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A "qualified patient" means a person who is at least 18 years old and who either has a terminal condition or has a medical condition such that, were the person to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful in restoring cardiac or respiratory function, the person would experience repeated cardiac or pulmonary failure within a short period before death occurs, or resuscitation would cause significant physical pain or harm that would outweigh the possibility the resuscitation would successfully restore cardiac or respiratory function for an indefinite period of time. Resuscitation means cardiopulmonary resuscitation or any component of cardiopulmonary resuscitation, including cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of cardiac resuscitation medications and related procedures. Resuscitation does not include the Heimlich maneuver or similar procedure used to expel an obstruction from the throat.
As defined in Wis. Stat. s. 154.17 (2) (exit DHS), a do-not-resuscitate order directs emergency medical technicians, first responders and emergency health care facilities personnel not to attempt cardiopulmonary resuscitation on the person for whom the order is issued if that person suffers cardiac or respiratory arrest. The purpose of a do-not-resuscitate order is to ensure that medical care provided in the emergency department and out-of-hospital settings is consistent with the patient's desire and the attending physician's authorization.
There are two types of Do Not Resuscitate (DNR) bracelets available to identify a person with a valid DNR order. One is a plastic ID bracelet which looks like a hospital identification band and is free. The other is a metal bracelet which is available from MedicAlert© for a fee. Both have been used in Wisconsin since 1995 and require a completed Do Not Resuscitate form DPH F-44763 (PDF, 154 KB) to be completed by the physician.
The plastic Do Not Resuscitate Bracelet is free of charge and should be obtained directly from the physician. With the hospital type bracelet the physician signs an official insert containing the preprinted logo of the State of Wisconsin. The insert must include the physicians name, business telephone number and signature. Please note that the Department of Health Services does not supply the plastic bracelets, and there is no selected vendor. Each facility can use any vendor the facility chooses.
Per Wisconsin Statute 154 (exit DHS), Medic Alert® is the only State of Wisconsin authorized vendor for a permanent type metal bracelet. The metal bracelet (from MedicAlert®) displays the internationally recognized symbol Staff of Aesculapius on the front and the words Wisconsin-Do-Not-Resuscitate-EMS and the qualified patients first and last names engraved on the back. There is room on the back of the bracelet to add other health concerns and Medic Alerts® 24-hour emergency phone number.
The metal DNR bracelet is purchased, for a cost, through Medic Alert® (PDF, 2 MB) and there is also an initial membership fee which is waived after the first year of membership. Any person who chooses to have a metal bracelet but is not able to afford the fees can apply for a sponsored membership and metal DNR bracelet. Please review the Medic Alert Sponsorship Program (PDF, 14 KB) for more information. For additional information on cost and fee information for a metal bracelet, please see the MedicAlert© website at http://www.medicalert.org (exit DHS).
Before the patient receives either bracelet, the attending physician must counsel the patient, the legal guardian, or the health care agent of an incapacitated patient. The counseling session should include written information about DNR procedures and documents to be placed in the patients file noting the qualifying medical condition that warrants the DNR order.
The patient, patients guardian, or health care agent who signed the Do Not Resuscitate (DNR) form can revoke the order by removing, or asking someone to remove, the DNR bracelet. The attending physician must be notified as soon as possible.
To receive a DNR bracelet, complete the Do Not Resuscitate form, DPH F-44763 (PDF, 154 KB) and take it to your primary care physician. You may then obtain the free paper insert and bracelet from your physician, or you can order a metal bracelet directly from Medic Alert (for a cost) using the Medic Alert Brochure.
If you are a healthcare facility or physician's office and want to order the printed Do Not Resuscitate Insert (F-44764) materials:
- Open the Publication Request Form F-80025A (Word, 158 KB).
- Fill in the shipping address (use street address only, no post office boxes), date, telephone number and email address.
- Request only the quantity that you will use over the next three to six months.
- Save the completed form to your computer and email it as an attachment to firstname.lastname@example.org.
- Please note that the Department of Health Services does not supply the plastic bracelets, and there is no selected vendor. Each facility can use any vendor the facility chooses.
For program information, please contact the Wisconsin Department of Health Services, Division of Public Health, Bureau of Communicable Diseases and Emergency Response by calling (608) 266-1568 or via email to email@example.com