November, 2000
AEDs:
Not As Common As The Office Water Cooler--But A
Lot More Helpful In Saving Lives
By Peter P. Greaney, MD
Board-Certified Occupational Physician
President, WorkCare
Although the automated
external defibrillator (AED) may never be as
commonplace as the office water cooler, the
device is beginning to appear in more businesses
as a way of saving lives from sudden cardiac
arrest.
Several nationally
recognized companies have taken the lead in
managing on-site medical emergencies by using
AEDs in the workplace. These companies
include IBM, Honda of America, General Mills and
Dow Chemical Company. The increased use of
these devices points to the fact that there is
greater “buy-in” from Corporate America
about the benefits that AEDs bring to the
workplace.
Although the value of
AEDs is apparent, occupational health/safety
professionals must address issues such as cost,
liability and prioritization of health and
safety resources to determine if the device is a
good business fit. Most AEDs cost around
$3,000 and are sold under guidelines approved by
the U.S. Food and Drug Administration.
Current FDA rules require a physician's
prescription to purchase an AED.
Approximately 225,000
people die each year from sudden cardiac arrest,
which is caused by abnormal heart rhythms, known
as arrhythmias. The most common type of
arrhythmia is ventricular fibrillation, which is
a malfunction of the heart's electrical system.
When a person experiences ventricular
fibrillation, their heartbeat goes into a
chaotic rhythm that causes the main pumping
chamber to quiver or “fibrillate.”
When the heart is in this unnatural state, it
cannot pump blood effectively to the body and
brain, causing the victim to lose consciousness.
Death is followed in minutes--if no emergency
attention is received.
AEDs are used to help
people with sudden cardiac arrest by restoring
their natural heart rhythm through the
therapeutic delivery of an electric current.
Defibrillation shock is the only recognized
treatment that can reverse sudden cardiac
arrest.
Currently, only 5% of
people stricken by sudden cardiac arrest
survive, with only a few resuming a normal life
after the incident. The American Heart
Association estimates that about 100,000 or more
deaths from sudden cardiac arrest could be
prevented if AEDs were more widely available to
trained, first-line emergency responders.
Because a person's chance
of survival from sudden cardiac arrest decreases
by about 10 percent for each minute that goes by
without treatment, early response and use of an
AED can mean the difference between life and
death. The American Heart Association
developed the “chain of survival” to help
increase the survival rate of sudden cardiac
arrest.
The “chain of
survival” is a guideline of emergency response
actions for bystanders, medical personnel and/or
first responders who encounter a sudden cardiac
arrest victim. The four-step emergency
treatment process involves:
Ø
Ensuring early access to care (calling 911)
Ø
Early Administration of Cardiopulmonary
Resuscitation
Ø
Early Defibrillation
Ø
Early Advance Care
The AED works by using a
computer to assess a patient's heart rhythm
through electrodes that are attached to the
person's chest. The AED's microprocessor
analyzes the heart rhythm and determines if
defibrillation is needed. The device will
only advise the operator to shock if ventricular
fibrillation or extreme ventricular tachycardia
is detected.
Technological advances in
AEDs have created a new generation of devices
that can be used safely by non-medical personnel
who receive basic training. Many of the
devices have built-in audio prompts and/or
visual displays that guide an operator through
the process, instructing the user how and where
to place the electrodes and advising if a shock
is necessary.
The AED has proven to be
safe by anyone who has been trained to use it,
according to an American Heart Association
report. “Studies have shown the devices
to be 90% sensitive (able 90% of the time to
detect arrhythmia that should be defibrillated)
and 99% specific (able 99% of the time to
recommend not shocking when defibrillation is
not indicated).
The device was even
proven safe and user friendly for children, as
demonstrated by a study that involved a
simulation of cardiac arrest.
Results of the study published in the Journal of
the American Heart Association showed that it
took sixth-grade students only 27 seconds longer
than trained professionals to use the device to
apply a shock that could restore a heartbeat.
The study underscored the fact that AEDs are now
much more user friendly than previous models.
Although AEDs are safe
and easy to use, the American Heart Association
recommends that people who have access to the
device participate in the agency's AED
Heartsaver class, a four-hour course that is
available through community training centers in
most cities. The course teaches people how
to recognize sudden cardiac arrest, when to
activate emergency medical services and how to
perform cardiopulmonary resuscitation.
AED manufacturers, the
American Heart Association and the American Red
Cross, have addressed safety, ease of use and
training issues, making the device far more
attractive to businesses. However,
perceptions about company and individual
liability regarding AED usage have hindered
efforts to expand public access defibrillation
programs.
Given our
litigious-driven environment, AEDs have not yet
earned widespread acceptance because of
potential civil liabilities posed to AED
operators, owners, trainers and prescribing
physicians.
This situation is
beginning to change. Now 49 states, including
California , have adopted legislation that gives
critical protection from lawsuits to all or some
AED operators, such as lay persons (Good
Samaritans), rescuers, enablers, medical
directors and AED trainers.
In addition, Congress
recently passed the Cardiac Arrest Survival Act
that will extend immunity for Good Samaritans in
those states that do not offer protection from
liability. The bill also authorizes the creation
of guidelines to place AEDs in all federal
buildings. President Clinton signed the
Act on November 15, 2000.
Until recently, support
for AEDs in the workplace did not receive
significant support from the corporate sector,
due to concerns over the possibility of
negligence lawsuits arising from the use of
company-owned AEDs. It's reasonable for
businesses to take this issue into consideration
when analyzing the risks and benefits of AEDs.
Yet a closer look at the
issue reveals that it may be more likely for a
company to reduce its liability risks by having
an AED at the worksite.
Legal experts on AED
liability cases state that recent jury verdicts
indicate a trend toward finding companies
negligent for not fulfilling their duties in
providing timely emergency response actions.
According to Attorney
Richard A. Lazar, four essential elements must
be proven in order for a plaintiff to
successfully sue an AED purchaser or user.
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These include
duty, breach of duty, causation of
injury, and legally recognized damages.
The failure to prove any one of these
elements is fatal to a plaintiff's case.
The element of greatest importance in
the AED context is that of duty.
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Duty in
negligence law is defined as “an
obligation, to which the law will give
recognition and effect, to conform to a
particular standard of conduct toward
another.” In the absence of a
legal duty, no liability can be imposed.
In other words, one cannot be
successfully sued for failing to perform
an act in the absense of a legally
mandated obligation to perform the act
in the first place.
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In the context of
duty, businesses contemplating the
purchase of AEDs must consider whether a
legal obligation to render medical aid
to patrons exists and, if so, the scope
of the obligation. In effect, this
constitutes an analysis of legal risk.
While bystanders generally have no legal
obligation to provide affirmative
medical aid to ill or injured persons,
the existence of certain relationships
between a victim and one in a position
to render aid may create a duty to
provide assistance.
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Business sectors
including common carriers (airlines,
rail line, etc.) and innkeepers (hotels,
motels, etc.) and commercial business
establishments open to the public (most
other businesses) may be compelled by
law to render a minimum level of first
aid care and to timely summon outside
emergency medical assistance. The
scope of this duty is generally defined
by appellate court case law, trial
courts and juries.
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Bolstering this point are
two recent 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 Garden's 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,
Lufthansa Airlines was ordered to pay $2.7
million to a plaintiff for the loss of a family
member who suffered sudden cardiac arrest on its
plane. The court found that the airline
failed to provide emergency medical treatment on
a timely basis.
Leading the effort to use
AEDs on airplanes, American Airlines was one of
the first companies to equip its entire fleet of
planes with the device. Now more than 30
of the world's airlines carry the AEDs on board
on some of their flights.
Although AEDs may
actually reduce a company's risk of liability,
the most compelling reason to support AEDs in
public places is because they save lives.
A just-published study in
the New England Journal of Medicine provides
conclusive evidence that laypersons trained on
the operations of AEDs can improve survival
rates for out-of-hospital victims.
The study involved
training casino security officers in the use of
AEDs and cardio pulmonary resuscitation.
The AEDs were placed in strategic locations of
the casino, which made it possible to provide
early defibrillation--with the response-time
goal being three minutes, from collapse to first
defibrillation.
For the 105 casino
patients who suffered sudden cardiac arrest, the
survival rate was 74% for those who received
their first defibrillation no later than three
minutes after collapse. For those that
received their first defibrillation shock after
three minutes, the survival rate dropped to 49%.
This study provides
clear, compelling proof that a shorter
defibrillation response time greatly improves a
sudden cardiac arrest victim's chance for
survival. Furthermore, the high survival
rate in this study--compared to the national
standard of 5%--provides strong testimony to
support public access defibrillation programs.
Occupational health and
safety professionals--those who are charged with
maintaining a safe working environment--must
consider the following facts:
Two out of three deaths
from sudden cardiac arrest occur outside a
hospital, in public places such as airlines,
urban centers and work. And with over 139
million U.S. workers who spend a third of their
time at work, it makes “life-saving” sense
to support public access defibrillation
programs.
Something to think about
while you are at the water cooler.
Sources Cited
Lazar, Richard A.
“Defibrillators Enter the Business MarketPlace.”
Occupational Health & Safety August 1997
Link Reference
http://www.americanheart.org/
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