Bonus Feature: Two Heads Are Better Than One

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By Larry Soehren, BOMA International From the March 2003 issue of Today’s Facility Manager

Imagine for a moment an employee or tenant who suddenly collapses from cardiac arrest and needs medical attention immediately. It could easily happen; about 250,000 Americans die each year from sudden cardiac arrest (SCA).The idea of having to attend to a person suffering SCA before professional medical help can arrive is a frightening thought. It could be a truly daunting task, especially for someone who has little or no medical training or education. Through the use of technology and trained lay people, cardiac emergencies do not have to become tragedies. With prompt, proper care and a device called an automated external defibrillator (AED), it is now possible for employees to revive a person suffering from a heart attack. Recent advances in technology have given rise to AEDs that are safe, effective, easy to use, and relatively inexpensive.

Partnerships

Today, more organizations are taking action to set up early defibrillation programs to help save the lives of people who suffer from SCA. They are installing AEDs in key locations where people gather, such as airports and sports arenas. For example, the Players Golf Association (PGA) of America has partnered with the AHA to install AEDs on the golf courses chosen for its tournaments. Recognizing the importance of this issue, BOMA International partnered with the AHA in 2001 to encourage the installation of AEDs in commercial facilities. This joint program is also designed to implement programs to reduce the time to defibrillation and improve the SCA survival rate. AEDs are being installed in federal government facilities as well.

Guides

In May 2001, the Department of Health and Human Services (HHS) and the General Services Administration (GSA) issued a Notice of Availability of Guidelines on the placement and use of AEDs, entitled “Guidelines for Public Access Defibrillation Programs in Federal Facilities.” The guidelines provide a general framework for initiating a design process for public access defibrillation (PAD) programs in federal facilities, and they provide basic information to familiarize facilities’ leadership with the essential elements of a PAD program. BOMA International has also been actively involved in the effort to proliferate AED usage for the past few years and has produced a publication entitled The Property Professional’s Guide to Managing an AED Program. The document explains, step-by-step, the main components of establishing an AED program. It covers everything facility managers need to know-including the legal ramifications of incorporating a program in their buildings. This comprehensive guidebook also covers the causes of cardiac arrest, the issues involved when integrating with the Emergency Medical Services (EMS) System, and what factors to consider when purchasing and placing an AED. BOMA International took decisive action on the AED issue when the Board of Governors approved a research project examining the many issues concerning the implementation of AED devices in buildings in 2000. After a six-month research effort, the final report was presented to the BOMA International Board of Governors. This resulted in a formal policy statement that states: “Legislation and regulatory action regulating the use of AEDs in public and private office buildings must provide immunity from civil liability for laypersons or Good Samaritans who acquire and use the devices on victims in perceived medical emergencies, whether trained or untrained, if acting in good faith.”

Recommendations

The decision to establish a PAD program and purchase the proper AED should be based on the particular needs of a company. To ensure that AEDs outside the emergency medical system are used as safely and effectively as possible, BOMA International recommends that any facility voluntarily choosing to obtain AEDs incorporate them into a PAD program. Based on the recommendation of the AHA, the key elements of a PAD program are:
  1. Training designated rescuers to perform CPR and use an AED;
  2. Having physician oversight to help ensure quality control;
  3. Integrating with the local EMS system; and,
  4. Using and maintaining AEDs according to manufacturer specifications.
On the federal legislative front, BOMA International supported The Cardiac Arrest Survival Act, signed into law by President Clinton in November 2000. This bill was the first major piece of federal legislation governing the use of AEDs. The legislation approved the placement of AEDs in federal buildings and provided limited immunity protections for authorized users. If a Good Samaritan, building owner, or occupant acts in good faith to purchase or use an AED to save a life, this law will provide protection from unfair lawsuits. Last year, the BOMA/AHA initiative received a major boost when Congress passed the Community Access to Emergency Devices Act. This five-year measure, included in the bioterrorism bill, authorized $30 million in federal grants during the first year for local AED purchases and training. Grant funds would also be used to train first responders to administer immediate lifesaving care, including AED use and cardiopulmonary resuscitation (CPR). The bill also encourages private companies to purchase AEDs and to train employees in CPR and emergency defibrillation. Senate Majority Leader Bill Frist (R-TN), who introduced the legislation in the Senate, and Senator Ted Kennedy (D-MA), described the bill as “a much needed measure that will save lives.” Frist, a heart surgeon and the only physician currently serving in the Senate, predicted that widespread and timely use of emergency defibrillation devices could save up to 100,000 lives annually.

State Actions

Legislation has also moved rapidly on the state level. Back in 1997, Florida was the first state to enact a broad public access law. Today, all 50 states have approved measures designed to increase AED implementation. Most of the bills enacted in the last three years included one or more provisions to:
  • Establish legislative intent that an “automatic external defibrillator may be used by any person for the purpose of saving the life of another person in cardiac arrest”;
  • Encourage or require training in the use of AED devices by potential users;
  • Require AED devices to be maintained and tested to manufacturer’s standards;
  • Create a registry of the location of all such defibrillators, or notification of a local emergency medical authority;
  • Allow a “Good Samaritan” exemption from liability for any individual who renders emergency treatment with a defibrillator; and
  • Authorize a state agency to establish more detailed requirements for training and registration.
Someday, AEDs may be as commonplace as fire extinguishers and first aid kits; however, during this period of transition, facility managers, building owners, and employees in general need to become more familiar themselves with AEDs. Instruction and training in their use really could save lives. Soehren is president of BOMA International.

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