TPOPP vs DNR in Kansas: Which Emergency Medical Order Do You Need?
TPOPP vs DNR in Kansas: Which Emergency Medical Order Do You Need?
If you're researching end-of-life planning in Kansas and see references to POLST, TPOPP, and DNR, the terminology can be confusing. Here's the distinction: Kansas uses its own branded version of the national POLST program called TPOPP (Transportable Physician Orders for Patient Preferences), and the state also has a separate pre-hospital Do Not Resuscitate (DNR) order. They serve different purposes, and neither one is an advance directive.
What a Pre-Hospital DNR Does
A Kansas pre-hospital DNR is a single-page physician order — typically printed in red — that tells EMS and emergency room staff not to attempt CPR if your heart or breathing stops. That's its entire scope.
A DNR addresses one question only: should paramedics perform cardiopulmonary resuscitation? It says nothing about other treatments like antibiotics, hospital admission, ventilators, or feeding tubes.
A DNR must be signed by an authorized Kansas practitioner (physician, PA, or APRN). You can't create one yourself — it's a medical order, not a self-help form.
What TPOPP Covers
The TPOPP form is broader. It's a comprehensive, double-sided medical order set printed on bright pink paper designed for individuals with advanced progressive illness, chronic frailty, or limited life expectancy. It translates your treatment preferences into actionable medical orders across four areas:
- Cardiopulmonary resuscitation — attempt CPR or do not attempt
- Medical interventions — full treatment, selective treatment (IV fluids, antibiotics, but no intubation), or comfort-focused treatment only
- Antibiotics — full course, limited use, or comfort measures only
- Medically administered nutrition — tube feeding for a trial period, long-term, or no artificial nutrition
Like the DNR, the TPOPP must be signed by an authorized practitioner based on a goals-of-care conversation with you (or your legal representative). It's completed collaboratively, not unilaterally.
Key Differences
| Feature | Pre-Hospital DNR | TPOPP |
|---|---|---|
| Scope | CPR only | CPR + treatment intensity + antibiotics + nutrition |
| Who it's for | Anyone who wants to decline CPR | People with advanced illness or frailty |
| Format | Single page, red | Double-sided, pink border |
| Portability | Kept at home, travels with patient | Travels across all care settings |
| Created by | Physician order | Physician order after goals-of-care discussion |
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How They Differ from Advance Directives
Neither a TPOPP nor a DNR is an advance directive. The distinction matters:
Advance directives (DPOA-HC and living will) document your future wishes and appoint someone to make decisions later. They're completed by you and activated when you become incapacitated or terminally ill.
Medical orders (TPOPP and DNR) are active now. They're completed by a physician and followed immediately by any healthcare provider or paramedic who encounters them. EMS doesn't read advance directives in the field — they follow medical orders.
For a comprehensive plan, you need both layers: advance directives for the legal foundation (who decides and what your values are) and medical orders for the clinical implementation (what paramedics and hospitals do right now).
When to Get a TPOPP vs. a DNR
Get a DNR if your only concern is declining CPR — you don't want chest compressions, defibrillation, or intubation if your heart stops, but you want other treatments to continue normally.
Get a TPOPP if you want to define your treatment preferences comprehensively — including how aggressively to treat infections, whether to use feeding tubes, and how much intervention you want short of CPR. This is the right tool for anyone in a progressive decline, managing a life-limiting illness, or transitioning to hospice.
Neither replaces the other. A TPOPP includes a CPR section, so if you have a TPOPP, you don't need a separate DNR. But you still need a DPOA-HC to designate who can make decisions for you if you lose capacity — the TPOPP only records current orders, it doesn't appoint a decision-maker.
How to Get Started
Ask your physician or care team about completing a TPOPP or DNR at your next appointment. Kansas hospitals, hospice programs, and nursing homes all have the forms. Your healthcare agent (appointed via a DPOA-HC) can participate in the goals-of-care conversation if you want their involvement.
The Kansas Advance Directive & Living Will Kit covers the advance directive side — the DPOA-HC and living will that provide the legal foundation your TPOPP and DNR orders build on.
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