DNR Issues In Airport And Airline AED Programmes: The Need For Dialogue And Openness In Developing Policy

Abstract

This paper is concerned with the safeguarding of patient autonomy in the context of early defibrillation (AED) programmes, with particular reference to airlines and airports. It focusses especially on the role of out-of-hospital Do-Not-Resuscitate (OOH-DNR) orders as a means of communication with non-physician first responders. The ethical and legal issues surrounding OOH-DNR orders and lay first responders are briefly discussed. The implications of extending 'Good Samaritan' protection to operators unschooled in the determination of advance directives are raised. Most of all, the paper stresses the importance of wide consultation and open publicity regarding the DNR policy of any AED programme. In recent years, the use of automated external defibrillators (AEDs) by laypersons both trained and, in some cases, untrained has become increasingly widespread. Among the most enthusiastic adopters of AEDs have been commercial passenger airlines and airports. The Australian carrier QANTAS was the first to equip its fleet with AEDs [1] and since then a large number of both major and minor airlines have followed suit. As a result of federal legislation, all USbased carriers are now obliged to carry AEDs and train flight attendants in their use [2, 3]. Amongst other AED-equipped carriers are the Brazilian airline Varig [4], German Lufthansa [5], Air France [6], South African Airlines [7], British Airways [8], and Virgin Atlantic [9]. With regard to airport programmes, the one at Chicago's O'Hare Airport is probably the most widely publicized [10], though many airports, including London's Heathrow and a number of smaller UK airports, now have similar provision [11].