1. Will a ‘Do not resuscitate’ medal’ be recognised by rescuers?
Wiebe de Vries PhD, educational consultant Heartsafe Living
Sander van Goor RN, ambulance nurse at GGD Haaglanden EMS The Hague The Netherlands
Frank de Pooter RN, ambulance nurse at White Cross EMS The Netherlands
Purpose of the study
In The Netherlands every citizen is allowed to refuse lifesaving help if they feel that this would harm
their quality of life. This wish should be written and undoubtable be the wish of the victim.
1
The Dutch Resuscitation Council recommends lay rescuers not to start CPR if a ‘Do not resuscitate’
(DNR) declaration is available with the victim and the rescuer is sure it belongs to the victim. But they
should not lose any time in searching for it. If the lay rescuer finds a DNR-declaration while unbarring
the chest, he is allowed to stop CPR. However, this might be of great psychological benefit and
therefore the lay rescuer is not responsible if he decides to continue.
2,3
CPR is an automated skill in a well-trained provider. Therefore it might be that a lay rescuer provides
CPR without noticing any specific information. This study was undertaken to compare the recognition
of a DNR medal by (trained) lay rescuers to EMS providers.
Materials and methods
Participants were trained lay rescuers and EMS providers. The lay rescuers followed a CPR/AED
provider course in accordance with the ERC guidelines and recommendations. They were taken from
their daily work situation without any warning before. They were invited to provide help to a victim who
collapsed. No additional information was given.
The EMS providers were dispatched to the test location. Dispatch centre told them that life support
had to been given to the patient.
Two certified BLS/ALS instructors assessed each situation, using a validated form. For all items, time
from entering was taken. A face impression or spoken words, indicating that the medal was observed,
was taken as start of recognition.
Results
Forty lay rescuers and 39 EMS providers were included. Table Z shows the mean time per item.

2. From the lay rescuers 32/40 (80,0%) notified the DNR medal. Of those providers 5 (12,5%) decided to
continue CPR as they declared that it was to healthcare professionals to decide to stop or not.
From the EMS providers 29/39 (74,4%) notified the DNR medal. Of those providers 9 (23,1%) decided
to continue CPR, despite of the fact that national protocol required them to stop CPR and additional
life support.
Conclusions
Lay rescuers seems to be well informed about the non-resuscitation medal. However, EMS
professionals, who have a duty to respect the declaration do not all recognizes the medal, and if they
do, 23,1 % still decides to continue help.
1. Minister of Health, Welfare and Sport (VWS), Letter concerning one uniform non-resuscitation
medal of 11 November 2014 (2014Z14120). The Hague, Ministry of Health, Welfare and Sport
(VWS) 2014.
2. Zijlstra JA, Beesems SG, De Haan RJ, Koster RW. Psychological impact on dispatched local lay
rescuers performing bystander. Resuscitation. 2015 May 6;92:115-121.
3. Van Drenth J, Henny W, Koster RW, De Vries W. Guidelines for Resuscitation 2010 in The
Netherlands and Belgium; Basic Life Support to Adults. Uden/Leuven Dutch Resuscitation
Council/Belgian Resuscitation Council 2011.
Figure 1 The DNR-medal used during the test.