According to a report on the Early Defibrillation Law and Policy Center Web site (www.edlpc.com), “Out-of-hospital sudden cardiac arrest (SCA) death strikes between 350,000 and 450,000 people annually in the United States — at least 1,000 per day. Most individuals who experience SCA have not been previously identified as high-risk individuals and events usually occur in public places or at home rather than in medical settings. Because of this, the overall SCA survival rate in the United States is estimated to be between 5 percent and 7 percent.”
Staggering statistics such as these have added to the increasing pressure from the legislative and judicial branches of the government for health clubs to install and deploy automated external defibrillators (AEDs).
“I think that right now the prime target is the health club,” says Richard A. Lazar, president and CEO, Early Defibrillation Law and Policy Center (EDLPC). “There are plenty of forces impacting the health clubs. Some are from policymakers on both the state and local level, and increasingly, we are seeing pressure coming from lawyers filing suits. Now there is more pressure coming on a grassroots level from families as well as survivors.”
With legislature passing in several states already — and more expected to be introduced — the pressure placed by the government may be leading the way to requiring AEDs in health clubs throughout the country.
So far, Louisiana, Rhode Island, Illinois and New York have passed legislation mandating the placement of AEDs in health clubs.
“The Louisiana, Rhode Island and Illinois laws provide clubs with the necessary liability protection that IHRSA sought,” says Kevin Buckley, deputy director of government relations for IHRSA. “New York legislation passed without sufficient protection. After intense lobbying, IHRSA was able to get the governor to delay implementation of the law. IHRSA will go back this session to have liability protections added. A bill is still pending in New Jersey that would require health clubs to have AEDs on premises, and at this time we can say the clubs in the states of California and Pennsylvania should expect to see similar legislation introduced.”
And with reports and research, such as a recent study published in the Journal of the American Medical Association (JAMA) showing that CPR is often performed inadequately by even trained medical professionals, pressure to make AEDs more readily available will continue to mount on public and governmental operations. In fact, Massachusetts State Senator Scott Brown (R-Wrentham) recently filed legislation that would require all Massachusets Bay Transportation Authority commuter trains to be equipped with defibrillators after a man on the train died from a heart attack in 2001.
Adding to the pressure being felt by legislators — and eventually business owners — is increasing activity on the judicial side of the political equation.
Recently, lawsuits related to AEDs have been filed against health clubs, such as a lawsuit filed late last year against an L.A. Fitness club in Ft. Lauderdale, FL, for not having an AED on site when a member suffered a fatal heart attack.
“It is going to be harder and harder for health clubs to defend not having AEDs on site,” says Lazar. “So far, we have seen mostly suits against those that didn't have AEDs. But as they (AEDs) get out in the world, there is an emerging standard of care coming out of these laws for fitness facilities having and using AEDs so we will probably see more cases around improper use.”
But IHRSA's Buckley says that the perception of lawsuit risk is greater than reality shows since few AED-related lawsuits have been filed so far.
“No health clubs have been found liable for not having an AED on premises. We need to keep the facts in perspective. The fact is that 90 percent of all cardiac arrests occur in the home or the hospital. While any SCA incident is tragic, the risk of a cardiac event occurring in a health club is extremely small.”
This slight risk is part of the association's position on the deployment, forced or otherwise, of AEDs in fitness facilities.
“After significant research, IHRSA has concluded that there is not a legal standard of care that requires that automated external defibrillators be in all fitness centers,” Buckley says. “However, the association encourages health club operators to consider the advantages of installing AEDs in their facilities.”
And there are some significant advantages of installing AEDs in fitness facilities, not the least of which is the chance to save a life.
A 2003 American Medical Association study found that the survival rate for individuals treated with public access defibrillation was similar to or better than that of patients treated by medical professionals. While the vast majority of defibrillations are still conducted by professional first responders, as AEDs become more widely available, the number of AED resuscitations continues to increase
That is exactly what happened last month at a Prairie Life Center in Olathe, KS, after a 24-year-old man collapsed while shooting baskets on the club's basketball court. Staff members used the AED on the man, who survived, and the club, which had had the AED for three years without having to use it, was recognized by the community for its staff's quick action.
But while good press and good feelings come from a situation such as this, it is good pre-planning that makes it happen — and reduces risks, says Lazar.
“Despite the legislative process requiring an AED or not, the least risky thing to do is to deploy the AED in a proper, programmatic way,” he says. “The worst thing that a business can do is to deploy and use the AED in a way that is improper.”
Good Samaritan laws related to AED use are in effect in every state, says Jim Moss, a risk management consultant and attorney who also serves as editor of the SNEWS® Law Review, an outdoor and fitness specialty site.
“That alone means the standard has changed,” he says. “If you add in the fact that several lives have been saved at health clubs with AEDs and the growth of AEDs in places where blowing your heart up is not as big of a proposition, and I think the standard has changed. You better get it (an AED) in your health club.”
However, Lazar says that many of the Good Samaritan laws have a long list of steps and requirements that must be followed to provide protection.
“They also vary a bit in every state and that adds pressure to regional or national chains to keep up with various requirements,” Lazar says.
IHRSA's Buckley says that the Good Samaritan laws as well as the wording added to some of the laws specifically targeting health clubs may not be enough to provide protection to fitness facilities.
“Many club operators are understandably concerned about the legal ramifications of placing a medical device in a recreational facility,” he says. “At this time, the necessary laws are simply not in place that provide businesses and/or their employees with the necessary liability protection.”
While there are still plenty of risks and rewards when it comes to the decision to place an AED in a fitness facility — especially when not mandated by law yet — it seems clear that there will come a day when businesses without AEDs and AED-trained staffs will be the exception not the rule.
According to the Early Defibrillation Law and Policy Center, as AEDs become more common, a higher risk exists for businesses that fail to purchase and properly use these devices. To reduce this risk, fitness facilities need to develop a Cardiac Arrest Survival System, not just buy an AED. The program must:
Comply with all applicable local, state and federal legal/regulatory requirements — current and future
Meet life-saving response time goals
Be designed for the unique characteristics of each program site
Properly configure the people, systems, methods, equipment and actions required to save lives
Create an environment that encourages life-saving action
Properly balance system costs, benefits and risks
Be thoughtful, defensible and well documented
Source: EDLPC Web Site
Brain death and permanent death begin to occur in just 4 to 6 minutes after someone experiences cardiac arrest, according to the American Heart Association (AHA).
To help cardiac arrest victims avoid permanent damage, the American Medical Association (AMA) encourages the American public to be trained in using AEDs and performing CPR.
The AMA also supports federal legislation to increase funding for the purchase of AEDs so that they are readily available throughout communities. The benefits of these devices are clear, and the risks are minimal because they work only if they detect a faulty heart rhythm. AEDs can be operated by most people who can understand English or read simple instructions.
According to the American Heart Association (AHA), when a person suffers sudden cardiac arrest, their chance of survival decreases by 7 percent to 10 percent for each minute that passes without defibrillation. The AMA's policy on AEDs — adopted in 2002 and amended in 2004 — follows the recommendations of the AHA and the American Red Cross.