July 6, 2026

Ohio DNR Rules & Regulations for Paramedics 

Ohio's Do-Not-Resuscitate (DNR) protocol, governed by Ohio Administrative Code (OAC) Chapter 3701-62 and Ohio Revised Code (ORC) §§ 2133.21–2133.26, establishes the legal framework that all EMS personnel, including paramedics, must follow when encountering patients with DNR orders.1 Most recently updated effective September 8, 2025, these rules clarify provider authority, documentation standards, and EMS obligations in the field.2

Two Types of DNR Orders

Ohio recognizes exactly two DNR classifications.1 The first, DNR Comfort Care (DNRCC), activates the moment a DNR order is issued, meaning no resuscitative measures are to be performed from that point forward. The second, DNR Comfort Care – Arrest (DNRCC-Arrest), activates only upon cardiac or respiratory arrest — full medical treatment continues until that moment.1 Understanding this distinction is critical for paramedics, as it directly determines what care may be provided on scene.

What Counts as CPR — and What Doesn't 

CPR includes chest compressions, artificial airway insertion, resuscitation drugs, defibrillation, respiratory assistance, resuscitative IV lines, and cardiac monitoring.1 Importantly, clearing a patient's airway for a non-CPR purpose is not considered CPR and remains permissible.1 Even with a valid DNR in place, paramedics are still required to provide comfort care — including pain management, hydration for comfort, suctioning, and repositioning — as a DNR is NOT a "do not treat" order.1 

Valid DNR Identification 

EMS personnel must recognize legally valid DNR identification, which includes the official Ohio DNR order form, wallet cards, hospital-type bracelets, necklaces, and operative Living Will declarations containing CPR refusal language.1 All identifiers must bear the official DNR Comfort Care logo and the patient's name. Jewelry for DNRCC-Arrest patients must also include the word "ARREST."1 Critically, the DNR order form cannot be written upon or altered — any additions are not legally transportable.1

EMS Obligations and Protections 

Paramedics must comply with the DNR protocol when presented with valid DNR identification, a written DNR order, or a direct oral DNR order from an authorized provider.3 When an off-scene provider issues an oral DNR order, EMS must verify the provider's identity before complying.3 In emergencies, EMS is not required to search a patient for DNR identification.3 Paramedics acting in good faith under a valid DNR are fully protected from criminal prosecution, civil liability, and professional disciplinary action.1 

Revocation and Patient Rights 

A DNR can be revoked at any time — including mid-emergency — by the patient making an oral or written request for CPR, destroying their DNR documentation, or permanently removing DNR jewelry.1 If a patient verbally requests CPR, paramedics must honor that request immediately, regardless of any DNR documentation present.1

Family members cannot revoke a DNR on behalf of a competent patient; however, this situation has the risk of becoming volatile, so contact medical control if you need to. 

2025 Updates & Key Takeaways 

The 2025 rule updates expanded authority for APRNs and PAs to issue DNR orders without a physician co-signature; clarified the hierarchy between DNR orders, Living Wills, and Healthcare Powers of Attorney; and reinforced transport documentation requirements.2 When in doubt on scene, paramedics should contact medical control immediately and document all actions thoroughly.3

Thank you for your time,

Jeffrey Luk, MD, MS

Sources:

1. https://codes.ohio.gov/ohio-administrative-code/chapter-3701-62 

2. https://www.leadingageohio.org/aws/LAO/pt/sd/news_article/595055/_BLANK/ebulletin_layout_newsletter_details/false 

3. https://codes.ohio.gov/ohio-administrative-code/rule-3701-62-07