DNRs in Alaska - Comfort One & POLST
End of life decisions are tough, especially for those who are terminally ill. People want their wishes to be respected, but there are family members and friends to consider.
Comfort One and POLST are Do Not Resuscitate (DNR) programs for people diagnosed with a terminal illness who do not wish to have life-saving measures, such as cardiopulmonary resuscitation (CPR) performed on them when their breathing and heartbeat stop. It enables health care providers to easily identify these patients who have expressed these wishes.
A qualified patient is enrolled in the either Program by his or her physician who fills out a Program enrollment form. In the case of the Comfort One program, the patient is given a copy of the form and a wallet card at the time of enrollment in that program. Some patients choose to purchase an optional Comfort One / DNR bracelet, which provides additional evidence of Program enrollment. This bracelet may be used for both programs.
Under the statewide protocol, health care providers and EMS personnel can provide palliative care (moderating pain and discomfort, making it easier to bear) and emotional support, but CPR will not be started, and will be stopped if already in progress on patients who are confirmed to be enrolled in an approved DNR Program.
Comfort One and POLST are different from a Living Will and Advanced Directives. One is prehospital, the other hospital.
Comfort One, established in Alaska in 1996, is being replaced by the POLST program in Alaska, effective January 1, 2022. However either DNR program will be accepted, POLST is an approach to improving palliative or end-of-life care that was created in 1991 in Oregon and is or currently being implemented by many states. The difference between the POLST and Comfort One programs is the portability and cross-care recognition between different levels of providers that patients and their families might expect to come in contact with while care is being provided during this process, to include EMS, home healthcare, hospice, emergency departments. To facilitate the change from Comfort One to POLST, a collaboration between different levels of providers like palliative care specialists, home and extended healthcare, EMS, and emergency room physicians are meeting and working together to ensure that POLST is implemented with representation, support, and education for providers and the public. For more information regarding POLST and its implementation, please go here.