Do EMTs Really Need Your Health Care Directive? Where Should You Keep It?

Dear Mr. Miller:

This Covid-19 situation has me really worried.  What if my Husband or I are stricken with it and need an ambulance to get to the hospital?  What about our Health Care Directives?  The paramedics may need them when they arrive and the hospital will certainly need them in order to treat us.  Where should we keep them so they are readily available.  My friend said I should keep them on the kitchen table.

This is keeping my up at night; I am so worried!

Worrying Myself to the Hospital

What Documents Interest the EMTs
Who Does the Hospital Listen to without any Health Care Directive
Where to Keep the Copy of the Health Care Directive
Where to keep the Original of the Health Care Directive
DNR Orders and POLST

Dear Worried:

What Documents Interest the EMTs:  Your signature line says it all.   If you keep worrying about this you may very well make your prophecy come true.  So let’s see if we can offer you some rational and easy to use answers.  First, it is highly unlikely that an EMT (the ambulance) will ask for this document.  They are interested in a DNR order (more on that below) but the lack of either document should not affect their providing services.  Here’s an article from Eisenhower Health regarding that topic.    So you should not need the health care directive when the EMT arrives.

Who Does the Hospital Listen to without any Health Care Directive:  At the hospital, it may be a different story.  If your spouse is unable to make rational health care decisions, then the medical staff is going to need direction from someone else.   That is you.  But for them to follow your lead, they generally want a document granting you that authority.  Interestingly, I learned a few years ago that in the absence of a Health Care Directive (HCD), they have protocols in place to determine from whom they will take direction.   Spouses are typically high on the list.  But to what extent the staff will follow your instructions without the HCD is an open question and my bet is that every hospital differs on this subject.  So you do want the document.

Where to Keep the Copy of the Health Care Directive:  First, the hospital has never asked me for the ink original when checking in for elective surgery or for the various ER visits that we all make for the cut finger, etc.   But they could.  Nevertheless, having quick access to a photocopy/digital version of the signed document is important as that should suffice, at least at first.  Keeping the HCD on the kitchen table strikes me as a bit “betting against yourself”  and over the weeks, months, or years, that it sits there it is going to get lost.  My wife placed ours on top of the auxiliary refrigerator.  She forgot it was there and I found it when placing something up there.  To me, somewhat of a ridiculous place for it.   Here is an extensive article I wrote several years ago on the subject. Bottom line answer in that article was that there were a number of online ways, both for a charge and for free, to have a signed copy available at almost a moment’s notice.  And for those who are not even minimally computer savvy to be able to retrieve the document online, several other options were offered.  As to the ink original, I have seen suggestions that a notation be made on copies as to the location of the original; a good idea I think.  But where to keep the original so it is available?

Where to keep the Original of the Health Care Directive:  I used to keep all of my ink original estate planning documents (Wills, Trusts, HCD, etc.) in the bank safe deposit box.  It turned out that whenever I wanted access (7 pm at night, Sunday, etc) they were closed.  So it was not working for me and a major inconvenience to have to go down to the bank in the first place.   I came to the conclusion that I could keep the documents at home.  There was little chance that any thief would want it as it would be of no value to anyone but the family.  So an expensive safe was determined to be overkill.  A fire resistant file cabinet was the answer.  About $500 and heavy as anything.   Of course, you must remember that there are two risks with which you must deal.  First, is fire.  So you want a cabinet that is rated as fire resistant for a certain number of hours (nothing is fire proof).  One or two hours would be my choice.  And, of course, you have to remember to keep it closed.  Second, is water.  The fire department is going to use water to put out the fire and water tends to destroy paper documents.  The solution is to purchase what are essentially glorified sandwich bags (big and thick sides) into which you place the documents which you, in turn, then place in the fire resistant file cabinet.

DNR Orders and POLST:  What about DNR orders?  That is a document in which the EMTs will be interested.  It is often called a POLST or Physician’s Order for Life Sustaining Treatment.  It is a document that you and your physician craft together and that both of you sign.  It is printed on pink paper so that the EMTs can spot it easily.   Hanging it on the refrigerator with a magnet is a very useful idea.  It essentially indicates what care you are to receive (by the physician’s order) based on the condition in which the EMTs find you (no pulse and not breathing vs pulse or breathing).  It is for people who are seriously ill or frail.

Of course, you also need to make sure your Power of Attorney for Assets, Will, and Living Trust are up to date.  Currently, we are offering new clients a free initial consultation.  Give us a call at 760-436-8832 for experienced direction on all of these issues.