For Safety's Sake

San Diego has put defibrillators in its building code.

A handful of states and some countries, such as Japan, require automated external defibrillators (AEDs) in schools, in dental offices, or at gyms. And if your own organization takes employee health seriously, you likely have AEDs deployed at your workplace.

AEDs, lifesaving devices for victims of sudden cardiac arrest (SCA), are now considered common-sense safety fixtures just like fire alarms or fire extinguishers. Considering their track record for saving lives, we have to ask ourselves: Why aren’t AEDs required in every new building of a certain size, right from the start of construction?

The good news is that in San Diego, where I have just concluded my term as a City Council member, AEDs soon will be installed in every new building. And if public safety advocates in your city are heard, perhaps your city will be next to require this common-sense protection for its residents.

On Dec. 2, 2008, the San Diego City Council voted unanimously to require defibrillators in all new buildings with more than three stories or more than 10,000 square feet; in places of assembly with capacity for more than 300 people; and in educational facilities with 200 or more students. This groundbreaking legislation covers practically all new commercial buildings; medical, dental, and outpatient clinics; hotels; motels; restaurants; schools; theaters; churches; and warehouses.

The new San Diego code requires new buildings to be prewired during construction for dedicated wall mounts for AED systems with self-testing alarms, similar to requirements for installations of sprinkler systems and fire alarms. After all, for every fire death in the United States, 96 people die from SCA.1

Under the new code, San Diego building owners will be required to register their AED equipment with the fire rescue department, test it annually, and notify the fire department each time the device is used. This establishes a citywide program for AED protocols and creates a system for tracking AED usage data.

As any health and safety professional or risk manager knows, while having AEDs placed in buildings is essential, there needs to be human infrastructure to support their use. Under the new San Diego legislation, as soon as five AEDs are installed in a building, five people in the building must be trained to use them. AED training is now part of basic CPR training that everyone should have. The new legislation has guidelines on placement of the devices, as well, with the practical goal of having enough devices deployed in any building to achieve a three-minute response time to a sudden cardiac arrest incident.

With San Diego’s precedent in place, I envision a time when placement of AEDs in new buildings will be mandatory, just like fire extinguishers became mandatory decades ago. Cities and counties across the country are taking notice, and I expect to find many other jurisdictions following suit on what is a practical way to protect our communities from the pervasive threat of SCA.

AED Advocacy Campaigns Often Start with a Death
Sadly, what should be obvious and pragmatic policy such as this typically is enacted only after a preventable death occurs. My experience is no different.

I became involved in cardiac safety issues when a good friend of mine, Ron McElliott, died of SCA while running a 10K race in 1999. Two respiratory clinicians running in the race came to his aid and immediately started CPR. Unfortunately, an ambulance assigned to the event (with an AED on board) had been called away moments earlier to a non-emergency. A shock was not delivered when Ron needed it, and when he was transported to the hospital, he was pronounced dead upon arrival. He was 56 years old and in his prime. Ron might have lived if an AED had been readily available.

In 2001, two years after Ron’s untimely death, I partnered with his widow to create San Diego Project Heart Beat. It is a partnership with the City of San Diego, the County of San Diego, the American Heart Association, San Diego Firefighters Local 145, and AED manufacturer Cardiac Science Corp. The program offers the San Diego region the best AEDs available at the most reasonable price. Through the American Heart Association Training Center, certification courses are provided in CPR/AED and first aid. Program management services assist with compliance requirements. Through this program, more than 4,000 AEDs have been placed around our county, and 52 lives have been saved.

SCA kills nearly 365,000 people annually, or about 1,000 people a day; that’s nearly one person every 90 seconds. According to the American Heart Association, as many as 7,000 children die from it every year despite the popular misconception that heart problems are exclusively a threat to older people. The availability of an AED within five minutes of a SCA incident greatly increases the survivability of a victim. Unfortunately, today the average time between a call to 911 and the arrival of emergency services is nine minutes for a typical community.2

An estimated 95 percent of SCA victims die before they can get emergency help.When a person suffers from SCA, each minute that passes without defibrillation decreases the chance of survival by 10 percent.

Thanks to Project Heart Beat, AEDs can now be found almost everywhere in San Diego, including office buildings, hotels, public parks, swimming pools, and libraries. Our experience has shown that when a shock is delivered within one minute, survival rates can increase seventeenfold—rising from initial levels of 5 percent to as high as 86 percent.

Currently, the County of San Diego is partnering with Project Heart Beat to get AEDs in public facilities. Recently, San Diego County Supervisor Greg Cox led the effort to install AEDs in every public school throughout his south San Diego County district. And in the San Diego Unified School District, the state’s second- largest school district, a fund-raising drive is under way to install AEDs at each of the 265 school sites in the district. In fact, the district has adopted a plan to install three AEDs at each high school, two in each middle school, and one in each elementary school.

San Diego Project Heart Beat was voted best “Large Community Program” in October 2003 by the National Center for Early Defibrillation for its organization and success, a title the city still holds today. We have helped nearly 30 major municipalities create programs similar to it, something we plan to do regarding the new AED building code measure, as well.

Liability Issues
Early on in the project, property owners and businesses expressed concerns about their liability related to placing and using AEDs. More recently, some of the same voices raised the same concerns regarding the new law requiring AEDs in new construction.

Property owners and businesses wanted to make sure they wouldn’t be sued if something went wrong following an AED deployment. In response, I worked with then-Assembly Member Juan Vargas, D-San Diego, to sponsor California’s AB 204, the AED Good Samaritan Law. This law provides legal coverage for property owners, landlords, and others who are concerned with potential liability. Similar laws now exist throughout the country.

Maureen O’Connor, a San Diego emergency medical technician who has been with the Heart Beat program since its inception, offers some interesting observations. “Today, we are finding more businesses and building owners who are concerned over liability if they do not have an AED, a complete reversal from our early experiences,” she says.

If you have similar experiences with AED placement issues, I would appreciate hearing from you. Though San Diego is currently in the forefront when it comes to health and safety, we plan to have a lot of company in the coming years.We would be happy to share our experiences and are eager to learn about yours.

The great news is that AEDs have become simple to use and affordable, and that, together with CPR, they are proven to save lives. There’s no reason why they shouldn’t be embedded in every part of our workplace and public-building infrastructure. Putting them in the building code, as we are doing in San Diego, is an effective way to save lives in our communities.

1. National Fire Protection Association, Fire Loss in the U.S. During 2006; AHA. 2008 Heart and Stroke Statistical Update.

2. 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 February 2009 issue of Occupational Health & Safety.

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