Wednesday, July 12, 2006

Municipalities Without AEDs at Risk of Litigation

If public locales don't have automatic external defibrillators (AEDs), they might be at risk of litigation. Claims this lawyer's website:

"West Palm Beach, Florida, attorney, Craig Goldenfarb, is on the Board of American Heart Association “AED Task Force” also recognized by the local American Heart Association chapter as the area's legal expert on Florida law as it applies to the use of these life-saving devices.

If you or a loved one believes a life may have been saved if a public facility such as a gym, a theme park, a sporting venue, or an airport would have had an AED, please contact our office to discuss the merits of your possible case."

The question now is, what defines a "public facility?" One's worksplace? The baseball field? Municipal buildings? It looks like the courts will have to decide each case based on its merit. But "Dwight," a sudden death survivor from California that tipped me to this story states:
"I attended a Christmas party last December at the company where I had my Sudden Cardiac Arrest. Due to my cardiac arrest, the owner of the company hired a training company to come in to teach and certify all employees on CPR. I thought it was great and I thanked the owner for doing that! I then asked when the employees would be receiving the AED portion of the training and was told that he had elected to NOT spend the money for that part of the training. I also asked if they had installed any AEDs in the building and was told that they could not justify spending $2,000 on an AED. It is way too much money, he said. I looked around at the party. There were large trays of freshly barbecued rib eye steaks for all the employees. They were passing out grocery store checks to all employees. They had numerous bottles of very expensive Cabernet everywhere, while others were drinking premium tequila, cognac & scotch. I estimated that the cost of that party would have paid for several AEDs PLUS AED training for all employees. As I always say, it's not the cost of AEDs that is so high, it a matter of how spending is prioritized!"

Point well taken, Dwight. I recently had a company who purchased an AED because they knew they had an employee at high risk of sudden death - and it saved his life. They then bought an AED for each floor of their building. They became believers.

But not all doctors believe in wide distribution of AED devices, based on the cost versus probability of an event occurring. From the Journal of General Internal Medicine, 2003 study:
OBJECTIVE:The American Heart Association (AHA) recommends an automated external defibrillator (AED) be considered for a specific location if there is at least a 20% annual probability the device will be used. We sought to evaluate the cost-effectiveness of the AHA recommendation and of AED deployment in selected public locations with known cardiac arrest rates.

DESIGN:Markov Decision Model employing a societal perspective.

SETTING:Selected public locations in the United States.

PATIENTS:A simulated cohort of the American public.

INTERVENTION:Strategy 1: individuals experiencing cardiac arrest were treated by emergency medical services equipped with AEDs (EMS-D). Strategy 2: individuals were treated with AEDs deployed as part of a public access defibrillation program. Strategies differed only in the initial availability of an AED and its impact on cardiac arrest survival.

RESULTS:Under the base-case assumption that a deployed AED will be used on 1 cardiac arrest every 5 years (20% annual probability of AED use), the cost per quality-adjusted life year (QALY) gained is $30,000 for AED deployment compared with EMS-D care. AED deployment costs less than $50,000 per QALY gained provided that the annual probability of AED use is 12% or greater. Monte Carlo simulation conducted while holding the annual probability of AED use at 20% demonstrated that 87% of the trials had a cost-effectiveness ratio of less than $50,000 per QALY.

CONCLUSIONS:AED deployment is likely to be cost-effective across a range of public locations. The current AHA guidelines are overly restrictive. Limited expansion of these programs can be justified on clinical and economic grounds.

But an added dimension is upon us: can such a refusal to purchase an AED in the era of corporate largess be defended? Corporate America and municipalities might heed Dwight's warning and realize that there's hungry lawyers out there everywhere.

And such a purchase might just save a life. Believe me, that's one heck of a quality-adjusted life year (QALY) for that person.



DwightM said...

Dr. Wes: One of the major financial objections to installing AEDs and implementing the program initially is the up front cost for purchase & training. $2,000 is probably a good round figure to use for the purchase price of an AED, though soem are cheaper and some more expensive. Cost for training varies greatly. So let's say that the initial overall cost is $2,500. People will then object based on the cost versus the probability of needing the device. From that perspective, most buildings are now required to have sprinkler systems, fire extinguishers, fire alarm systems, smoke alarms, "EXIT" signs with own power source and emergency lighting. That is a LOT of money. Yet what is the probability that a building will ever have a catastrophic fire? If we were to base the purchasing decision on the most prevalent calls fire departments respond to, AEDs would have the priority as emergency health issues account for an overwhelming majority of fire department responses.

AEDhub99 said...

I recently published an article on AEDs – here is a quote from it, in case you are interested:

Statistics give us more and more pieces of information that are bound to worry us, to make us react and change something if we can. More and more people and in earlier and earlier stages of their life die of a heart disease. Statistics, only in the US, are extremely alarming:
- Every 30 seconds someone dies because of a heart disease;
- More than 2.500 Americans die daily because of heart diseases;
- Every 20 seconds there is a person dying from a heart attack;
- Each year 6 million people are hospitalized because of a heart disease;
- The number 1 killer is a heart disease.
Although AEDs are not a universal panacea for all heart diseases, nothing else can compete to its major feature, that of actually re-starting the heart after it has been stopped by a sudden cardiac arrest. Under these circumstances is it necessary to ask you why anyone in this world, any family, in any home would hope for having such a device in their first aid locker?

If you feel this help, please drop by my website for additional information, such as Public Access Defibrillatio PAD or additional resources on AED manufacturers such as Philips defibrillators, Zoll AEDs or Cardiac Science AEDs.