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 

July 13, 2026

Patient refusals represent one of the highest medicolegal risk situations in all of EMS — and for Ohio paramedics, the stakes are particularly significant. What may feel like a routine, low-acuity call can quickly become the foundation of a civil lawsuit, an Ohio EMS Board investigation, or even criminal exposure if not handled with precision, documentation, and clinical rigor.1

The Ohio Legal Landscape

Ohio law under ORC § 4765.49 provides paramedics with immunity from civil liability for damages arising from the administration of emergency medical services.2 However, this protection is conditional; it evaporates entirely when services are rendered in a manner that constitutes willful or wanton misconduct.2 This means that a poorly executed refusal — one involving an incomplete assessment, falsified documentation, or a failure to assess patient capacity — can strip a paramedic of immunity and expose them to the full force of civil litigation. Beyond civil liability, Ohio paramedics also face administrative action through the Ohio EMS Board under ORC § 4765.101 and § 4765.111, which can result in suspension or permanent revocation of a paramedic certificate.1,3 In the most serious cases, criminal prosecution remains a real, if rare, possibility, particularly when documentation is falsified.1 

Capacity Is Not an Assumption

A legally valid refusal requires that the patient possess decision-making capacity at the time of the refusal. Capacity is a medical determination made by the paramedic on scene, and it requires that the patient be able to understand that a decision must be made, comprehend the specific risks of refusing care, communicate those risks back to the provider, and act free of coercion.1 Common capacity killers — including hypoxia, shock, intoxication, dementia, and pediatric age — must be actively assessed and documented. Ohio law under ORC § 4765.162 mandates dementia-specific training for all EMS providers, recognizing how easily this population can appear oriented while lacking true decision-making capacity.1, 3 

The Hidden Danger: Provider-Induced Refusals

One of the most underappreciated risks is the provider-induced refusal: when a paramedic, intentionally or not, steers a patient away from transport by minimizing symptoms, emphasizing cost or inconvenience, or signaling that staying home is reasonable. This conduct can be reframed legally as patient abandonment and can transform a defensible refusal into a gross negligence claim.1

Documentation Is Your Defense

Every refusal must be supported by a complete, accurate, and specific Patient Care Report (PCR). This means documenting a full set of vital signs, a thorough mental status and capacity assessment, the specific risks explained to the patient in plain language, the patient's own words repeating those risks back, any family or bystander involvement, and encouragement to call back at any time.1 Investigators now routinely examine ePCR metadata, timestamps, and even surveillance footage, making documentation integrity more critical than ever.1 

Best Practices: The FEARS Framework 

Ohio paramedics should apply the FEARS framework on every high-risk refusal: conduct a Full exam with vitals; Explain Real risks in condition-specific terms; Ask for assistance from family or Medical Control; Record the discussion thoroughly; and maintain a Supportive attitude throughout.1  

Contacting Medical Control on high-risk refusals is especially important; it increases the likelihood of patient compliance, documents appropriate escalation, and protects the paramedic from claims of unilateral decision-making.1 

The Bottom Line 

There is no such thing as a routine refusal. Every patient who declines care deserves the same clinical rigor and documentation discipline as any critical transport. Ohio's immunity statute protects paramedics who act within their protocols, but it will not shield those who cut corners, skip assessments, or falsify records.2, 3 The paramedic's best legal protection is always a thorough assessment, an honest conversation with the patient, and a complete, accurate PCR. 

This summary is for educational purposes only and does not constitute legal advice.  

Thank you for your time,

Jeffrey Luk, MD, MS

Sources:

1. https://codes.ohio.gov/ohio-revised-code/chapter-4765 

2. https://codes.ohio.gov/ohio-revised-code/section-4765.49 

3. https://law.onecle.com/ohio/title-47/chapter-4765/index.html 

July 20, 2026

In Ohio, the emergency application for psychiatric evaluation — commonly known as a "pink slip" — is governed exclusively by Ohio Revised Code (ORC) Chapter 5122, specifically Section 5122.10.1 Unlike Florida's Baker Act, Ohio has its own distinct legal framework for involuntary psychiatric holds, and understanding it is critically important for paramedics who regularly respond to mental health emergencies.2 

The Central Legal Issue: Paramedic Authority 

The most significant legal issue for Ohio paramedics is that they are not listed as authorized initiators of a pink slip under ORC 5122.10.1 The statute provides a closed, enumerated list of authorized persons, including psychiatrists, licensed physicians, licensed clinical psychologists, health officers, parole officers, police officers, and sheriffs, but paramedics are conspicuously absent.1 This means a paramedic cannot independently take a patient into custody for psychiatric evaluation, regardless of how clearly the patient may meet the legal criteria. However, a potential pathway exists through the "health officer" designation under ORC 5122.01(J), which allows local health districts or ADAMH boards to formally designate individuals, potentially including paramedics, to perform health officer duties.3 Paramedics should consult their local medical director and legal counsel to determine if such a designation exists in their jurisdiction. 

The Paramedic's Role in Practice

While paramedics cannot independently initiate a hold, they play a vital and legally protected role in assisting authorized persons. Under ORC 5122.34, any person acting in good faith, either upon actual knowledge or information believed to be reliable, who procedurally or physically assists in the hospitalization of a patient under Chapter 5122 is immune from criminal and civil liability.3 This means that when a police officer or physician initiates a pink slip, a paramedic who transports the patient is fully protected under Ohio law, provided they act in good faith. 

Legal Criteria and Required Procedures 

For a pink slip to be valid, the patient must have a mental illness and, because of that illness, represent a substantial risk of harm to themselves or others, be unable to meet basic physical needs, or create a grave and imminent risk to the rights of others.3 The initiating person must provide a written statement to the receiving hospital documenting the circumstances and reasons for the hold.1 Critically, the patient must be informed that the custody-taking is not a criminal arrest, told the name of the receiving facility, and notified of their rights — including the right to legal counsel and an independent evaluation.1,3 All efforts must be made to take the patient into custody in the least conspicuous manner possible.1 

Timeline, Confidentiality, and Downstream Consequences 

Once transported, the hospital must examine the patient within 24 hours.1 If criteria are met, the patient may be held for up to three court days (meaning weekdays but excluding holidays) before the hospital must admit them voluntarily, file a court affidavit, or discharge them.1 All records related to the hold are strictly confidential under ORC 5122.31 and federal HIPAA law.3  

Key Takeaway for Paramedics 

Ohio paramedics occupy a critical but legally constrained role in psychiatric emergencies. They cannot independently initiate a pink slip, but they can and should coordinate with law enforcement and medical direction, document clinical observations thoroughly, protect patient property and dignity, and transport patients under the authority of a properly authorized person — all while enjoying the protection of Ohio's good faith immunity statute. Staying current with ORC Chapter 5122, as most recently amended by House Bill 96 effective September 30, 2025, and working closely with agency legal counsel and medical directors is essential for every Ohio paramedic.1 

This summary is for educational purposes only and does not constitute legal advice.   

Thank you for your time,

Jeffrey Luk, MD, MS

Sources:

1. https://codes.ohio.gov/ohio-revised-code/section-5122.10

2. https://law.onecle.com/ohio/title-51/5122.10.html

3. https://codes.ohio.gov/ohio-revised-code/chapter-5122

July 27, 2026

Overview 

In Ohio, one of the most legally complex situations a paramedic can face is when Online Medical Control orders the transport of a psychiatric patient, but law enforcement refuses to initiate an involuntary hold, commonly known as a "pink slip." This conflict exposes a critical distinction that every Ohio paramedic must understand: Medical authority is not the same as legal custody authority.

The Pink Slip and Who Can Issue One 

Under Ohio Revised Code (ORC) § 5122.10, the pink slip (formally known as the "Application for Emergency Admission") is the legal mechanism for placing a person into involuntary psychiatric custody. Only a specific list of authorized individuals may initiate this hold, including psychiatrists, licensed physicians, licensed clinical psychologists, psychiatric-certified nurse practitioners, health officers, parole officers, police officers, and sheriffs. Paramedics are explicitly not on this list. Without a signed pink slip from one of these authorized persons, no lawful basis exists for involuntary transport.

The Core Legal Conflict

When Online Medical Control (a physician) orders transport, that order carries clinical and medical direction authority. However, it does NOT automatically satisfy the statutory requirements of ORC § 5122.10. The physician issuing the order has typically not personally observed the patient and has not signed the pink slip form required by law. Therefore, a radio or phone order from a physician does not necessarily grant the paramedic legal authority to detain a refusing patient. When police decline to pink slip the patient, the primary legal mechanism for involuntary custody has been refused, leaving the paramedic in a precarious position. 

Legal Risks of Forcible Transport

If a paramedic forcibly transports a patient without lawful authority, they face serious consequences, including civil liability for false imprisonment or battery, potential criminal exposure for unlawful restraint, and licensure jeopardy with the Ohio State Board of Emergency Medical, Fire, and Transportation Services. While ORC § 5122.34 provides good faith immunity for those assisting within the lawful framework of Chapter 5122, this protection does not extend to unlawful detentions conducted outside of that framework. 

Possible Recommended Courses of Action

When this conflict arises, paramedics should follow a structured approach. First, attempt voluntary transport: if the patient consents, no pink slip is needed. Second, advocate for law enforcement to reconsider initiating the hold based on clinical findings. Third, explore whether the Online Medical Control physician can formally sign the pink slip, since licensed physicians are authorized under ORC § 5122.10, provided they have sufficient basis to do so. Fourth, contact the agency medical director for further guidance. Fifth, consider the judicial hospitalization route under ORC § 5122.11, where any person may file an affidavit with the Probate Court, though this is not a rapid emergency solution. Finally, and most critically: if no lawful authority exists and the patient refuses, do not forcibly transport. 

Reminder that if a patient lacks decision-making capacity, then the patient cannot refuse transport as the patient does not have the capacity to refuse. 

This summary is for educational purposes only and reflects Ohio law as of June 2026.

Thank you for your time,

Jeffrey Luk, MD, MS