What happens if the patient lacks decision-making capacity but has a POLST Form?

• A. The form remains in effect and guides care in a manner consistent with the patient’s known preferences.
• B. Care proceeds with full aggressive resuscitation by default.
• C. The form is voided.
• D. EMS must refer to medical control.

Answer: (A)

Lack of decision-making capacity does not nullify a POLST. POLST forms are portable, signed medical orders that express a patient’s treatment preferences and are meant to guide EMS across settings, even when the patient cannot communicate. If the POLST indicates do-not-resuscitate or specifies a limited set of interventions, EMS must follow those orders and provide care consistent with the patient’s known wishes. The form remains in effect because it represents explicit, physician-ordered directives intended to be honored regardless of the patient’s current capacity, provided the form is current, valid, and accessible. It isn’t voided simply by incapacity, and EMS is not required to default to full aggressive resuscitation unless the POLST itself calls for it. Medical control referral isn’t a prerequisite to honoring a valid POLST, though you may consult medical control if the form is unclear or if there’s a conflict with other protocols.