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Jess Ma

Hong Kong’s Fire Services Department has said paramedics will operate on an “if in doubt, rescue first” principle when determining whether to resuscitate patients in need after a new law on end-of-life directives takes effect next week.
Assistant Chief Ambulance Officer Gary Tong Sze-ho of the department said on Friday that rescuers must verify a physical copy of the do-not-attempt cardiopulmonary resuscitation (DNACPR) order before withholding specified life-sustaining treatments from the patient.
“If we cannot verify the document on-site, we will carry out life-saving measures on the patient based on the principle of ‘if in doubt, rescue first’,” Tong said.
Under the new legislation on end-of-life directives, Hongkongers can specify which life-sustaining treatments, such as cardiopulmonary resuscitation (CPR), they wish to refuse in the future should they lose their mental capacity or reach a defined clinical condition such as a persistent vegetative state. The law will take effect next Friday.
Hongkongers will also be able to obtain a DNACPR order, which instructs rescuers not to perform CPR in out-of-hospital environments when a patient suffers cardiopulmonary arrest.
However, Tong said officers must be able to verify that the patient’s DNACPR form was valid and applicable before they could bring the unconscious patient to hospital while offering other forms of care and treatment applicable.
The validity of the order depends on whether the document at hand is an original or a legal copy authorised by a lawyer or a doctor, and whether the required signatures are in place. The order is not available in electronic form.
“Photocopies made by the patient’s relatives would not be acceptable under the law. We cannot treat that as a valid document,” Tong said.
The order will also only be applicable if a rescuer on-site agrees that the patient’s cardiopulmonary arrest is not caused by a suspected suicide attempt, homicide or accident.
“As our colleagues ascertain the situation, our rescuers will continue to offer life-saving treatments,” Tong said.
In a demonstrative video screened to the press on Friday, the department showed that an officer taking an emergency call in the control room would first confirm with a caller that the patient in question had signed a DNACPR order.
The caller is also expected to tell control room officers that an order is in force for the patient in question.
Paramedics will then be notified of the patient’s wish not to be resuscitated while on their way to handle the case. Upon arrival, a supervisor of the paramedic team will check the physical copy of the DNACPR order while a team member assesses the patient’s condition and offers treatment.
Tong urged families to place the DNACPR order and a corresponding standardised bright yellow pouch issued by the Hospital Authority in a visible location near the patient, as rescuers would not rummage through personal belongings to locate the order.

“If the patient is living alone and no one is living with him or her, then when our rescuers arrive at the scene, we will perform what we have to do, which is to check the patient to assess their condition,” Tong said.
“If we can see the order next to him or her in the area, then we will immediately check if the order is valid or applicable.”
Rescuers will be exempt from any legal liability concerning any discovery of a patient’s valid DNACPR order after they have been sent to hospital or if they had accidentally authorised a fraudulent document presented as the order.
“As long as our colleague on-site has reasonably looked at the form and genuinely believes it to be real, we will treat that as a valid decision. If anyone has misled our staff, they will need to bear corresponding legal responsibility,” Tong said.
Representatives of the city’s ambulance services – namely those from the Fire Services Department, Auxiliary Medical Service and Hong Kong St John Ambulance – said paramedics had undergone training to handle situations involving a DNACPR order while operators would put up notices to remind frontline officers of procedures for this new medical directive.


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Paramedics to follow ‘rescue first’ rule if in doubt under new end-of-life law

Queen Elizabeth Hospital. Hongkongers will be able to upload orders specifying which life-sustaining treatments they do not wish to receive when terminally ill. Photo: Edmond So

Fire Services Department’s Gary Tong displays the yellow pouch issued by the Hospital Authority. Photo: Sun Yeung

‘No time to be a detective’: medics warn of split-second calls under new end-of-life law

The Hospital Authority's Doris Tse says ambulance workers have clear guidelines on how to handle emergencies under the new law. Photo: Dickson Lee

Tim Pang of the Society for Community Organization says low-income families may struggle to afford advance directives outside public hospital settings. Photo: Karma Lo

End-of-life directives to go on eHealth as new law takes effect in Hong Kong

The Hospital Authority's Doris Tse says the new ordinance provides clearer legal protection for both patients and healthcare professionals. Photo: Elizabeth Cheung

The Hospital Authority offers yellow bags to patients to store documents related to advance care planning. Photo: Elizabeth Cheung

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Hong Kong

Society

Health & Environment

Fire Services Department official says paramedics must first verify physical proof before stopping life-sustaining treatment on patient


Fire Services Department official says paramedics must first verify physical proof before stopping life-sustaining treatment on patient.


Hong Kong rescue services

Hospital Authority

Fire Services Department ( Hong Kong)

Paramedics to follow ‘rescue first’ rule if in doubt under new end-of-life law

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Fire Services Department official says paramedics must first verify physical proof before stopping life-sustaining treatment on patient

Fire Services Department official says paramedics must first verify physical proof before stopping life-sustaining treatment on patient