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RESEARCH AND BRIEFINGS

Onsite Defibrillators: Benefit or Burden?

 


According to Statistics Canada, nearly 40,000 cardiac arrests occur each year in Canada — one episode every 12 minutes1 — which accounts for 29% of all deaths in Canada.

While studies have shown that the most common place for cardiac arrest to occur is within the home, public facilities such as private businesses, shopping malls, and sporting complexes have also been implicated as being high-incident areas. 2

In Ontario, the Workplace Safety and Insurance Board (WSIB) reports that there has been an average of 200 claims of heart attack within the workplace over the last three years. This data shows that an organization with 200 employees at an average age of 40 can expect at least one cardiac arrest in the workplace annually. 3

Since less than five percent of cardiac arrest victims4 survive an out-of-hospital cardiac arrest, installing Automatic External Defibrillators (AEDs) is an effective strategy to help improve the chances of survival.

A 2004 study in the New England Journal of Medicine showed that training and equipping volunteers and personnel to “initiate early defibrillation in a structured response system can increase the number of survivors” following cardiac arrest in a public location. 4

Liability Concerns

Not surprisingly, one of the greatest barriers of the installation of AEDs in the workplace is related to liability. In Canada, many provinces have instituted “Good Samaritan laws” that legally limit the types and scope of negligence lawsuits permissible in a court of law; by those laypersons who provide emergency medical care.

In Ontario, the Chase McEachern Act (2007) was introduced after the tragic death of an 11 year old boy. This act, also known as the Heart Defibrillator Civil Liability Act (2007), protects those individuals from liability in the process of providing assistance to someone using, or making available, a defibrillator in an emergency situation (under certain conditions). Other provinces, such as Manitoba, are taking things one step further by mandating the installation of AEDs in public places. Owners of the premises designated under the Manitoba Defibrillator Public Access Act will be required to install AEDs on their premises by January 31, 2014.

In the US, all 50 states have instituted Good Samaritan laws giving at least some immunity to lay people who engage in lifesaving situations. At the federal level, the Cardiac Arrest Survival Act (2000) is the first legislation in the US that recognizes the lifesaving role of AEDs. It highlights the importance of utilizing these devices by laypersons and augments the Good Samaritan laws by providing federal liability protection for those who have been trained in AED use.

By 2010, all jurisdictions in the United States had enacted laws for public access defibrillators.5 The American Hospital Association recommended that all states provide civil liability immunity to lay rescuers who “act in good faith, without specific compensation, as a reasonable and prudent person, with the same level of training would respond in an emergency.” Interestingly, when analysing the legal implications and liability exposures associated with AEDs, issues have risen primarily from not having readily accessible AEDs and trained staff on the premises when faced with a cardiac arrest situation. 6

1 Heart and Stroke Foundation. (2011). Position Statement: Public Access to Automated External Defibrillators (AEDs). Retrieved on April 5, 2013 from:
http://www/heartandstrokefoundation.com

2 Public Access Defibrillation Trial Investigators. (2004). Public Access Defibrillation and Survival after Out of Hospital Cardiac Arrest. N Engl L Med 2004;351;637-.

3 Heart and Stroke Foundation Statistics. Retrieved

4 Weisfeldt, M.L., Everson-Stewart, S., Sitlani, C., Rea. T. et al. Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home. N Engl J Med 2011;364;313-21.

5 Gilchrist, S., Schieb, L., Mukhtar, Q., Valderrama, A., Yoon, P., Sasson, C., et al. A Summary of Public Access Defibrillation Laws, United States, 2010. Prev Chronic Dis 2012;9;110196.

6 Konig, B., Benger, J., & Goldsworthy, L. Automatic external defibrillation in a 6 year old. Arch Dis Child 2005;90;310-311.