There is no dispute that portable defibrillators, simple-to-use
devices that supply jolts to shock a stilled heart to beat again,
could save tens of thousands of lives a year in this country alone
if they are accessible. But across America, there is anything but
agreement among states about rules for the use of automated
external defibrillators (or AEDs): where they must be located; if
they should be registered so authorities know where they are;
whether a business that installs one is fully protected from
liability; or even if a company is obliged to use one if someone on
the premises suffers sudden cardiac arrest.
And some experts say the uneven patchwork of laws and regulations
is a worrisome barrier to more widespread distribution and use of
the battery-powered devices, which, if employed within minutes of
cardiac arrest, can bring a person back to life.
For instance, many AEDs still carry labels saying they should
only be used by "medical professionals" even though there are laws
in every state giving "good Samaritan" protection to anyone who
tries to use one to save the life of someone in cardiac arrest.
"The concerns about risk and liability remain very high," said
Richard Lazar, president of Readiness Systems LLC, a Portland,
Ore., firm that consults with businesses and governments on AED
training and placement.
Mandates for where AEDs should be placed are a national
checkerboard. Nineteen states impose no mandates. But, in
New York state, AEDs are required in health clubs, while in
Florida, they're mandatory in public high schools. Yet recent court
rulings in both states have held that, just because those
facilities are required to have the devices, they are under no
legal obligation to use them.
Many states require AED owners to register the devices with state
or local emergency services, but only a few dozen communities use
the information when they dispatch calls.
At least 14 states plus the District of Columbia require AEDS in
health clubs, but most exempt spas in hotels. Nineteen states
require the devices to be in at least some schools. Some states
budget money for the devices, which can cost up to $2,000 each, but
most leave it up to the schools to find the funds.
But only a few states, including New York and Oregon, have broad
requirements to install the devices in "places of public assembly"
or in buildings that have 25 or more people inside them each day.
That could change as several cases wind through the courts
questioning whether stores, hotels and other businesses have a
common-law duty to have and use an AED if a visitor goes into
cardiac arrest. One such case, against Target Corp., is pending
before the California Supreme Court, arising from the 2008 cardiac-
arrest death of a customer in a Los Angeles store that did not have
an AED. The family sued Target, arguing it had a duty under
California common law to have an AED on hand.
For now, the lines are divided. "In many companies, the insurers
and risk-management guys still seem to think they're better off not
having AEDS than having them," said Linda Campbell, a retired
American Airlines occupational-health nurse who helped found the
company's AED program in the mid-1990s, and is now on the board of
the Sudden Cardiac Arrest Association.
Much of the confusion arises from the very nature of AEDs. On the
one hand, they are sophisticated, high-risk medical devices on par
with pacemakers and replacement heart valves under U.S. Food and
Drug Administration rules. Although they've been available for
"public use" since the 1990s, only in the past 10 years has the FDA
allowed any of the devices to be sold without a doctor's
prescription. Most states still require physician supervision of
AED deployment, and formal training of some or all "expected users"
in a particular place.
At the same time, the machines have grown both more technically
sophisticated and simpler to use, with more and more places
installing them to be accessible to the general public as well as
to more highly trained staff. …