Hawaii DNR Form: POLST, Comfort Care Only Bracelets, and How They Work

Searching for a "Hawaii DNR form" leads to confusion because Hawaii does not use a standalone do-not-resuscitate order the way many mainland states do. Instead, Hawaii uses two interconnected systems: the Provider Orders for Life-Sustaining Treatment (POLST) form and the Comfort Care Only (CCO) bracelet.

Understanding which does what — and which one EMS actually follows — is the difference between your wishes being honored and full resuscitation being performed against your will.

The POLST Form: Hawaii's Version of a DNR

The Hawaii POLST is a bright lime-green form that converts a patient's treatment preferences into active, enforceable medical orders. Unlike an advance directive, which is a planning document, a POLST is a set of physician orders that take effect immediately.

A POLST can specify:

• Section A: Whether to attempt CPR or allow natural death (this is the DNR component)
• Section B: Level of medical interventions — full treatment, selective treatment, or comfort-focused treatment only
• Section C: Whether to provide artificial nutrition via feeding tube

The form must be signed by the patient (or their authorized surrogate) and a qualified healthcare professional — a physician, advanced practice registered nurse (APRN), or physician assistant (PA). You cannot create a POLST on your own. It requires a clinical conversation about your current medical condition.

The most recent version was revised by the Hawaii Department of Health in May 2023, incorporating input from Kokua Mau, the statewide hospice and palliative care organization.

The Comfort Care Only Bracelet

The CCO bracelet is a physical, wearable identifier that tells EMS responders the patient has a valid POLST with comfort-care-only orders. When paramedics arrive at a scene on any Hawaii island, they look for the lime-green POLST form or the CCO bracelet before deciding treatment.

Without one of these two items physically present, EMS is legally required to perform full resuscitation — regardless of what your advance directive says. Paramedics are not trained or authorized to interpret advance directives in the field.

CCO bracelets are typically ordered through the patient's healthcare provider or through Kokua Mau. They are distinct from generic medical alert bracelets — only the official CCO bracelet carries legal weight with Hawaii EMS.

POLST vs. Advance Directive: They Do Different Things

An advance directive under HRS Chapter 327E is a planning document for future incapacity. You fill it out while healthy, it sits in your medical records, and it activates when your physician determines you lack capacity.

A POLST is a set of current medical orders for someone with a serious illness or advanced frailty. It goes into effect the moment it is signed and travels with you — on the refrigerator door, in the ambulance, to the emergency room.

Most people with a serious illness need both. The advance directive covers long-term decision-making authority. The POLST covers what happens in the next emergency.

Who Should Have a POLST

A POLST is not for everyone. It is designed for people who:

• Have a serious, life-limiting illness (cancer, advanced COPD, end-stage renal disease)
• Are in advanced age with increasing frailty
• Live in a care facility (nursing home, assisted living, residential care home)
• Have a condition where full resuscitation would cause more suffering than benefit

Healthy adults do not need a POLST. They need an advance directive that names a healthcare agent and documents treatment preferences for a future scenario. The POLST becomes relevant when the medical situation shifts from hypothetical to active.

Getting a POLST on Neighbor Islands

On Oahu, most hospital systems (Queen's Health System, Hawaii Pacific Health, Kaiser Permanente) have integrated POLST discussions into their palliative care and discharge planning workflows. On the Big Island, Maui, and Kauai, access to the clinical conversation required for a POLST can be harder to arrange — fewer palliative care specialists, longer waits for appointments, and limited hospice coverage in rural areas.

Kokua Mau maintains resources and provider directories for all islands. Your primary care physician can also initiate the POLST conversation — it does not require a specialist.

Connecting Your DNR Wishes to Your Advance Directive

The Hawaii Advance Directive & Living Will Kit includes a POLST coordination reference that explains how your advance directive treatment instructions align with each POLST section — so your planning documents and your active medical orders say the same thing.

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