Emergency response with lights and sirens to patients with a suspected out-of-hospital cardiac arrest and a do-not-attempt-resuscitation order in the hospital record: a one-year observational study.
Resuscitation · 2026-07-27 · Observational study
Abstract
INTRODUCTION: Do-not-attempt-resuscitation (DNAR) orders issued within the hospital are not accessible to prehospital care providers including the emergency medical dispatchers handling distress calls. Danish legislation mandates dispatch of ambulances with lights and sirens and community first responders in suspected out-of-hospital cardiac arrests (OHCA). Attempted resuscitation despite a documented DNAR-order challenges patient autonomy and carries ethical, resource, and safety implications for prehospital personnel. OBJECTIVES: We aimed to report how often emergency vehicles were dispatched with lights and sirens to patients with suspected OHCA despite having a physician-issued DNAR-order in the hospital record. One-day, 30-day, one-year mortality, and resource utilisation were assessed. METHODS: This retrospective observational study included all emergency dispatches to suspected OHCA in 2024 in the Region of Southern Denmark. Data were obtained from prehospital and hospital records. Prehospital and hospital records were systematically reviewed for documentation of DNAR-order, mortality, and prehospital resource utilisation. RESULTS: There were 1695 dispatches to patients with suspected OHCA. In 266 (15.7%) cases, the patient had a physician-issued DNAR-order in the hospital record. Of these, 126 (47.4%) were registered as requested by the patient. One-day mortality in patients with DNAR was 90.6% versus 69.5% in the group without DNAR (p < 0.001). There was no significant difference in the number of units dispatched and arriving at the scene. CONCLUSION: In almost every sixth dispatch to suspected OHCA, the patient had a physician-issued DNAR-order in the hospital record. We call for physician-issued DNAR-orders to be accessible for all healthcare providers, including emergency medical dispatchers and other prehospital personnel.