DNR vs POLST in Maine: Which Document Do You Actually Need?

Your Advance Directive Will Not Stop Paramedics

This is the single most important thing to understand about end-of-life documents in Maine: if emergency medical services arrive at your home and you go into cardiac or respiratory arrest, they are legally required to perform full CPR and resuscitation — even if you have a signed advance directive sitting on the kitchen table.

Under Maine EMS protocols, first responders can only withhold resuscitation when presented with a valid, signed medical order. An advance directive is a legal planning document, not a medical order. The distinction sounds bureaucratic, but in an emergency it is the difference between your wishes being honored and being intubated against them.

The Three Documents and What Each Does

Advance Health Care Directive

• What it is: A legal planning document where you name a healthcare agent and record treatment preferences
• Who signs it: You, plus two adult witnesses
• Actionable by EMS? No. Paramedics cannot legally follow it.
• Purpose: Guides your healthcare agent and hospital-based physicians in making decisions when you cannot communicate

Maine EMS Comfort Care / DNR Order

• What it is: A specific medical order instructing EMS personnel to withhold cardiopulmonary resuscitation
• Who signs it: A licensed physician, physician assistant, or nurse practitioner
• Actionable by EMS? Yes. Must be physically present — either the distinctive bright pink form or official Maine EMS Comfort Care/DNR jewelry (wrist bracelet or necklace)
• Purpose: Prevents unwanted CPR in pre-hospital emergencies

Provider Orders for Life-Sustaining Treatment (POLST)

• What it is: A comprehensive set of medical orders covering resuscitation, medical interventions, and nutrition/hydration
• Who signs it: A healthcare provider (MD, DO, PA, or APRN) and the patient or their legal surrogate
• Actionable by EMS? Yes. The lime-green form must be physically accessible
• Purpose: Translates your treatment preferences into standing orders that follow you across all care settings

DNR vs POLST: Key Differences

A DNR order addresses one question: should paramedics perform CPR if your heart stops? That is its entire scope.

A POLST form addresses that question plus two others:

• Section A: CPR orders — checking "No CPR" functions as a DNR order
• Section B: Medical intervention orders — ranging from "Full Treatment" (hospitalize, use ventilators, ICU) to "Comfort-Focused Treatments" (manage pain, do not hospitalize unless comfort cannot be achieved otherwise)
• Section C: Nutrition and hydration orders — whether to use IV fluids, feeding tubes, or limit to oral nutrition only

If you want only CPR withheld, a DNR order is sufficient. If you want broader control over your care during a medical crisis, a POLST covers more ground.

Who Should Have a POLST or DNR

These are not documents for healthy 40-year-olds. POLST and DNR orders are designed for people with:

• A serious illness that is expected to be life-limiting
• Advanced frailty where CPR would be medically futile or cause more suffering
• A terminal diagnosis with a prognosis of six months or less
• A preference for comfort-focused care over aggressive intervention

Your physician initiates the conversation. You cannot create a POLST or DNR on your own — both require a licensed provider's signature because they are medical orders, not legal documents.

Where to Keep the Documents

Both the POLST and DNR forms must be physically accessible to be honored by EMS:

• At home: Post the original colored form on the refrigerator or another conspicuous location. EMS personnel are trained to look there first.
• In a care facility: The form goes at the front of the physical medical chart.
• During transport: The form travels with the patient. If you are being moved by ambulance between facilities, the form must be on the stretcher.
• DNR jewelry: Maine recognizes official Comfort Care/DNR bracelets and necklaces. These are useful for people who are mobile and may not have a paper form nearby.

A form locked in a filing cabinet or safe deposit box is legally worthless during an emergency.

How to Revoke a POLST or DNR

The patient or their legal representative notifies the medical provider and physically destroys the original colored document. If you have DNR jewelry, it must be removed and returned or destroyed.

Revocation is effective immediately. There is no waiting period or court process.

How These Documents Work Together

Think of them as layers:

1. Advance directive → your long-term plan, naming an agent and recording preferences
2. POLST/DNR → your physician translates those preferences into actionable medical orders

You complete the advance directive first. Then, when your medical situation warrants it, you and your physician create the POLST or DNR based on the preferences you already documented.

The Maine Advance Directive & Living Will Kit includes a POLST/DNR reference guide that explains how to coordinate your advance directive with these medical orders, so your wishes are honored at every level of care.

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