Heart in the right place - automatic heart defibrillators

American Fitness, March, 1999 by David L. Herbert

Are defibrillators part of the standard of emergency response care owed to health and fitness facility patrons?

In January, 1997, The Exercise Standards and Malpractice Reporter reviewed several emergency response issues important to health and fitness facilities ("Update on Various Emergency Response Issues," pages 12-13). Among them were several updates regarding the acquisition of automated portable defibrillators (sometimes referred to as automatic external defibrillators or AED's) by airlines and at least one police department in Cincinnati, Ohio. Since then, we have learned the American Heart Association is refining a proposal to place AED's in 300 stores and businesses--including health clubs--to determine if defibrillators should be distributed to increase the chances of recovery for those who suffer cardiac arrest while in such establishments.

This study may provide valuable information regarding the usefulness and efficacy of defibrillators in a variety of public establishments. In that case, the results of the study may impact the standard of emergency response care for health and fitness facilities seeking to uphold their duties and obligations.

AED's range in price from $3,000 to $5,000, weigh about five pounds and are apparently "idiot proof" since they diagnose distress and indicate whether an external shock is necessary. Despite their diagnostic capabilities, current laws in many states may limit their use to trained health care providers.

Despite potential legal problems, an effort is underway to lobby state legislatures for the amendment of current statutes allowing non-medical personnel to operate defibrillators. Nearly a dozen states have passed such laws, while a like amount are considering the issue. However, a recent California proposal failed to get out of committee due to opposition by trial lawyers who represent injured parties. They specifically opposed provisions in the bill that would limit the number of lawsuits dealing with the use of such devices by lay individuals. If laws are changed and such devices are made widely available, the standard of emergency response care in health and fitness facilities will undoubtedly evolve to require the use of AED's.

However, the question remains as to whether these devices are now required in such facilities as part of the standard of care. Some facilities are indeed integrating AED's into their operations. The Elmhurst in Illinois has reportedly begun using such a device and implemented training and instructional programs for them every four months. The facility apparently acquired the device out of a desire to provide the highest quality of service to its members.

The recently adopted standards of the American Heart Association and American College of Sports Medicine (AHA/ACSM Scientific Statement, "Recommendations for Cardiovascular Screening, Staffing and Emergency Policies of Health/Fitness Facilities," 1998) do not require the presence of a defibrillator as part of an emergency response plan for supervised cardiac rehabilitation programs (as recommended by "Guidelines for Clinical Exercise Testing Laboratories: A Statement for Health Care Professionals from the American Heart Association," and Guidelines for Cardiac Rehabilitation Programs, Second Edition, 1995).

While the second edition of ACSM's Health/Fitness Facility Standards and Guidelines (Human Kinetics, Champaign, Illinois, 1997) recommends the availability of a stocked first aid kit to deal with emergencies, no requirement for having a defibrillator is specified. Likewise, the International Health Racquet and Sportsclub Association (IHRSA) has no such requirement in its standards for member institutions.

The Arizona court case Mandel vs. Canyon Ranch, Inc. addressed this particular issue and resulted in a defendant's verdict. The plaintiff's decedent went to the defendant's facility for several days in 1995. He allegedly purchased a spa package for his stay, which the plaintiff contends included a consultation with the defendant's medical staff for an evaluation of his health and physical condition. During his stay at the defendant's ranch, the decedent reportedly engaged in a wallyball game. Ten minutes into the game, he collapsed due to an alleged cardiac arrest. CPR and other on-site care provided by guests and members of the Canyon Ranch staff was unable to resuscitate the 50-year-old. According to the plaintiff's allegations, no staff member utilized any type of cardiac resuscitation equipment or cart (e.g., a defibrillator) when providing emergency care to the decedent. The plaintiff alleged the Canyon Ranch personnel were negligent in their screening and evaluation of the situation and "in failing to monitor and bring the appropriate medical equipment to handle this medical emergency, including--but not limited to--the failure to bring and utilize a heart defibrillator unit [the plaintiff further alleged is] kept on the Canyon Ranch premises for this type of situation" (Plaintiffs' Complaint, X Paragraph).