Objectives: Our primary objectives were to estimate how frequently emergency medical technicians with defibrillation skills (EMT-Ds) are forced to deal with prehospital do-not-resuscitate (DNR) orders, to assess their comfort in doing so, and to describe the prehospital care provided to patients with DNR orders in a system without a prehospital DNR policy (i.e., where resuscitation is mandatory). Methods: Using Dillman methodology, the authors developed a 13-item survey and mailed it to 382 of 764 EMT-Ds in the metropolitan Toronto area. Responses were evaluated using 5-point Likert scales, limited-option and open-ended questions. Narrative responses were categorized. Two authors independently categorized narrative responses from 20 surveys, and kappa values for agreement beyond chance were determined. Results: Among 382 EMT-Ds surveyed, 236 (62%) responded, of whom 221 (94%) answered the questionnaire. Overall, 126 of 219 (58%) indicated that they were called to resuscitate patients with DNR orders "sometimes," "frequently," or "all the time." In such situations, 22 of 207 (11%) stated they would honour the DNR order and 55 of 207 (27%) would honour the order but appear to provide basic resuscitation, in order to adhere to mandatory resuscitation regulations. Willingness to honour a DNR order did not vary by years of emergency medical service. EMT-Ds cited concern for the family and the patient, fear of repercussions and conflict with personal ethics as key factors contributing to this ethical dilemma. If legally allowed to honour DNR orders, 212 of 221 (96%) respondents would be comfortable with a written order and 137 of 220 (62%) with a verbal order. Conclusions: Prehospital DNR orders are common, and a significant number of EMT-Ds disregard current regulations by honouring them. EMT-Ds would be more comfortable with written than verbal DNR orders. An ethical prehospital DNR policy should be developed and applied. RÉSUMÉ Objectifs : Nos principaux objectifs étaient d'estimer la fréquence à laquelle des techniciens médi-caux d'urgence ayant une formation en défibrillation (TMU-D) sont confrontés à des demandes de ne pas réanimer en situation pré-hospitalière, d'évaluer leur niveau de confort face à de telles situations et de décrire les soins pré-hospitaliers administrés aux patients ayant fait une demande de ne pas réanimer au sein d'un système doté d'aucune politique à ce sujet en situation pré-hospitalière (i.e. la réanimation est obligatoire). Méthodes : À l'aide de la méthodologie de Dillman, un sondage en 13 points fut élaboré et envoyé par la poste à 382 des 746 TMU-D de la région métropolitaine de Toronto. Les réponses furent éval-uées à l'aide d'échelles de Likert en 5 points, de questions à choix limités et de questions à développement. Les réponses à développement furent classées. Deux auteurs (P.R.V. et L.J.M.) classèrent indépendamment les réponses à développement provenant de 20 sondages et les valeurs kappa pour une concordance non aléatoire furent déterminées.