This document provides information about Medical Orders for Life-Sustaining Treatment (MOLST) forms in Massachusetts. It explains that MOLST forms document patient preferences for resuscitation, ventilation, hospital transfer and other life-sustaining treatments. Unlike Comfort Care/Do Not Resuscitate forms which apply only to cardiac arrest, MOLST forms apply to all healthcare settings and can provide orders on additional medical interventions. Emergency personnel are required to follow valid MOLST forms to ensure treatment aligns with patient wishes.

2. MOLST starts with a discussion process between a
patient and their physician, resulting in the
completion of a MOLST form containing medical
orders about:
• Resuscitation
• Ventilation
• Transfer to hospital
• Plus other life‐sustaining treatments

3.  MOLST forms are for all healthcare
settings such as nursing homes and
hospitals as well as in the patient’s
home.
 CC/DNRs are for EMS/First
Responders only.
 CC/DNR forms are order verification
form only while the MOLST form is a
medical order form.

4.  A CC/DNR is an all or nothing
protocol for cardiac/respiratory
arrest only.
 EMS and First Responders either
perform full resuscitation or none at all.
 MOLST allows a patient and/or their
family to select the types of life
sustaining care that fits their wishes.

5. • Portable medical orders (stays with
patient).
• For very sick patients (not for
everybody).
• Used to refuse or request treatment.
• Can be honored by all health
professionals.

6. BUT COPIES ARE VALID
FORM
MAYBE
PINK

7.  Massachusetts Department of Public
Health and OEMS approved the use
of the MOLST form for all healthcare
settings.
 Massachusetts EMS providers are
authorized and required to follow the
medical orders on a valid MOLST form.

8.  The Massachusetts Comfort Care/Do
Not Resuscitate Verification form remains
valid.
 MOLST can be thought of as an
expansion of the CC/DNR form, because
it also includes management of other
medical needs.

9.  For cardiac or respiratory arrest,
follow the most recent (by date)
resuscitation orders from either form.
 If the patient is NOT in cardiac or
respiratory arrest follow the MOLST
form. The CC/DNR form is ONLY for
cardiac or respiratory arrest.

10.  Essentially in the same places as a
CC/DNR.
 Health Care professionals as well as
patients and their families are advised to
print the form out on bright (preferably
pink) paper. Remember, copies and faxes
are valid.

11.  Refrigerator doors are common place to
find MOLST forms as well as CC/DNR
forms and other medical information
 Ask the patient and/or family about a
CC/DNR and MOLST form OR if there
are papers about emergency medical
care.

12. Review the MOLST form:
 Section D – Patient Information
 Section E – Clinician Information
 If either section D or E is incomplete the
form is invalid, therefore treat per
protocols!

13.  If section D and E are complete
then the form is valid
 If any other section is incomplete
treat that section’s interventions
per protocols!

14.  If the patient can communicate their
wishes:
 Follow the patient’s wishes
 If the patient can not communicate
their wishes:
 Treat per protocol

15.  Physician
 Nurse Practitioner (NP)
 Physician's Assistant (PA)
 Registered Nurse (RNs) are NOT
authorized to sign a MOLST form at
this time.

16.  MOLST forms do NOT expire
UNLESS specified in the optional
block under section E.

18.  This section is for a patient in
cardiac or respiratory arrest and
one of two boxes maybe
checked:
Do Not Resuscitate
Attempt Resuscitation

19.  This section discusses ventilation
for patients presenting in
respiratory distress.

20.  There are two types of ventilation
modalities included:
 Supplemental Ventilation with BVM
and Intubation.
 Non-Invasive Ventilation (e.g. CPAP)
 There are check boxes for each
modality; Perform or don’t perform
the treatment noted.

21.  Two check boxes are in this
section:
Do Not Transfer to Hospital
Unless needed for comfort
Transfer to the Hospital

22.  Regardless of what is indicated in Section C, if
a patient receives any treatment from EMS, the
patient must be transported to the hospital per
OEMS regulation.
 This would include but is not limited to:
 Supplemental oxygen
 Pain and anti-emetic medication administration
 Simple comfort measures such as positioning are
permitted

23.  Yes, yes and yes!!!!!!!!
 A patient can change their mind
and request care previously
prohibited on the MOLST form if
they so desire.

25.  Gently explain that the form is about the
patient’s wishes.
 Inform the family that EMS and First
Responders are required to follow the
patient’s wishes as noted on the MOLST
 If the situation can not be resolved the
patient should be transported.

26.  MOLST forms do not have tracking
numbers.
 Document in your PCR:
• The patient’s name and second
identifier;
• The clinician signer’s name ;
• The MOLST instructions; i.e. sections
A, B, C
• What occurred/the treatment given.

27.  EMTs are encouraged to call Medical
Control if they have questions about
situations with MOLST or CC/DNR
instructions in the field.

28.  While these sections are not directed at
EMS providers is useful to be aware of
them.
 Section F includes additional information on
intubation, ventilation and non-invasive
ventilation.
 Section F also includes decisions regarding
dialysis, artificial nutrition and artificial
hydration as well as a general

29.  Massachusetts Statewide Treatment
Protocols; Appendix B
 OEMS advisory; MOLST & CC/DNR
dated March 6, 2013 available for
viewing on OEMS web site.
 www.molst-ma.org

30. Thank you
for your attention!
Fini