DNR orders on NEMT rides: what drivers do and do not do

Who a DNR order speaks to

An out-of-hospital do-not-resuscitate order tells EMS crews and clinicians not to start resuscitation if the person’s heart or breathing stops. It is a medical order signed by the rider’s physician or another authorized clinician. The state laws that create these orders name who they address, and van drivers are not on those lists:

• Texas. The order speaks to “health care professionals,” defined as physicians, physician assistants, nurses, and emergency medical services personnel. It covers out-of-hospital settings, which the statute says include vehicles used for transport. It directs them not to start or continue CPR, advanced airway management, artificial ventilation, defibrillation, or transcutaneous cardiac pacing. It never authorizes withholding comfort care, pain relief, water, or nutrition.
• Florida. The Department of Health says its DNRO is a limited direction only to paramedics and EMTs certified in Florida.
• Virginia. The Durable DNR statute authorizes qualified EMS personnel and licensed practitioners in state-licensed facilities and programs, or in registered continuing care retirement communities, to follow the order.
• Pennsylvania. The out-of-hospital DNR law requires EMS providers to comply.

So the driver’s job is not to carry out the order. It is to get EMS to the rider quickly and make sure the crew sees the paperwork. Liability protection follows the same lines. Texas, for example, shields a health care professional, facility, or entity that withholds CPR in good faith under the statute.

Pennsylvania adds a twist worth knowing. Its Department of Health counts someone using an automated external defibrillator under the state’s Good Samaritan AED protection as an EMS provider for these orders. A Pennsylvania driver who reaches for an AED is expected to respect an order, bracelet, or necklace displayed with the rider.

DNR, POLST, and advance directives are different papers

Drivers may be handed several kinds of end-of-life paperwork, and each does something different:

National POLST describes POLST as an active medical order that travels with the person and begins with a conversation with their care team. Florida’s Department of Health draws the line between its DNRO and other documents: paramedics and EMTs do not have to interpret advance directives or other forms. Pennsylvania’s POLST form says an EMS provider needs an order from its medical command physician to follow it, and it tells clinicians to discuss a separate out-of-hospital DNR order when a patient wants EMS to honor a no-CPR choice. Senate Bill 730, which would put POLST into Pennsylvania law, passed the Senate 49-0 on June 23, 2026 and was referred to the House Health Committee the next day.

State forms at a glance

Each state has its own form, and details like paper color matter to EMS. A few examples:

Your drivers do not need to memorize this table. They need to know that the form is a medical document that belongs with the rider, not in the driver’s door pocket, and that EMS decides whether it applies.

When a rider with a DNR stops responding

The steps are the same as any in-vehicle emergency, with one addition: the paperwork.

1. Stop the van somewhere safe and dial 911. A DNR does not replace the call. Florida’s Department of Health tells people with a DNRO to still call 911.
2. Tell the call-taker about the form. “My passenger has a DNR form with them” or “a POLST form” is enough. Then do what the call-taker says.
3. Find the form and keep it with the rider. Check the envelope or bag the facility sent. Do not guess at what it says or read it aloud to other passengers.
4. Hand the form to EMS the moment they arrive, and point out any bracelet or necklace. In Texas, the crew confirms the order appears valid and matches the person. If it does not, the statute says life-sustaining procedures must be started.
5. Call dispatch once EMS has the rider. Dispatch calls the broker and the family or facility, and moves the rest of the driver’s trips.
6. Write the report before the shift ends.

The general playbook for sudden illness, including what to tell EMS, is in medical emergency during a NEMT ride.

Decide your CPR policy before it is needed

The hard question is what a CPR-trained driver does in the minutes before EMS arrives. Some programs require that training. CareOregon’s manual, for one, has drivers certified in first aid and CPR before their first member trip. The DNR laws above do not answer the question for drivers, because they are written for EMS and clinicians. Settle it as a company, in writing, before a driver faces it alone:

• Always call 911. No exceptions for any rider.
• Tell the call-taker about any form or bracelet, and follow the call-taker’s directions.
• No form, no assumptions. A family member’s word, a note in the trip request, or a form left at home does not travel with the rider. Tell 911 what was said and let EMS decide. Pennsylvania’s Department of Health warns that an order EMS finds in a drawer or away from the person may be treated as revoked or uncertain.
• Never argue at the scene. If a relative wants CPR or wants it stopped, relay that to 911 or the crew. Texas lets certain people at the scene, such as the patient’s guardian, agent, or qualified relative, ask the EMS crew to start or continue CPR.
• Review it with your broker, insurer, and a lawyer. Brokers may have their own expectations, and your insurance carrier may want to review the wording.

Train on it with a scenario, the same way you train securement or evacuation. CPR and first aid for NEMT drivers covers the courses themselves.

Paperwork from facilities and hospices

Facilities may send this paperwork along with a rider. When a nursing home transfers a resident to another provider, federal rules require it to send advance directive information to the receiving provider, along with other items (42 CFR 483.15). New York’s MOLST and Pennsylvania’s POLST are both meant to move with the patient between settings. So the envelope handed to your driver may hold the rider’s DNR or POLST.

Handle it like any health record:

• Keep it with the rider or in a closed folder, out of sight of other passengers.
• Hand it to staff at the destination, and note who took it and when.
• Do not copy, photograph, or keep it. The form belongs to the rider.

Some facilities tell dispatch that a resident travels with a DNR or POLST so the driver knows where it is. If yours do, note the location (“orange envelope in the tote bag”), not the diagnosis behind it. See nursing home pickups and hospice transportation for the rest of those trips.

Document everything that happened

A rider going into arrest in your vehicle will be reviewed by the broker, possibly by an insurer, and sometimes by the family. Your report should record:

• The time the rider stopped responding, and what the driver saw
• The time of the 911 call and the call-taker’s instructions
• Whether a DNR form, POLST, bracelet, or necklace was present, and where
• What the driver did, and when EMS arrived
• The EMS agency or unit, and who took the paperwork
• Who dispatch notified, and when

Report fast. MAS, New York’s Medicaid transportation manager, requires immediate notice of any event involving a death, ambulance response, or hospitalization, and requires providers to keep the report at least six years, or three years past the rider’s 18th birthday if that is later. MTM’s Rhode Island handbook lists calling EMS or an ambulance among its top-tier (Tier 1) events, which means phoning MTM at once and sending a written report within 24 hours. The incident report template has the fields, and NEMT incident investigation covers the follow-up. What the office may tell the family afterward is covered in HIPAA and family members.

Where HealthRide fits on a hard day

Once 911 is called, the office has two questions: where is the van, and what went on. In HealthRide, dispatch sees the stopped van on the live map, and the driver can send a chat or voice note from the app once EMS has the rider. Every trip keeps its own timestamps, which gives the incident report the times it asks for.