honor those [wishes] because we could not be sure. Consequently, there was a lot of grief for the families.”

Highley said the state Health Depamnent needs to ensure the ID necklaces, bracelets and wallet cards “are somethmg that is readily visible. If they’re not, I’m sure resuscitation efforts would start. They really will have to provide some way of notifying the EMTs.”

Randy Hertzer, a spokesman for the state Health Department, said: “The whole purpose is to set up a system that is uniform, that is recognizable, that is consistent across Ohio.”

Several states have already adopted similar protocols, Hertzer said.

Jacquie Vermillion, legal counsel for the Health Department, said the agency expects to levy a fee for the bracelets, necklaces and wallet cards, but the price has not yet been determined.

She said there has been no opposition to the “comfort care” rules, which have been posted on the Health Department’s Internet site for about two weeks.

State Rep. George Terwilleger, a Lebanon-area Republican, sponsored the law creating “comfort care” and the new ID tags. It unanimously passed both houses of the Ohio legislature last year.

Terwilleger said the law eliminates any legal liabilities for emergency crews and doctors who comply with a do-not-resuscitate request.

“At the end of a life, I’m trying to make sure it’s between the person and God,” Terwilleger said. “And I was also trying to say there shouldn’t be a bunch of lawyers in there afterwards suing and saying there was liability for doing the wrong thing.”

Under the rules up for public hearing next month, the Health Department plans to issue a statewide
do-not-resuscitate protocol by mid-May.

Once the protocol was enacted, people could go to their physicians, fill out a form and file for the ID tags and card.

Emergency medical personnel would be required to make a “reasonable effort” to verify a patient’s identity if they find an ID card or dog tag. And if they cannot confirm the patient’s identity, emergency workers “still should follow the protocol,” the rules state.

If a person is conscious, the rules say, he or she can ask for help and cancel the protocol.

Do not resuscitate:
What it means

The Ohio DNR (Do Not Resuscitate) protocol wilI specify limited emergency medical procedures for those patients who request to join the program.

What emergency workers will be allowed to do:

-Suction blocked airways
-Administer oxygen
-Position for comfort
-Splint or immobilize
-Control bleeding
-Provide pain medication
-Provide emotional support
-Contact appropriate health care providers, including hospice, home health care or the patient’s doctor.

What emergency workers will not be allowed to do:

-Administer chest compressions
-Insert artificial airways
-Administer resuscitative drugs
-Defibrillate or cardiovert
-Provide artificial respiratory assistance other than administering oxygen
-Initiate resuscitative IV
-Initiate cardiac monitoring

SOURCE: Ohio Department of Health & the Plain Dealer