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:
"West Palm Beach, Florida, attorney, Craig Goldenfarb, is on the Board of American Heart Association “AED Task Force” and...is 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."
"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.