In November 2000, a significant piece of life saving workplace legislation was passed into law. As part of President Clinton’s effort to prevent deaths resulting from sudden cardiac arrest (SCA), The Cardiac Arrest Survival Act (CASA) directed the placement of automated external defibrillators (AEDs) in federal buildings around the nation. (AEDs are portable devices that deliver an electric shock to treat SCA and restore a normal rhythm. For an overview of AEDs, see the article entitled “Defibrillators In The Workplace,” by Mark Altmann, Today’s Facility Manager, September 2001.) Guidelines for placing AEDs in federal buildings will be established by the U.S. Secretary of Health and Human Services.
Last December, The Community Access To Emergency Defibrillation Act Of 2001 was introduced into the House of Representatives. This bill passed in the Senate on February 6, 2002 and is now in the House for consideration. In addition, the Occupational Safety and Health Administration (OSHA) recently issued a Technical Information Bulletin outlining the potential benefits of workplace AED programs.
A letter from Assistant Secretary of Labor John Henshaw, who administers OSHA, notes that the Agency will distribute AED-related information to more than 125 trade, professional, and union organizations, as well as feature the benefits on their Web site. The site will convey the benefits of making AEDs available in the workplace and will point employers towards the resources necessary to develop such programs. Legislation and regulations from many sectors clearly indicate that employers must be made more aware of this important life saving technology.
For many employers, the most significant hurdle to AED program implementation is fear of lawsuits. Fortunately, all 50 states have adopted Good Samaritan laws, giving some degree of immunity to lay people who help others in distress. Since the goal of CASA is to encourage people to respond in a cardiac emergency by using an AED, the law actually augments existing state Good Samaritan laws by ensuring federal liability protection for trained users and purchasers of AEDs. It also protects any person who has maintained the AED, provided training, tested the device, or even provided medical oversight for the machine.
In an August 1997 issue of Occupational Health & Safety, Richard A. Lazar, an attorney in the field, points out four key elements which must be proven in order for a plaintiff to sue an AED purchaser or user. “These include duty, breach of duty, causation of injury, and legally recognized damages.” He adds, “No lawsuits, verdicts, or appellate cases are identified involving the use of a defibrillator in the business environment to help a victim of SCA.”
Dr. Peter Greaney, president of Orange, CA-based WorkCare reinforces Lazar’s point by citing “two cases in which companies were found to be negligent in providing emergency care. In 1996, a Florida jury awarded a plaintiff $500,000 for her daughter’s death that occurred at Busch Gardens. The jury found that Busch Gardens was negligent for failing to have essential medical equipment–including a defibrillator–on site and for providing its employees with insufficient emergency care training, which resulted in the girl’s death.
In another case, Greaney notes, “Lufthansa Airlines was ordered to pay $2.7 million to a plaintiff for the loss of a family member who suffered SAC on its plane. The court found that the airline failed to provide emergency medical treatment on a timely basis.”(“AEDs: Not As Common As The Office Water Cooler–But A Lot More Helpful In Saving Lives,” Osh.Net, November 2000.)
AEDs Take Off In Airports
Naturally, the Lufthansa suit sparked a great deal of reaction in the airline industry. American Airlines was one of the first major U.S. carriers to install AEDs aboard its entire fleet of planes. Since the adoption of the initiative, survival rates for patients receiving defibrillation rose to 40%. In April 2001, the Federal Aviation Administration (FAA) issued a final rule requiring AEDs on passenger flights with at least one flight attendant. The rule goes into effect May 12, 2004. (Federal Register, Vol. 66, No. 71, April 12, 2001.)
While The Airport Medical Assistance Act of 2000 (H.R. 5323) stalled in the House (and has since been redrafted but not submitted), airlines, airports, and other major transportation hubs have led the push to incorporate AEDs. As one of the sponsors of H.R. 5323, Congressman Bill Lipinski (D-IL) was disappointed by the FAA’s decision not to require AEDs in airport terminals. The FAA issued a decision (65 Federal Register 35971, June 20, 2000) stating that the agency would not propose a regulation to require AEDs at airports, since most major airports “have already taken necessary steps to provide for the medical capability to address cardiac events.”
Irvine, CA-based Cardiac Science President and CEO Raymond W. Cohen says, “We are seeing firsthand that local government agencies, including airport authorities, are beginning to respond to the overwhelming evidence that AEDs are extremely effective, safe to be used by virtually anyone, and can be the single most important public health and safety decision they can make to protect citizens.”
L.A. Leads The Way
In January, Los Angeles officials launched a citywide public access defibrillation (PAD) program to protect residents, workers, and visitors to public buildings throughout the city. As a result of the program, AED technology is now available in the most frequented buildings and tourist destinations, including city hall, parks, recreation facilities, the convention center, the city’s airports, and the zoo.
“Los Angeles is among the nation’s leading cities that have created bold, far-reaching programs to improve survival rates from SCA,” says Deborah DiSanzo, vice president and general manager for cardiac resuscitation at Andover, MA-based Philips Medical Systems.
David Freeman, worldwide marketing director at Philips adds, “Once people hear about L.A., communities across the country are responding to an incredible degree. The L.A. story tells urban communities that municipal governments really should take a proactive role in PAD program development.”
How To Get AED Training
While AEDs have been used successfully by lay personnel, some degree of training is recommended for those administering the device in airports, businesses, and other public buildings. In the words of Naomi Katzman, marketing manager for Solon, OH-based Complient, “purchasing an AED is just one small part of saving the life of an SCA victim.” (Complient specializes in the design, implementation, maintenance, and management of AED-based emergency medical response programs.)
Two studies reported in the October 2000 issue of the New England Journal of Medicine indicate that people with minimal training can successfully use simple, portable defibrillation devices to save lives that might otherwise be lost. “The more people who learn CPR and are trained to use an AED, the more lives will be saved,” says Mike Bell, director of training and field operations at the American Heart Association (AHA). Katzman adds, “Since OSHA requires regular safety and health training at most facilities, CPR and AEDs should simply be included as part of the standard process.”
AED manufacturer Medtronic Physio-Control of Redmond, WA has joined up with Washington, DC-based Lifelink MD to offer “LIFEPAK® Heart Safe Solutions”–a package that combines equipment with medical oversight, training, and customer service. This offering provides fms with “a committed partner to handle program setup as well as ongoing program management,” according to Jon Tremmel, president of Medtronic Physio-Control.
Another company, Zoll Medical of Burlington, MA is taking additional steps to help make public access defibrillation a widespread reality. The company is providing an educational grant to establish an AED Instructor Foundation, which should help save thousands of lives from being lost to SCA.
The Money Issue
With prices ranging from $3,000 to $4,000 per unit, the purchase of multiple AEDs for larger commercial facilities may raise some financial eyebrows during these difficult economic times. For smaller companies, the money simply might not be in the budget.
In response to this concern, Bill Buth, BOMA/St. Paul president and chair of BOMA International’s AED committee states, “If someone has a heart attack in your building and doesn’t make it, what will $3,000 to $4,000 buy you? It’s a small price to pay to save a life.”
But “at $3,800 a piece, businesses might be slow to adopt them,” says David Wright, president of Severna Park, MD-based LifeSignsAmerica. His company makes AEDs affordable for all organizations that wish to install them; they’re actually free. The EyeCatcher/Freefone/AED, manufactured by DiAZiT of North Carolina, uses a combination of billboard-like advertising and free phone service to pay for the unit–or possibly even provide income for the businesses that host them.
“The signs generate revenue for the companies in which they are placed. Many companies are using the funds for charitable donations since we estimate one sign can generate $21,600 per sign per year,” Wright explains.
In spite of their ability to prevent sudden heart failure, AEDs are noticeably absent in many facilities across the country. Indeed, very few facilities have been proactive regarding this matter. Clearly, the urgency of strategically placed AEDs and the need for trained workplace personnel will continue to grow over the next few years. Fms must adopt the proper attitude, overcome skepticism, and convince management to make the investment in an AED program. After all, the life they save could be their own.