Nebraska DNR Form: Out-of-Hospital DNR Orders and POLST Explained

One of the most dangerous misunderstandings in Nebraska end-of-life planning is the belief that a living will or advance directive prevents emergency responders from performing CPR. It does not. Nebraska EMS personnel are legally mandated to initiate full cardiopulmonary resuscitation unless they are presented with a physical, signed Out-of-Hospital Do Not Resuscitate Order or a POLST (Provider Orders for Life-Sustaining Treatment) form at the scene.

Without one of these physician-signed clinical orders visible in the home, a 911 call triggers full resuscitation regardless of what the patient's advance directive says.

DNR vs. Advance Directive: The Critical Difference

An advance directive is a legal planning document created by the patient. It guides long-term clinical care and appoints a healthcare agent.

An Out-of-Hospital DNR and a POLST are medical orders created by a physician. They translate patient preferences into actionable instructions that EMS, nursing staff, and hospital teams must follow immediately without consulting a healthcare agent or reviewing a longer planning document.

This distinction exists because emergency responders operate under time pressure and need clear, standardized orders rather than multi-page legal documents that require interpretation.

Nebraska Out-of-Hospital DNR Order

The Out-of-Hospital DNR is a specific clinical order directing that CPR not be initiated if the patient experiences cardiac or respiratory arrest outside a hospital setting. Key requirements:

• Must be signed by both the patient (or their legal surrogate) and a licensed physician
• The original form must be physically accessible in the home (commonly placed on the refrigerator door or at the bedside)
• EMS personnel will look for the form before beginning resuscitation
• The order applies to out-of-hospital settings only; in-hospital DNR orders are separate

The DNR is a single-purpose document: it addresses only the CPR decision. It does not cover other interventions like intubation, IV antibiotics, hospitalization, or comfort care preferences.

Nebraska POLST Form

The POLST covers a broader range of emergency medical decisions. It is designed for individuals with serious advanced illnesses, frailty, or a terminal diagnosis whose medical conditions make specific emergency instructions clinically appropriate. The POLST addresses:

• Section A: CPR decision — Attempt resuscitation or do not attempt (functions like a DNR)
• Section B: Medical interventions — Full treatment, selective treatment, or comfort-focused treatment
• Section C: Artificially administered nutrition — Long-term tube feeding preferences

POLST requirements:

• Must be signed by both the patient (or legal surrogate) and a licensed physician
• Portable across all care settings: home, transport, nursing facility, hospital
• Travels with the patient physically (bright-colored form designed for visibility)
• Valid until revoked or superseded by a new POLST

The POLST is voluntary and not appropriate for healthy individuals. It is intended for people whose current health status makes specific emergency treatment decisions medically meaningful.

Who Can Request These Forms

Any competent adult can discuss a DNR or POLST with their physician. The physician must agree that the orders are clinically appropriate, as these are medical orders rather than patient-directed legal documents.

If the patient lacks capacity, a legally authorized surrogate can request these forms. In Nebraska, that means a healthcare agent designated under a Power of Attorney for Health Care, a court-appointed guardian, or a default surrogate under the Health Care Surrogacy Act hierarchy (spouse, then adult child, then parent, then adult sibling).

Common Mistakes That Invalidate the Protection

Relying on an advance directive alone. Even a perfectly executed advance directive with clear instructions to refuse CPR does not bind EMS. The separate DNR or POLST form is required.

Storing the form in a filing cabinet. EMS personnel search for the form in the immediate area where the patient is found. If it is filed away rather than posted visibly, responders will initiate resuscitation while searching.

Not distributing copies. The physician's office, the patient's primary care clinic, any home health agencies, and the local EMS service should all have copies on file. If the patient is transported to a hospital, the POLST should travel with them.

Confusing a hospital DNR with an out-of-hospital DNR. A DNR order written during a hospital stay applies only within that facility. A separate Out-of-Hospital DNR must be obtained for the order to apply after discharge.

Coordinating With Your Advance Directive

The advance directive and the POLST/DNR serve complementary purposes. The advance directive handles the broader planning: who makes decisions, what treatments you prefer across a range of scenarios, and what values guide your care. The POLST/DNR handles the immediate emergency: what happens in the first minutes of a 911 response.

Executing both creates a complete framework. The advance directive appoints a healthcare agent and documents your values. The POLST translates those values into standing medical orders that emergency responders can act on without delay.

The Nebraska Advance Directive & Living Will Kit covers coordination between advance directives, POLST forms, and Out-of-Hospital DNR orders, including when each document is appropriate and how to ensure they do not contradict each other.

See more Nebraska guides →