EMS responds to a call for a suicide attempt. The patient is a 58- year-old man who was recently diagnosed with pancreatic cancer and, according to the family, has been extremely depressed. The patient tried to hang himself in his room in a suicide attempt, and, when family found him still gasping for air, they cut him down. He has a weak, thready pulse, sonorous respirations with stridor and poor air entry. He also has crepitus over the soft tissue of his neck and he appears pale. The family informs EMS that he recently signed a DNR and they have the proper documentation. EMS calls in for your advice on how to proceed. Which of the following is the most appropriate response?

a. The patient has a DNR order; therefore EMS must abide by his advance directive and take no intervention.

b. Take no intervention but bring the patient to the ED as quickly as possible and provide supportive care.

c. Secure the patient’s airway but inform EMS that they cannot proceed with CPR if the patient loses his pulse.

d. Secure the patients airway and provide full supportive care, disregarding the patient’s DNR directive due to the circumstance of a suicide attempt.

e. Tell EMS to stand by and contact your hospitals medical ethics board for counsel immediately.