Introduction

Cardiopulmonary resuscitation (CPR) is treatment for a casualty that is 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 to not 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 have been designed for healthcare professionals and care staff working closely with the patient. They were not designed for bystanders who may come across the patient in the public domain or people with a duty to respond to a member of 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 www.resus.org.uk/dnacpr/decisions-relating-to-cpr/.

Considerations

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 number of 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 or more commonly known as 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; the aim 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 it should be needed. For more information visit www.resus.org.uk/respect/

Guidance

RLSS UK would advise Operators to use this guidance as an aid to explain the challenges a leisure centre/swimming pool faces if, an individual makes a request for DNR/ DNACPR/ ADRT/ReSPECT plan. Given the challenges detailed, RLSS UK would not advise Operators to accept a request

Click here to download this guidance