New
Mexico Register / Volume XXXVI, Issue 17 / September 9, 2025
TITLE 7 HEALTH
CHAPTER 27 EMERGENCY
MEDICAL SERVICES
PART 6 EMERGENCY
MEDICAL SERVICES ADVANCE DIRECTIVES
7.27.6.1 ISSUING
AGENCY: New
Mexico department of health, emergency medical systems bureau.
[7.27.6.1 NMAC - Rp, 7.27.6.1 NMAC, 9/9/2025]
7.27.6.2 SCOPE: This regulation applies to all
people of New Mexico who have capacity, or by a person duly appointed under a
durable power of attorney for health care, physicians, advanced practice
nurses, or physician assistants, and emergency medical services personnel.
[7.27.6.2 NMAC - Rp, 7.27.6.2 NMAC, 9/9/2025]
7.27.6.3 STATUTORY
AUTHORITY: These
regulations are promulgated pursuant to the Department of Health Act, Subsection
E of Section 9-7-6 NMSA 1978, which authorizes the secretary of the department
of health to “make and adopt such reasonable and procedural rules and
regulations as may be necessary to carry out the duties of the department and
its divisions”; and the Emergency Medical Services Act, Subsection I of Section
24-10B-4 NMSA 1978, which authorizes the department of health to adopt “regulations
pertaining to authorization of providers to honor advance directives to
withhold or terminate care in certain pre-hospital or inter-facility
circumstances, as guided by local medical protocols”.
[7.27.6.3 NMAC - Rp, 7.27.6.3 NMAC, 9/9/2025]
7.27.6.4 DURATION: Permanent.
[7.27.6.4 NMAC - Rp, 7.27.6.4 NMAC, 9/9/2025]
7.27.6.5 EFFECTIVE
DATE: September 9, 2025, unless
a later date is cited at the end of a section.
[7.27.6.5 NMAC - Rp, 7.27.6.5 NMAC, 9/9/2025]
7.27.6.6 OBJECTIVE: These regulations will inform the
public and New Mexico emergency medical services providers of the procedures to
authorize the use of advance directives in pre-hospital and inter-facility
settings.
[7.27.6.6 NMAC - Rp, 7.27.6.6 NMAC, 9/9/2025]
7.27.6.7 DEFINITIONS:
A. Definitions beginning with “A”:
(1) “Advance directive” means a
written instruction, such as a living will, durable power of attorney for
health care or emergency medical services do not resuscitate form recognizable
under state law and relating to the provision of health care when an individual
is incapacitated.
(2) “Advanced practice nurse” means a registered nurse who has completed the required education and training and received state of New Mexico approval to practice as a certified nurse midwife or advanced practice registered nurse.
(3) “Authorized health care decision
maker” means a person authorized under a durable power of attorney to make
health care decisions on behalf of another, a court-appointed guardian or the
parent of a minor or any other person authorized by law to make health care
decisions for another.
B. Definitions beginning with “B”: “Bureau” means the emergency medical systems bureau of the office of health emergency management of the epidemiology and response division of the department.
C. Definitions beginning with “C”: “Capacity” means an
individual’s ability to understand and appreciate the nature and consequences
of proposed health care, including its significant benefits, risks and
alternatives to proposed health care and to make and communicate an informed
health-care decision.
D. Definitions beginning with “D”:
(1) “Designee” means a physician
assistant, registered nurse or nurse practitioner, licensed or otherwise
authorized to practice, who is designated by a physician to explain an EMS DNR
order to a person who may execute the order.
(2) “Durable power of attorney” means
a document executed according to the provisions of Sections 45-5-501 through
45-5-502 NMSA 1978 of the New Mexico Probate Code, which designates an
individual to make health care decisions for the person executing the document,
or an advance health-care directive executed according to the provisions of Sections
24-7A-1 through 24-7A-18 NMSA 1978 of the New Mexico Uniform Health-Care
Decisions Act, which designates an agent or surrogate to make health care
decisions for an individual.
E. Definitions beginning with “E”:
(1) “Emergency medical services (EMS)” means
the services rendered by emergency medical technicians or certified emergency
medical services first responders in response to an individual’s need for
immediate medical care to prevent loss of life or aggravation of physical or
psychological illness or injury.
(2) “EMS bracelet” means a
bracelet, medallion or some other item of personal wear, approved by the bureau
for indicating in a standard, readily-recognizable manner that the person has
executed an EMS DNR order.
(3) “EMS do not resuscitate (DNR) order”
means an order issued by a physician, and signed by
the person or authorized health care decision maker, on a form approved by the
bureau, indicating that resuscitative measures should not be performed.
(4) “EMS personnel” means persons
currently licensed or certified by the bureau to practice as emergency medical
technicians (EMTs) or emergency medical services first responders in New
Mexico.
F. Definitions beginning with “F”: [RESERVED]
G. Definitions beginning with “G”: [RESERVED]
H. Definitions beginning with “H”: [RESERVED]
I. Definitions beginning with “I”: [RESERVED]
J. Definitions beginning with “J”: [RESERVED]
K. Definitions beginning with “K”: [RESERVED]
L. Definitions beginning with “L”: [RESERVED]
M. Definitions beginning with “M”: “Medical control” means
supervision provided by or under the direction of physicians to EMS personnel
by written protocol or direct communications.
N. Definitions beginning with “N”: “New
Mexico Medical Orders for Scope of Treatment (MOST) form” is a bureau
approved advanced healthcare directive/healthcare decision that may be used
either in conjunction with or as an alternative to the EMS DNR order; it
must be signed by a physician, advanced practice nurse, or physician’s
assistant and by the patient or patient’s healthcare decision maker.
O. Definitions beginning with “O”: [RESERVED]
P. Definitions beginning with “P”:
(1) “Physician” means a doctor of
medicine or doctor of osteopathy licensed or otherwise authorized to
practice medicine or osteopathic medicine.
(2) “Physician’s Assistant (PA)” means
a person who has received the education, training and approval from the State
of New Mexico to practice as a PA in New Mexico.
(3) “Pre-hospital setting” means any setting outside of
a hospital where EMS personnel are called for assistance, including but not
limited to long term care facilities, private homes or during transport.
Q. Definitions beginning with “Q”: [RESERVED]
R. Definitions beginning with “R”: [RESERVED]
S. Definitions beginning with “S”: [RESERVED]
T. Definitions beginning with “T”: [RESERVED]
U. Definitions beginning with “U”: [RESERVED]
V. Definitions beginning with “V”: [RESERVED]
W. Definitions beginning with “W”: [RESERVED]
X. Definitions beginning with “X”: [RESERVED]
Y. Definitions beginning with “Y”: [RESERVED]
Z. Definitions beginning with “Z”: [RESERVED]
[7.27.6.7 NMAC - Rp, 7.27.6.7 NMAC, 9/9/2025]
7.27.6.8 EMS
DO NOT RESUSCITATE (DNR) ORDER:
A. Execution and duration of an EMS DNR
order, including Section A of the MOST form:
(1) Any physician, advanced
practice nurse, or PA may execute an EMS DNR order on behalf of any person with
capacity, with the person’s informed consent.
The physician, advanced practice nurse, or PA or
designee shall explain to the person the full meaning of the order, the
available alternatives, how the order may be revoked, and answer any questions
the person may have about the order.
Both the physician, or the physician’s designee upon a verbal order from
the physician, and the person for whom the order is executed, shall sign the
document, as well as the physician, advanced practice nurse, or PA. A registered nurse may sign the EMS DNR or
MOST if a verbal order for the EMS DNR or MOST has been received from a
physician, advanced practice nurse, or PA; the name of the physician, advanced
practice nurse, or PA must be printed beneath the signature.
(2) If the person for whom an EMS DNR
order is contemplated has appointed an agent under a durable power of attorney,
and the person for whom the DNR order is contemplated lacks capacity, the
physician, advanced practice nurse, or PA or designee may discuss the
situation with the person’s authorized health care decision maker, if any. The physician, advanced practice
nurse, PA, or designee shall explain to the authorized health care decision maker the
full meaning of the order, the available alternatives, how the order may be
revoked, and answer any questions the authorized health care decision maker may
have about the order. If the authorized
health care decision maker gives informed consent to the order, the
decision maker will sign the EMS DNR or MOST, as will the physician, advanced
practice nurse, or PA. A registered
nurse may sign the EMS DNR or MOST if a verbal order for the EMS DNR or MOST
has been received from a physician, advanced practice nurse, or PA; the name of
the physician, advanced practice nurse, or PA must be printed beneath the
signature.
(3) An EMS DNR or MOST order
shall remain in effect indefinitely unless revoked or unless an expiration date
is specified in the document.
(4) An EMS DNR or MOST order
shall be periodically reviewed by the person for whom the EMS DNR order is
executed or by the authorized health care decision maker.
(5) A person for whom an EMS DNR order is
executed may choose to wear an optional EMS bracelet indicating the existence
of the order.
B. Revocation of an EMS DNR or
MOST order:
(1) An EMS DNR or MOST order
may be revoked at any time orally, by executing a subsequent order, or by
performing an act which indicates an attempt to revoke the order, such as by
burning, tearing, canceling, obliterating or destroying the order or any part
of it, by the person on whose behalf it was executed.
(2) If an EMS DNR or MOST order is
revoked, EMS personnel shall initiate appropriate resuscitation measures.
C. Execution and duration of a durable
power of attorney:
(1) Any adult with decisional capacity may
execute a durable power of attorney.
(2) A durable power of attorney shall
remain in effect indefinitely unless revoked or unless an expiration date is
specified in the document.
D. Revocation of a durable power of
attorney: a durable power of attorney
may be revoked at any time by executing a subsequent durable power of attorney
or by performing an act which indicates an attempt to revoke the durable power
of attorney, such as by burning, tearing, canceling, obliterating or destroying
the document, or any part of it, by the person who executed it. It may also be revoked by an oral statement
by the person who executed it.
[7.27.6.8 NMAC - Rp, 7.27.6.8 NMAC, 9/9/2025]
7.27.6.9 EMS
PERSONNEL AND PROCEDURES:
A. Authorization of EMS personnel: EMS personnel shall follow EMS DNR orders,
MOST form instructions or durable powers of attorney when encountering persons in
pre-hospital settings in accordance with these regulations and local EMS
medical protocols.
B. EMS procedures for verifying EMS DNR
orders: EMS personnel shall comply with
the following procedures when encountering a possible EMS DNR order:
(1) primary assessment - perform initial
primary assessment, i.e., assess airway, breathing and carotid pulse;
(2) verification of identification -
verify by:
(a) using a driver’s license or other
signed photo identification;
(b) identification by a family member; or
(c) positive third-party identification by
someone who knows the person;
(3) verification of existence of the appropriately completed MOST form by the steps in Subsection D of this section;
(4) verification of EMS DNR or
MOST order
- verify the existence of an EMS DNR or MOST order for the person, using the
following indicators:
(a) EMS DNR order only: if a valid EMS DNR order is immediately
accessible, proceed to Subsection C of this section;
(b) intact EMS bracelet: if the person is wearing an EMS bracelet that
is fully intact and not defaced, proceed to Subsection C of this section;
(c) non-intact or defaced EMS bracelet
with an EMS DNR order: if the person is
wearing an EMS bracelet that is not fully intact or is defaced, but an EMS DNR
order is immediately accessible, proceed to Subsection C of this section;
(d) non-intact or defaced EMS bracelet
without an EMS DNR order: follow the regular resuscitation protocol and
ask family member(s) or others present to locate the EMS DNR order; if the EMS
DNR order is located, proceed to Subsection C of this section; if the EMS DNR
order is not located, continue the regular resuscitation protocol and contact
medical control for consultation;
(e) no EMS bracelet and no EMS DNR order: if the person is not wearing an EMS bracelet
but there are other indications that the person is on DNR status, follow the
regular resuscitation protocol and ask family member(s) or others present to
locate the EMS DNR order; if the EMS DNR order is located, proceed to Subsection
C of this section; if the EMS DNR order is not located, continue the regular
resuscitation protocol and contact medical control for consultation;
(5) if there is any question about the
validity of an EMS DNR order or MOST form, or there is any indication of an
attempted homicide, initiate resuscitation until such time that the questions
have been answered; if possible, contact medical control for consultation.
C. EMS procedures for implementing EMS
DNR orders or MOST form instructions: if a person has a valid EMS DNR order or MOST form as evidenced by the steps in Subsection
B of this section, proceed as follows:
(1) for all persons: the following procedures may be initiated for
the comfort of the person if they have not been refused by the person or by the
authorized health care decision maker:
(a) administering oxygen by mask or
cannula;
(b) suctioning;
(c) managing airways except intubation and
other advanced airway maneuvers;
(d) administering analgesics, as
authorized by the New Mexico scopes of practice
(e) controlling bleeding;
(f) other care indicated on MOST form if utilized;
(g) making
patient comfortable; and
(g) comforting family.
(2) for all persons in cardiac or
respiratory arrest: the following
procedures shall be withheld:
(a) external cardiac compressions;
(b) artificial ventilations, intubation or
other advanced airway maneuvers;
(c) defibrillation/external cardiac
pacing;
(d) administration of cardiac medications;
and
(e) artificial respiration.
(3) if there is any question about the
validity of an EMS DNR order, or there is evidence of an attempted homicide,
initiate resuscitation until such time that the questions have been answered;
if possible, contact medical control for consultation.
D. EMS procedures for implementing the
instructions on the MOST form or other durable powers of attorney:
(1) EMS personnel shall comply with the
following procedures when encountering a MOST form, a DNR or advance directive form from
any other source, or other durable power of attorney:
(a) primary assessment - perform initial
primary assessment, i.e., assess airway, breathing and carotid pulse;
(b) verification of identification -
verify, using a driver’s license or other signed photo identification, by
family member’s positive identification, or identification by a person who
knows the person, that the person is the one who executed the durable power of
attorney; verify the identification of the person identified in the durable
power of attorney as the authorized health care decision maker; if
needed, contact medical control for consultation and then follow
that person’s instructions as authorized by the MOST form, other DNR
form, other advance directive, or durable power of attorney;
(2) if there is any question about the
validity of a MOST form, other DNR form, or other durable power of attorney,
initiate resuscitation until such time that the questions have been answered;
if possible, contact medical control for consultation.
E. Relationship of EMS DNR orders to
durable powers of attorney: Where a
person has both an EMS DNR order and a MOST form or other durable
power of attorney, the most recent document shall prevail for EMS treatment
only.
[7.27.6.9 NMAC - Rp, 7.27.6.9 NMAC, 9/9/2025]
7.27.6.10 ENFORCEABILITY
AND PROGRAM ADMINISTRATION:
A. Enforceability of DNR orders and
durable powers of attorney from other states:
EMS personnel may honor DNR orders and durable powers of attorney that
are executed in another state or jurisdiction in compliance with the laws of
that state or jurisdiction, or in compliance with the laws of New Mexico, to
the extent the document is not inconsistent with the public policy of New
Mexico.
B. Program administration: the bureau shall distribute, or arrange for
the distribution of, EMS DNR order forms and relevant information to interested
citizens and appropriate health care providers.
These materials shall include specific guidance on how to obtain
additional forms and the EMS bracelet.
[7.27.6.10 NMAC - Rp, 7.27.6.10 NMAC, 9/9/2025]
HISTORY
OF 7.27.6 NMAC:
Pre-NMAC
History: The
material in this part was derived from that previously filed with the state
records center:
DOH Regulation 94-10 (CHSD), Regulations Governing EMS Advance
Directives For The State Of New Mexico, filed 12/28/1994.
History
of Repealed Material:
DOH Regulation 94-10 (CHSD), Regulations Governing EMS Advance
Directives For The State Of New Mexico (filed 12/28/94) repealed 01/1/2006.
7.27.6 NMAC, Emergency Medical Services Advance Directives, (filed
12/16/2005) Repealed effective 9/9/2025.
Other
History:
DOH Regulation 94-10 (CHSD), Regulations Governing EMS Advance
Directives For The State Of New Mexico (filed 12/28/94) was renumbered,
reformatted and replaced by 7.27.6 NMAC, Emergency Medical Services Advance
Directives, effective 01/1/2006.
7.27.6 NMAC, Emergency Medical Services Advance Directives, (filed
12/16/2005) Replaced by 7.27.6 NMAC, Emergency Medical Services Advance
Directives, effective 9/9/2025.