Managing the Risk of Sudden Cardiac Arrest

Managing the Risk of Sudden Cardiac Arrest 

What duty does a business have to workers and customers?

Guilford, CT
March 12, 2014

Sudden cardiac arrest is America’s leading cause of death; yet victims’ lives can be saved by prompt treatment with an automated external defibrillator (AED). What is the duty of a business should sudden cardiac arrest occur?

To find the best answer to this question, workplace safety managers must consider the expectations and legal recourses available to workers, customers, vendors and any others who may suffer sudden cardiac arrest on a business’s property. Sudden cardiac arrest strikes about 380,000 Americans each year.

Complying with statutory law is only a part of meeting this duty. Yes, a safety manager must make sure the organization complies with mandates and other laws pertaining to AED programs. But meeting the requirements of these laws does not totally fulfill a company’s sudden cardiac arrest risk management responsibilities. Additional precautions should be taken to minimize potential legal consequences while strongly communicating a commitment to the health and safety of workers, customers and others on a business’s premises.

California Supreme Court case to answer if AEDs should be required on commercial property

An interesting case now in the California Supreme Court demonstrates how a workplace without an AED available can be challenged. Verdugo v. Target asks the question: "in what circumstances, if ever, does the common law duty of a commercial property owner to provide emergency first aid to invitees require the availability of an AED for cases of sudden cardiac arrest?" The legal challenge to the retail chain came from the survivors of a woman who died from sudden cardiac arrest while shopping in Target’s Pico Rivera store near Los Angeles. The case is expected to be decided in 2014.

AED program expert Richard A. Lazar is the founder and president of Readiness Systems, which helps organizations create and maintain operationally ready and risk-managed AED programs. He explained that this challenge to Target comes despite California having no statutory requirement for an AED to be available on commercial property. Yet, the retail giant is not the first organization to be put to the test of “common law duty.” Under common law, judges and juries use the concepts of “community expectations” and “reasonableness” to determine the “standard of care” in a particular circumstance. Workplace safety managers must understand these concepts and consider the impact they might have if sudden cardiac arrest occurs.

Lazar explained that court decisions hinge on what judges and juries define as being reasonable and expected by a community. Their decisions define the “standard of care” that must be met. It’s the job of a safety manager to anticipate what a jury would expect as a reasonable precaution to the possibility of sudden cardiac arrest and make decisions about AEDs according to that judgment.

Workplaces meeting statutory law requirements may not always meet what a judge or jury may consider to be the standard of care, Lazar emphasized. “What is reasonable and foreseeable? What would the community expect? The best standard of care is common sense,” he stated. “The perception is that AED laws dictate the standard of care, and they don’t.”

Would workers and customers expect an AED to be available?

Workplaces must apply common-sense practicality to their thinking about AED programs. They must consider whether an AED would be expected. If the answer is yes, would the AED be operationally ready at a moment’s notice? For example, failing to save a customer, either due to having no AED or one with a dead battery due to improper maintenance, can very likely cause a common law challenge. Failing to save a co-worker for one of the same reasons may lead to a larger-than-usual workers’ compensation settlement while having a detrimental impact on employee morale and public relations.

Some organizations look only at statutory requirements and make a decision on an AED program on those considerations alone, Lazar said. It’s important for safety managers to look at a bigger picture and consider common law, workers’ compensation laws, industry norms, worker and customer expectations, organizational values, and more, he added.

For example, mandates in some states for AEDs in schools, fitness centers and dental offices – coupled with AEDs becoming more commonplace in workplaces and public areas – may create a reasonable expectation that an AED be located in every workplace. In addition, AEDs are more commonplace in some industries than others, sometimes as a result of a legal challenge. Airlines, health clubs, transportation authorities, theme parks and other organizations have paid settlements or damages for failing to have AEDs or for not having staff properly trained to use them. In many cases, damages were paid in the absence of statutes requiring AEDs.

AED treatment achieves higher sudden cardiac arrest survival rates than EMS

Workplace safety managers should also consider the upside to having an AED. A workplace with an AED on the premises simply has a better chance of saving a sudden cardiac arrest victim than it would by depending on EMS. That’s because even the fastest EMS team will likely need several minutes to travel to the rescue site, and quickly providing a defibrillating shock is the most important aspect of AED lifesaving. Up to 90 percent of sudden cardiac arrest victims receiving AED treatment within two minutes survive, but the survival chances decrease with each passing minute. By 10 minutes, most victims die.

A Johns Hopkins study of sudden cardiac arrest responders demonstrated that “speed is more important than training.” Non-medical volunteers – including employees in workplaces – coming to the rescue with AEDs achieved the highest survival rate (40 percent) – higher than healthcare workers (16 percent) and police (13 percent). Non-medical volunteers achieved the higher rate simply because they arrived on the scene sooner, the study determined. “On average, early AED defibrillation before EMS arrival seems to nearly double a victim’s odds of survival after OHCA (out-of-hospital cardiac arrest),” the study’s authors wrote.

AEDs are easier to use than ever, but they must be properly maintained

Technological innovations occurring within the past several years have made AEDs very easy to use. The life saves made by non-medical users – including bystanders who have not received AED/CPR training – prove this ease of use. These improvements include real-time video and text instructions for rescuers, built-in self-training modules, and maintenance reminders. For example, when the Defibtech VIEW AED’s audio says and text reads, “Place pads on patient’s chest,” the video shows exactly where to place the pads. A survey by Defibtech and Harris Interactive found that an AED with video, audio and text instruction would be used with confidence by up to 97 percent of the respondents. Today’s AEDs are like smart phones – easy to use and intuitive.

But no matter how many state-of-the-art features an organization’s AEDs have, safety managers still must make sure batteries and defibrillation pads are checked and replaced periodically. For large organizations with many AEDs located on their properties, this ongoing maintenance can be a challenge. Most AED providers can recommend outsourced services that can help with this upkeep.

Managing risk, therefore, requires many considerations, from knowing how various aspects of law work and common-sense approaches to maintaining AEDs. By looking at this big picture, safety managers can put their organizations in the best place to succeed for financial stakeholders, employees and customers. Do what’s right, and everyone wins.

Published in EHS Today, March 12, 2014
Written by Debra Ford – Director of Marketing