EMTs: Contact your Regional EMS office for the MOLST training module (OEMS training approval number 120316). The Massachusetts EMS Pre-Hospital Treatment Protocol Appendix B (pps. 136-142) about MOLST can be found at: http://www.mass.gov/eohhs/docs/dph/emergency-services/treatment-protocols-1001.pdf.
Frequently Asked Questions about MOLST
What are “Medical Orders for Life-Sustaining Treatment” (MOLST)?
The MOLST form is a standardized document containing valid medical orders about life-sustaining treatment. It stays with the patient and is honored by health professionals across all health care settings.
Do EMTs have to honor MOLST forms?
Yes. The Massachusetts Department of Public Health's Office of Emergency Medical Services (OEMS) has jurisdiction over emergency medical services and instructs that EMTs must honor valid MOLST instructions. EMTs should call Medical Control if they have questions about MOLST instructions in the field.
How does MOLST impact current OEMS protocols for providing emergency care?
MOLST does not change any current OEMS protocols for providing emergency care.
How is MOLST different from the Comfort Care/Do Not Resuscitate (CC/DNR) Verification Protocol?
Both forms are valid. The Comfort Care form verifies (for EMTs only) the existence of a current valid DNR order. The CC/DNR protocol also describes comfort care measures an EMT can provide to a patient with a valid CC/DNR form.
The MOLST form is a medical order that may contain instructions to attempt or not attempt a range of life-sustaining treatments. The MOLST form is honored by health professionals in the MOLST demonstration sites and by EMTs throughout Massachusetts. The MOLST form may eventually replace the CC/DNR form for EMS.
Where do I find a patient’s MOLST form?
Ask at the scene about the existence of a MOLST form. In homes, check the refrigerator, backs of doors and bedside area. Check (or ask someone else to check) the patient’s wallet. Original MOLST forms are bright pink, but a copy of any color is valid.
What makes a MOLST form valid?
Both Section D (patient info) and Section E (clinician info) must be complete before the EMT arrives for a MOLST form to be valid. EMTs should assume that all signatures on the form are valid.
Is a copy of only the front side of a MOLST form valid?
If Sections D and E are fully complete and legible, instructions contained in a copy of the front side of the MOLST form are valid.
What if Sections D and E are complete, but some other section(s) of the form is blank?
The form is still valid. If a section is blank, there is no limitation on the treatment indicated in that section.
What orders do I follow if the patient has both a CC/DNR form and a MOLST form?
For cardiac or respiratory arrest, follow the most recent orders. In all other situations, follow the MOLST instructions.
If the MOLST instructs “Do Not Intubate and/or Ventilate,” can I use CPAP?
Maybe. To decide whether to use CPAP, look to the next row under "Do Not Intubate and Ventilate" in Section B on Page 1 of the MOLST form to find instructions about non-invasive ventilation (e.g. CPAP).
Can I give treatment if the MOLST says “do not treat” but the person asks for treatment?
Yes, a patient can request and receive previously refused, medically indicated treatment at any time.
What if the MOLST form says “give treatment” but the patient or family/health care agent says no?
Treat and transport the patient. A new decision to withhold treatment is best made at the hospital and not at home.
What if a patient can’t communicate and the family or health care agent disputes the MOLST?
Explain that the MOLST form contains the patient’s wishes and that EMTs are required to follow MOLST instructions. If a situation of conflict continues or escalates, treat and transport the patient, and then document what occurred.
Do I have to bring the MOLST form with the patient to the hospital?
Yes. The MOLST form should always stay with the patient and return home with the patient.
How do I document MOLST instructions and what occurred?
Record the patient's name, the clinician’s name and contact information, the MOLST orders and what occurred.