Gary, a middle-aged man, clutches his chest and collapses during a worship service. The congregation is horrified. Some panic, and most have no idea what to do. One member tries to apply CPR. Another calls 911. Efforts to revive Gary fail, and he is pronounced dead on arrival at a local hospital. In the following days, church members wonder whether a defibrillator might have saved Gary’s life. Others wonder whether not having a defibrillator exposes the church to a lawsuit.
The risk of cardiac arrest
The tragedy involving Gary could happen in any church. Consider these facts:
- Someone goes into cardiac arrest every two minutes in the United States.
- Time is a factor. Survival rates plummet every minute after a heart attack, and go to almost zero after 12 minutes.
- Of those who experience cardiac arrest outside of a hospital, 95 percent die (and 60 percent of all cardiac arrests happen somewhere other than a hospital).
Can’t we just call 911?
While calling 911 is essential, it may not be enough to save a life.. Many churches are located in crowded urban or suburban areas where traffic congestion may delay the arrival of paramedics for several precious minutes. In many rural areas, the response time for paramedics (if they are available) may be 30 minutes or more.
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A case for defibrillators
(1) What is a defibrillator?
Automated external defibrillators (AEDs) are medical devices that can restart a heart that has stopped beating effectively, and replace the abnormal heart rhythm with a normal rhythm.
Defibrillators are subject to FDA approval, and can only be sold with a prescription by a licensed individual.
Defibrillators have been shown to be safe and effective, even when used by lay people, since the devices are designed to not administer a shock until after it has analyzed a victim’s heart rhythm and determined that an electric shock is required.
Defibrillator training courses are provided by the American Red Cross, the American Heart Association, local emergency medical services groups, and other public health and safety institutions.
(2) How effective are defibrillators?
Defibrillators are very effective. Consider the following statistics:
- Organizations that have established and implemented defibrillation programs have achieved average survival rates for cardiac arrest as high as 50 percent.
- According to the American Heart Association, wide use of defibrillators could save as many as 50,000 lives nationally each year.
- Studies show that defibrillators are successful up to 90 percent of the time in detecting ventricular fibrillations that should be defibrillated, and are successful up to 99 percent of the time in not sending electric shocks when ventricular fibrillations are not detected.
(3) Can my church afford one?
Defibrillators cost $2,000 to $3,000. Prices continue to drop, and some very effective units have been introduced recently that cost less than $1,500. Modern units are also much easier to operate. Many have voice commands to “guide” users.
Are defibrillators a substitute for CPR?
Most medical authorities agree that defibrillators are not a substitute for CPR.
While CPR is generally ineffective in cases of sudden cardiac arrest caused by ventricular fibrillation, it may sustain life for a few precious minutes until defibrillation can be applied.
CPR provides a small amount of blood to the brain and heart and keeps these organs alive until defibrillation can shock the heart into a normal rhythm.
Many modern defibrillators will instruct users (by verbal commands) whether CPR should be initiated or continued.
The American Heart Association recommends that defibrillator users be trained in both CPR and defibrillator use.
Tip: Many medical professionals recommend using the “Cardiac Chain of Survival” in responding to victims of sudden cardiac arrest. The first step in the chain is to call 911. The second step is to provide early CPR to the victim. The third step is to provide early defibrillation, and the fourth step is early advanced life support, which includes care by paramedics and transport to a hospital. The “chain” recognizes the value of CPR in conjunction with defibrillators.
Church leaders should not assume church members know CPR, but instead should recognize that, while CPR can sustain someone suffering cardiac arrest, only defibrillation can restore normal heart rhythm.
Legal considerations
There are several legal considerations associated with the use of defibrillators.
(1) What if a defibrillator is used on a person who is not a victim of cardiac arrest?
Okay, so you see the need for having a defibrillator in your church, but worry that buying and using one at the wrong time could make the situation worse. Thanks to improvements, defibrillators will not emit electric impulses until they analyze a victim’s heart rhythm and determine that an electric shock is required. If your church buys a defibrillator, be sure that it has this “failsafe” feature (to receive FDA approval, this feature is required).
(2) What if a defibrillator does not save someone’s life?
There are several responses to this concern.
Reducing the risk
Ensure your church’s defibrillator(s) are used properly and perform reliably by (1)training several members how to use it/them; (2) placing them in the proper places on church property (often this will be set by state law); (3) doing routine maintenance(again, as set by state law).
Court cases
Some court cases address liability based on ineffective use of a defibrillator.
In Young v. Houghton Lake Ambulance Service (2002), a Michigan widow sued an ambulance company after the defibrillator the paramedics used on her husband did not perform. She claimed the company had been grossly negligent in failing to test and maintain the device.
An appeals court dismissed the case, noting that state law gives immunity for those who use defibrillators unless their actions constitute gross negligence and willful misconduct. In this case, the jury could not conclude that the company’s conduct met that standard of gross negligence.
(3) Immunity under federal law
Federal law offers “Good Samaritan” protections regarding defibrillators.
Except as provided in subsection (b), any person who uses or attempts to use an automated external defibrillator device on a victim of a perceived medical emergency is immune from civil liability for any harm resulting from the use or attempted use of such device; and in addition, any person who acquired the device is immune from such liability, if the harm was not due to the failure of such acquirer of the device—
(1) to notify local emergency response personnel or other appropriate entities of the most recent placement of the device within a reasonable period of time after the device was placed;
(2) to properly maintain and test the device; or
(3) to provide appropriate training in the use of the device to an employee or agent of the acquirer when the employee or agent was the person who used the device on the victim, except that such requirement of training does not apply if—(A) the employee or agent was not an employee or agent who would have been reasonably expected to use the device; or (B) the period of time elapsing between the engagement of the person as an employee or agent and the occurrence of the harm (or between the acquisition of the device and the occurrence of the harm, in any case in which the device was acquired after such engagement of the person) was not a reasonably sufficient period in which to provide the training.
(b) Inapplicability of immunity
Immunity under subsection (a) does not apply to a person if—
(1) the harm involved was caused by willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious, flagrant indifference to the rights or safety of the victim who was harmed;
(2) the person is a licensed or certified health professional who used the automated external defibrillator device while acting within the scope of the license or certification of the professional and within the scope of the employment or agency of the professional . . . .
(c) Rules of construction
(1) In general
The following applies with respect to this section:
(A) This section does not establish any cause of action, or require that an automated external defibrillator device be placed at any building or other location. . . .
(e) Definitions
(1) Perceived medical emergency
For purposes of this section, the term “perceived medical emergency” means circumstances in which the behavior of an individual leads a reasonable person to believe that the individual is experiencing a life-threatening medical condition that requires an immediate medical response regarding the heart or other cardiopulmonary functioning of the individual.
(2) Other definitions
For purposes of this section:
(A) The term “automated external defibrillator device” means a defibrillator device that—
(i) is commercially distributed in accordance with the Federal Food, Drug, and Cosmetic Act .. . .;
(ii) is capable of recognizing the presence or absence of ventricular fibrillation, and is capable of determining without intervention by the user of the device whether defibrillation should be performed;
(iii) upon determining that defibrillation should be performed, is able to deliver an electrical shock to an individual; and
(iv) in the case of a defibrillator device that may be operated in either an automated or a manual mode, is set to operate in the automated mode.
(4) Immunity under state law
Every state has enacted a law that provides limited immunity from liability for the use of defibrillators. Most of these laws protect persons who have received training in the use of defibrillators, even if they have no formal medical training.
(5) Can we be liable for not having a defibrillator?
No laws or court decisions provide a clear answer to this question. However, the following text from the American Heart Association notes that “assessments of the legal risks associated with AEDs have found litigation arising primarily from not having a readily available AED and trained staff on the premises when a cardiac arrest occurs (11,27-29)” (emphasis added). .
Churches should enlist the assistance of a physician or public health official in drafting, adopting, and implementing a defibrillator policy. Both the policy and the efforts to enforce it should be reviewed annually.