July 12, 2000
DO NOT RESUSCIATE BRACELETS
By: Saul Spigel, Chief Analyst
You wanted to know who in Connecticut is responsible for the appearance of do not resuscitate (DNR) bracelets and other states' rules regarding their appearance.
A DNR bracelet is the visible sign to healthcare providers that the person wearing it is under a physician's order to withhold cardiopulmonary resuscitation, including chest compression, defibrillation, or breathing or ventilation by any assistive or mechanical means. In Connecticut and other states with laws permitting physicians to write advance directives for end of life care, it is the equivalent of a written DNR transfer form when a patient is transferred between healthcare institutions, and it is the only valid indication for emergency medical service personnel outside of a healthcare institution setting (for example, when they are called to a person's home) that the person is subject to a DNR order.
The Department of Public Health regulates the appearance and use of DNR bracelets in Connecticut. The department's regulations require its approval of bracelet design. The approved design calls for an orange information inset border, black lettering stating “EMS ALERT” and the wearer's name, and an orange plaid wrist strap. Bracelets may be worn either on the wrist or the ankle (Conn Agency Regs. 19a-580d-1 to 9). They are made available to physicians and institutions through the Connecticut College of Emergency Physicians.
Several other states also prescribe a particular type of DNR bracelet by regulation, guidelines, or medical protocols. Wisconsin and Massachusetts require their DNR bracelets to be modeled after a hospital identification bracelet; they do not specify color. New York's EMS guidelines state that the bracelet is a stainless steel metal plate the bears the traditional medical symbol on the front and DO NOT RESUSCITATE in big block letters on the back. Several states (Arkansas, California, Indiana, Kansas, Maryland, Nevada, and New Mexico) recognize bracelets distributed by the MedicAlert Foundation, a private, nonprofit membership organization. These bracelets are also metal. Louisiana's Secretary of State's office distributes engraved DNR bracelets (suggesting they are metal) and a laminated card.