The Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate (CCO-DNR) program allows patients diagnosed with a specific medical or terminal condition to express their wishes regarding end of life resuscitation in the pre or post-hospital setting.
The program requires that a patient’s attending physician certify and sign a Comfort Care Order (CCO) that states the patient (adult or child) has a specific medical or terminal condition. The patient, or his or her authorized decision maker or surrogate, must also consent and sign the CCO (verbal orders are not valid). The physician then places a Comfort Care bracelet on the patient.
When EMS personnel respond to calls for either cardiac or respiratory arrest related to the condition of a Comfort Care patient, they would recognize and honor the Comfort Care bracelet by providing supportive care but not resuscitating the patient, unless the Order has been revoked.
Requesting a CCO Form
The Comfort Care Order is available to physicians and health care facilities such as long term care institutions and hospices. The Department of Health may issue EMS Comfort Care forms directly to a patient but highly recommends that the forms be obtained through a physician. It is the physician’s responsibility to discuss the EMS Comfort Care Order with the patient or the person authorized to consent on the patient’s behalf.
Requests for blank EMS Comfort Care Order forms can be submitted to the EMS Division through our online ordering process. Simply complete the online request at online request form and the EMS Division will send you the blank forms.
The EMS Comfort Care Order and the accompanying temporary plastic bracelet are provided free of charge to the individual by the Department of Health.
When a patient first receives a CCO, they are given a hospital band that identifies them as having a CCO in place. If desired a metal bracelet can be ordered through the Sticky Jewelry, Inc. There is a fee for the permanent metal bracelet that can be obtained directly from Sticky Jewelry. The Department of Health does not sell the metal bracelets.
Implementing a Comfort Care Order
A competent person, over the age of eighteen, an authorized decision maker on behalf of the incapacitated person or a surrogate on behalf of a minor, may execute an EMS Comfort Care Order. Complete the EMS Comfort Care Order with the physician signing the “Physician Certification and Order” and the bracelet inserts at the bottom of the Order. Tear the bracelet insert off the original form, fold and trim it along the dotted line to insert in the temporary vinyl patient bracelet that has been provided. The physician must then place the enclosed patient bracelet on the patient’s arm or wrist.
The EMS Comfort Care Order should be kept in a safe place and shared with family members to gain support of the patient’s end of life wishes. An intact EMS Comfort Care bracelet is the only identifier that will be recognized by EMS personnel for the purposes of withholding cardiopulmonary resuscitation or advanced life support.
An EMS Comfort Care Order may be revoked at any time by the patient’s request for resuscitation. This request must be made directly to responding emergency medical services personnel by:
- defacing or destroying the EMS Comfort Care bracelet, or
- directing another person to remove, cut, destroy, deface or discard the bracelet in the presence of the patient, the authorized decision-maker or surrogate.
There is no expiration date for District of Columbia EMS Comfort Care Orders. However, patients, their authorized decision makers, and attending physicians are encouraged to review and re-assess the continuing need, desire, and qualification for an EMS Comfort Care Order.
When EMS Arrives
The EMS crew will confirm the patient has a CCO in place. They will provide supportive care for the patient, including transport if desired. If the patient goes into cardiac arrest they will not perform resuscitation efforts. If resuscitation has been initiated prior to identifying an intact EMS Comfort Care bracelet, EMS personnel will cease resuscitation efforts upon identification of the bracelet on the patient's arm or wrist.
For More Information
For additional information, you can complete our Online Information Request Form or you can contact the CCO-DNR Program at (202) 671-4222.