EMS providers have a duty to act when called. To alleviate possible confusion regarding patient wishes pertaining to resuscitation, Maine Emergency Medical Services currently endorses two Do Not Resuscitate (DNR) forms that will be easily recognized by responders.

One may choose between two different forms available, depending upon whether the patient has the capacity to make an informed decision. It is recommended that either be used in conjunction with Medic-Alert® type jewelry.

The Maine EMS Comfort Care/DNR Directive form is available for use by anyone over 18 years of age who is capable of making an informed decision. By completing the form, the person named on the form is directing EMS crews to not attempt resuscitation if the person’s heart or breathing stops. The Comfort Care/DNR Directive form must be signed by a licensed physician, who attests that the person has the mental capacity to make an informed decision concerning Do Not Resuscitate. A physician is under no obligation to sign the Comfort Care/DNR Directive form, but may do so if requested by the person whose name appears on the form.

The Maine EMS Comfort Care/DNR Order form is used when the person—whose name appears on the form—does not have the capacity to make an informed decision (e.g., guardianship, surrogate). When completed and signed by the patient’s physician and guardian/surrogate, the form documents a physician order to withhold resuscitation.

Use of either of these forms does not preclude delivery of all medical care. The patient will receive all care necessary, for health and comfort, stopping short of resuscitation. Both of these forms are available online for download in Adobe Acrobat format, as linked below, for use by your medical professionals and family. Please take the time to review options with your medical care professionals.

Note: These forms are not Delta Ambulance specific. They have been generated by the State of Maine, Maine Department of Public Safety – Emergency Medical Services (link), for Statewide EMS use.

PDF Downloads:

Do Not Resuscitate Comfort Care Directive
Do Not Resuscitate Comfort Care Order
Do Not Resuscitate Frequently Asked Questions