A New AED Mandate
New Law and Technology Aim to Increase Survival Rate
BY GREG SLUSSER

A new Oregon law that mandates at least one automated external defibrillator be present in every large, public gathering place may spur national organizations to adopt the law’s standards across the country.

Chris Chiames, executive director of the Sudden Cardiac Arrest Association, which works to create sudden cardiac arrest awareness and broaden public access to AEDs, says the new law “clearly has national chains paying attention. They recognize the ripple effect of possibly having other states follow suit, or the difficulty of having two standards within the company.”

Chiames says he has talked to people at various companies that are now considering AED implementation after having consistently resisted it in the past. “I wouldn’t want to have to explain to employees in other parts of the country that their safety wasn’t as important as the people in Oregon,” he said. Adding, there’s only one choice: embrace the reality of AEDs being a necessary emergency response in the workplace.

Facilities that must meet the mandate include all public gathering places with 50,000 square feet or more of floor space, as well as business facilities of the same size where 25 or more individuals are present on a normal business day. The law does not apply to schools and places of worship.

The Oregon law has a broad mandate compared to other states where mandates exist. Other mandates apply most commonly to state buildings, schools, athletic events or facilities, and fitness centers, according to the National Conference of State Legislatures (NCSL).

Oregon law also provides broad liability protection. Its broad mandate is not the only reason the law is notable. The law also provides significant Good Samaritan protection, except in cases of gross negligence or misconduct. Good Samaritan protection exempts individuals who render emergency treatment with an AED from liability.

Unlike some states, Oregon shields AED owners from lawsuits if injuries, death, or loss results from the use, attempted use, or nonuse of the AED. Some states also withhold liability protection when AEDs are not maintained properly or used correctly. While the intention of these stipulations is to encourage training and proper maintenance, these requirements may become barriers to AED implementation by raising liability concerns.

The Oregon law also protects AED users from liability, whether or not they have received AED training. This protection is significant because some states do not provide this protection to untrained users, even if the user is a Good Samaritan trying to help a sudden cardiac arrest victim. Recently, some states – where Good Samaritan protection at first was provided only to trained responders or emergency medical personnel – have amended their laws to broaden Good Samaritan coverage.

AED laws go back several years; by 2001, all 50 states had enacted laws or adopted regulations regarding the use of AEDs, according to a report by the NCSL. In 2002, the federal government authorized millions of dollars in grants to purchase and place AEDs in public places and to train first responders in life-saving care. The same legislation encouraged private companies to purchase AEDs and train employees in CPR and emergency defibrillation.

Oregon Law Latest in a Trend

The Oregon law is the latest one to identify AED treatment as a standard of care, Chiames says. He said the Oregon law acknowledges that AED treatment is the standard for victims of sudden cardiac arrest. “If someone falls and sprains an ankle, you would bring ice, not wait for EMS.

If someone were bleeding, you would apply pressure to stop the bleeding, not wait for EMS. Similarly, treatment with an AED is the expected response to sudden cardiac arrest.

Organizations that do not meet the standard of care expectation in states or municipalities where AEDs are mandated can face civil charges. Airlines, amusement parks, fitness centers, and transportation authorities have been successfully sued for a failure to have AEDs.

However, there has never been a successful suit of a Good Samaritan responder who was unsuccessful in resuscitating a sudden cardiac arrest victim with an AED.

Other Barriers

Once an organization recognizes the value of AEDs, it still may be daunted by the effort necessary to implement an AED program. Challenges to implementation include maintenance, training and lack of confidence

“There still is the fear of how do we get all this done,” says Dave Bingham, director of AEDs and training for Cintas First Aid and Safety. Organizations must make decisions about the kind of AEDs and how many to purchase, where they will be placed, how many employees should be trained and how to train them, how the AEDs will be maintained, and many other issues, Bingham states.

In response, many AED suppliers offer training and maintenance services that allow customers to outsource much of the necessary work.

Maintaining an AED is very simple compared to tending to property and equipment such as escalators, elevators, plumbing, and fire prevention systems. For example, AEDs perform automatic self-testing, requiring only regular visual inspection of the “ready” status light and periodic battery and pad replacement.

Some organizations worry that an attempt to save a life with an AED will fail and lead to a lawsuit. In many jurisdictions, they have no duty to have an AED and believe they have less liability exposure if they don’t have one.

Models Easy to Use

AED manufacturers are addressing this concern as well, designing AEDs that are less intimidating and easier to operate for lay responders. For example, real-time video instruction through a 2.5- x 3-inch LCD screen is available on Defibtech’s View AED. A responder can grab the unit, hit the “on” button, and follow the video instruction during an emergency to achieve life-saving results.

The unit tells a responder – with video, text and audio – how to apply the defibrillation pads, when to shock the patient, and how and when to provide chest compressions and rescue breaths. It reminds rescuers to call 9-1-1, so that the sudden cardiac arrest victim can be transported to a hospital as quickly as possible after being revived by the AED.

The video and text feature also helps during an emergency in a noisy environment or if the user does not understand the English voice prompts. In non-emergency situations, training can be enhanced with video walking the user through each step of life saving, allowing those receiving training to easily repeat necessary steps and gain confidence.

While new laws and technologies are strengthening the case for AEDs, Chiames emphasizes that the best reason to have an AED is the raw fact that only 5 percent of the nearly 300,000 people who suffer sudden cardiac arrest each year survive.

“The big picture is how many people die each year of sudden cardiac arrest,” he says. More AEDs at the scenes of sudden cardiac arrest will save a higher percentage of victims. “The focus must be on having AEDs just as you would have basic first aid in a workplace,” he explains. “AEDs can be part of a company- wide discussion of heart disease prevalence and risk factors, as well as overall wellness.”

The American Heart Association agrees, noting that as many as 50,000 lives could be saved annually if AEDs were more widely available. FSM

Greg Slusser is a vice-president at Defibtech, a designer and manufacturer of automated external defibrillators (AED). www.defibtech.com, 1-866-333-4248.