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FBAO & DNR Approach

Question #38

During an FBAO, if the patient has a pulse but is unconscious with a valid DNR. Are we allowed to perform CPR & ventilations to dislodged the obstruction? Or should CPR & ventilations be withheld and the patient should be put on an NRB / suction as needed then transport to the hospital? Thank you.

Answer:

In Ontario, the presence of a valid Ministry of Health (MOH) Do Not Resuscitate (DNR) Confirmation Form does not prohibit paramedics from providing care to a patient who is unconscious with a pulse due to a foreign body airway obstruction (FBAO). The DNR applies only when the patient is in respiratory or cardiorespiratory arrest, defined as the absence of respirations and pulse for at least three minutes (Ontario Ministry of Health, 2023).

In the scenario described, the patient remains perfusing and has not arrested. Therefore, the DNR does not come into effect, and care should be initiated. This includes attempts to relieve the obstruction using abdominal or chest thrusts, suctioning if indicated, and providing assisted ventilations if the patient is apneic or has inadequate respiratory effort. These interventions are aligned with the Basic Life Support Patient Care Standards and fall within the expectations of paramedic practice in Ontario (Ontario Ministry of Health, 2023).

The primary objective is to relieve the obstruction and support the patient until definitive care can be provided. These actions are not considered resuscitation under the DNR standard because the patient is not VSA. If the patient does arrest and a valid DNR Confirmation Form is present, then resuscitation efforts, including chest compressions, should be withheld in accordance with the standard.

In summary, when attending to a patient with a valid DNR who is unconscious with a pulse due to an FBAO, paramedics should:

  • Attempt to relieve the obstruction using appropriate airway clearance techniques.
  • Provide assisted ventilations if the patient is apneic or hypoventilating.
  • Monitor the patient closely and reassess frequently.
  • Understand that the DNR does not apply unless the patient becomes VSA.

These interventions are consistent with provincial standards and represent appropriate care in the presence of a valid DNR.

References

Ontario Ministry of Health. (2023). Basic Life Support Patient Care Standards (Version 3.4). Government of Ontario. https://files.ontario.ca/moh_2/moh-standards-basic-life-support-patient-care-standards-v3-4-en-2023-03-10.pdf

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Medical Directive Category

Cardiac Arrest

Published

09 June 2025

ALSPCS Version

5.4

Views

2

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.