Last Updated: January 2020

Click here to download this RLSS UK Statement Guidance


Cardiopulmonary resuscitation (CPR) is a treatment for a casualty not breathing normally; this could be due to an accident or medical episode.

When people are gravely ill or have a terminal illness, they can opt not to receive CPR, which may or may not prolong their life and could deprive them of a dignified death. In these circumstances, the individual would apply to a healthcare professional and, if granted a standardised form, would record the ‘Do Not Attempt CPR’ (DNACPR) decision.

It is also known as ‘Do Not Resuscitate’ (DNR) and ‘Advance Decision to Refuse Treatment’ (ADRT).

DNR/ DNACPR/ ADRT in a swimming pool environment

DNR/DNACPR/ADRT has been designed for healthcare professionals and care staff working closely with patients. They were not designed for bystanders who may come across a patient in the public domain or people with a duty to respond to a member of the public (such as lifeguards or First Aiders).

The British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing have created a document titled, Decisions relating to cardiopulmonary resuscitation, published in 2016


As many swimming pools are in public environments, consideration should be given to public perception when a lifeguard or First Aider does not give treatment. It could also be very distressing for a lifeguard or First Aider to do nothing and stand back when they are trained to ensure they take immediate action.

Many Swimming Pools and Leisure Centres operate for up to 18 hours a day and have a variety of employees working a few shifts throughout the day. This would make it very difficult to ensure all employees could identify an individual as a holder of a DNR/ DNACPR/ ADRT and be sure that attempts to resuscitate should not be completed.

How the authenticity of a DNR/ DNACPR/ ADRT certificate could be checked and should be applied is something that, in many cases, would be impossible.

Additional information:

After a review of DNACPR in 2014, the Recommended Summary Plan for Emergency Care and Treatment was developed, more commonly known as the ReSPECT plan. The ReSPECT plans are being implemented across Health Care Trusts within the UK and will become as common as DNR, DNACPR etc.

Existing DNACPR forms and Treatment Escalation Plans (TEPs) will continue to be effective and will not be replaced immediately. When healthcare communities implement the ReSPECT process, there will be a robust plan to ensure that existing DNACPR forms or TEPs remain valid for a substantial period of overlap. ReSPECT is not just a replacement for a DNACPR form; it aims is to promote recording an emergency care plan by many more people, including many whose ReSPECT forms will recommend active treatment, including attempted CPR, if needed.

For more information, visit


RLSS UK would advise Operators to use this guidance to explain the challenges a leisure centre/swimming pool faces if a DNR/ DNACPR/ ADRT/ReSPECT plan is requested.

Given the challenges detailed, RLSS UK would not advise Operators to accept a request.

Click here for other RLSS UK Guidance Statements