Public Access Defibrillators and Your Brand

Here's why your brand should figure into whether to deploy publicly accessible defibrillators.

Public access defibrillators are becoming ubiquitous in public spaces, including workplaces. What is strange is that some of the most public work environments -- those in retail and hospitality businesses -- are lagging the trend.

Liability, if a save goes wrong, is the reason most often given by retailers and hoteliers for not deploying AEDs. Risk managers in these industries will also emphasize the high turnover in their workforce, the strain training represents, and doubt that Good Samaritan laws adequately cover their particular workforce.

While a healthy discussion can be sustained on these points, what appears to be missing is consideration of brand management and a brand's ability to sustain a sudden cardiac arrest on company property. This is troubling because retail and hotel brands are largely established among patrons that visit company property, certainly to a greater degree than brand-based businesses located in industrial or office settings where defibrillators have become more common.

When The Wall Street Journal wrote in 2009 about a lack of public access defibrillators in hotels, reporter Scott McCartney illustrated the issue with a story of a man who collapsed in a particular hotel after dancing with his daughter at her wedding. McCartney wrote that physicians at the event yelled for a defibrillator, but one wasn't available. The man died.

His wife went on to become an advocate for greater availability of defibrillators -- leaving the hotel chain's brand, and a spokeswoman attempting to answer Mr. McCartney's questions, to serve as symbols of callousness. In an era when news that can impact brands is increasingly searchable, lives online forever, and spreads widely and easily among peers, one has to consider whether the dent in the brand is worth avoiding perceived legal risks or the costs of training and management.

In the last two years, journalists who report on deaths from sudden cardiac arrest are increasingly asking whether a defibrillator was available in the vicinity of the victim. They're not particularly concerned with whether the devices are legally required or not; it is almost a question of moral responsibility. If the answer is "yes, and it was used," the issue of moral responsibility typically ends there because it's clear that all attempts were made to save the victim.

Of course, it doesn't end there if the victim's family publicly alleges the business' staff was not properly trained or an available defibrillator was too far from the incident or not properly maintained. This scenario is not unknown. But the increasing ubiquity of defibrillators today and the growing perception of a moral responsibility to have them may lead to a bigger news splash after a death when a defibrillator is absent than a lawsuit over whether the defibrillators were properly maintained.

There also appears to be a greater tendency for families of sudden cardiac arrest victims to launch a campaign for defibrillator availability -- where advocacy groups are already well established and can support them -- than a campaign for better training and management of defibrillators born out of a failed save attempt. Such campaigns can add a longer tail to the story of a death in the absence of an AED, place the story on advocacy sites, and continually revive the initial incident and the brand's involvement.

This even can occur when a person survives, as in the case of a woman in Yakima, Wash., who collapsed while Christmas shopping in a large national retail store. A defibrillator was repeatedly called for, but none was available. The woman survived, but now the chain's name is repeatedly invoked every time the story is told of how the ensuing defibrillator campaign got started. What's more, other retailers in the same category are asked by reporters whether they have defibrillators accessible to workers and customers in Washington state, and they are called out when they don't.

It doesn't help when a store that sells defibrillators doesn't have them on its own walls, as the Yakima Herald-Republic noted in its reporting.

'Five Minutes to Ruin It'
Oregon's recently enacted law requiring public access defibrillators in public places does not help matters for company spokespeople when they respond to questions on a tragedy or near-tragedy. The law requires defibrillators in nearly all public places with more than 50,000 square feet or where the public congregates for deliberation, shopping, entertainment, amusement, or awaiting transportation. It also requires defibrillators in businesses where at least 25 people congregate on a normal business day. That captures just about all major national retail and hospitality chains.

This leaves a company spokesperson to explain that the business protects its workers and customers only in states where it is required, which typically doesn't match up to the company's customer-oriented brand promise.

A 2002 study of sudden cardiac arrest events in three well-populated Canadian counties found nearly twice as many cardiac arrests occurring in retail and hospitality workplaces than industrial sites, even after taking casinos, event halls, conference centers, and banquet facilities out of the numbers.1 Now, sudden cardiac arrest happens wherever people are, so if you increase the number of industrial workplaces in a community, you will see more sudden cardiac arrest there. But the point remains that sudden cardiac arrest does not respect legal and labor differences from one workplace to the next.

OSHA estimated in 2002 that there are 220,000 victims of sudden cardiac arrest per year in the United States; about 10,000 of those sudden cardiac arrests occur at work, according to the agency. In 1999 and 2000, 815 of 6,339 workplace fatalities reported to OSHA were caused by cardiac arrest.

Warren Buffett famously said, "It takes 20 years to build a reputation and five minutes to ruin it." He surely did not have in mind the established fact that availability of a defibrillator within five minutes of sudden cardiac arrest greatly increases the survivability of a victim. But taken in this light, the statistics on timing and survival bear further consideration.

For every minute that goes by without treatment, a cardiac arrest victim's chance of survival decrease by 7 to 10 percent. After 10 minutes without defibrillation, few attempts at resuscitation are successful.2 With this is mind, one study shows the median response time is 6.6 minutes for emergency medical services in mid-sized urban communities.3 Another has shown the average call-to-shock time for a typical community is nine minutes.4

This renders a spokesperson's argument that the company leaves the safety of its customers and workers in the hands of trained professionals in the emergency services difficult to sustain.

Is there a limit to the expense and legal exposure a company should be willing to take on to maintain and protect its brand? Of course there is. Public relations and brand protection is also not the only or the most important consideration in a defibrillator deployment, or a decision against it. Nonetheless, decision-making around whether to have a deployment, where to do it, and how to manage it should involve a member of a company's communications team.

Health and safety officers may have to proactively invite their company's communications team into a discussion, rather than wait for them to enter it themselves. While communications professionals may not end up carrying the day for a deployment, if that is what the officer is looking for, at the very least they will be able to think about sudden cardiac arrest as an element in their crisis communications planning.

Positive Publicity
There is another side of the public relations coin: Having publicly accessible defibrillators increases the chances of employees or customers saving a life and the brand's becoming associated with heroism through resulting coverage.

Consider a customer in an Australian supermarket who collapsed in April 2010 and was saved by another customer using the store's defibrillator. That near-death experience spurred a call for defibrillators in every supermarket, similar to the event in Washington. But in this case, the supermarket's brand was held in a positive light in local news coverage and was distinguished from that of competitors who didn't have the devices.

Unfortunately, in that case the defibrillator was present because it had been donated by a local Lions club, rather than due to a corporate policy. It's a shame from a public relations standpoint because the brand would have earned a broader boost if it had not appeared so accidental that the supermarket had been prepared.

In 2003, when defibrillators were less common in workplaces, Shop-Rite supermarkets did indeed have such a corporate policy and deployed the devices in its 190 stores nationwide. This allowed David Sylvester, vice president of loss prevention, to trumpet the fact in USA Today and highlight the number of employees and customers who had been saved thanks to ShopRite's policy, separating the ShopRite brand from that of competitors.

Of course, there is something else to consider beyond liability or the cost of management and brand management when considering a defibrillator deployment. Look at the airline industry and the adoption of defibrillators by many carriers before requirements were set up.

As Doug Wills, a spokesman for the Air Transport Association, told USA Today in a 2004 article, "Cardiac arrest happens frequently. The airlines decided having these on the plane is just a good thing to do."

1. Fedoruk JC, Currie WL, Gobet M: Locations of cardiac arrest: Affirmation for community public access defibrillation (PAD) program. Prehosp Disast Med 2002; 17 (4):202-205.
2. American Heart Association. "Early Defibrillation." Dallas, Texas: American Heart Association, 2006.
3. Braun O, McCallion R, Fazackerley J. Characteristics of midsized urban EMS systems. Ann Emerg Med 1990 May;19(5):536-46
4. Mosesso VN Jr, Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med 1998;32:200-207.

This article originally appeared in the June 2011 issue of Occupational Health & Safety.

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