Debbi Lamb looks into the dark world of dying almost every day, and sees the gray areas and knows the uncommon decisions that have to be made in a moment of crisis.
A paramedic with the Baltimore County Fire Department, Ms. Lamb has been visiting retirement and nursing homes to talk with their staffs about a new law permitting paramedics to make a life-and-death decision about a patient, provided proper documentation is available.
The law, which took effect July 1, provides a mechanism for patients who do not want medical intervention in an emergency to make their wishes known to paramedics by having signed a "Do Not Resuscitate" form. A DNR bracelet also is available.
"We're thankful to the Baltimore County Fire Department for taking the lead in this," said Dr. Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Services Systems. "The county has been unique among all the political jurisdictions in educating the staffs."
MIEMSS has been swamped with requests for the forms and bracelets, said coordinator George Smith, who also has been in the field talking to medical staffs. "The demand has exceeded our expectations," said Mr. Smith, who recently briefed the city health department. "We've also sent out mailings to everyone who might be involved."
The DNR forms and bracelets may be obtained by calling (410) 706-4367.
Ms. Lamb said the medical staffs with whom she has met have been receptive to the new law. "It's a bit complex, and they're anxious to learn about it," she said.
"We often arrive on a scene when a victim is really beyond hope, but we're obligated to try to revive a person unless we see the form or bracelet," Ms. Lamb said. "This often results in added pain for the victim and relatives."
Many elderly people have a living will, which designates a relative to make the life-and-death decision. But paramedics will recognize only the form or the bracelet because the new law shields them against lawsuits as long as they "act in good faith."
Ms. Lamb, a Fire Department paramedic for eight years, usually is stationed with Medic 5 in Halethorpe. Her more than 500 hours of training and experience have given her a keen eye for what is possible with resuscitation.
"We asked for this state law because we usually don't have time to find the patient's wishes on paper and read through them," she said. "This simplifies our decision. If the bracelet or form is there, and we determine there is no hope, we don't resuscitate."
She doesn't suggest that anyone necessarily wear the bracelet or post the form. The retirement home can keep the form in its files, and the bracelet can go in a location known to the medical staff.
"But it's not just for the elderly," Ms. Lamb said. "Anyone who is terminally ill might not want resuscitation and would want that known in a moment of crisis. Some young people with chronic illnesses wear them."
If there is any doubt about a patient's wishes, paramedics will attempt to revive the patient. Otherwise, they will try to keep the victim comfortable with oxygen and get him or her to a hospital, but there would be no invasive procedures.
"We would not do CPR, or administer an IV, or give cardiac monitoring," she said.
A patient in distress can override the instructions not to resuscitate at any time.
"If the person or a close relative asks us to resuscitate, we'll do our best regardless," Ms. Lamb said.
Some senior citizens said they are not eager to sign the forms.
Dr. Seymour Goldgraber, who lives at North Oaks Retirement Community near Pikesville and is a healthy 82, said his participation would depend on his condition.