The Bystander Factor: When an AED is not enough

Research shows that having an automated external defibrillator AED nearby can dramatically increase the survival rate for witnessed incidents of sudden cardiac arrest.

It’s  heart-wrenching when someone collapses from sudden cardiac arrest and people rush to the victim’s aid — only to discover there is no AED available. Seconds count, but an ambulance is several miles, or several minutes, away.

But what happens when cardiac arrest occurs, there is an AED at hand — and bystanders are unwilling or unable to use it?

Here is the result of two such tragic situations.

A death at a Pennsylvania insurance company

Carol Proudfoot. By email from Frank Pensiero,

After Carol Proudfoot suffered cardiac arrest, no one used the nearby AED. (Family photo)

In the first situation, Carol Proudfoot, a 50-year-old woman working at night on the custodial staff of a health insurance company in Pennsylvania, collapsed from what was later determined to be cardiac arrhythmia. Co-workers who found her unconscious called 911, but didn’t follow the 911 operator’s request that they use the AED in the building. One witness told Pennlive.comthat she didn’t think using an AED would have made any difference. When EMTs arrived, they were unable to revive Proudfoot.

Proudfoot’s family was devastated. But state officials told the media that no one was required to use the AED. Pennsylvania law doesn’t require that businesses have AEDs, and doesn’t require that businesses with AEDs provide staff training.

Sudden cardiac arrest at a Manhattan gym

In 2006, a Mr. DiGiulio was working out at a Manhattan gym when he collapsed from sudden cardiac arrest. According to court records, health club employees called 911 and began CPR. More than seven or eight minutes after DiGiulio’s collapse, and paramedics arrived and used a defibrillator to restore his heartbeat. However, DiGiulio never fully recovered from the incident. He remained hospitalized and died nearly four months later.

There was an AED nearby in the gym, and one of the club employees who assisted DiGuilio was trained in AED use. He explained that he didn’t use the defibrillator because it was in a locked cabinet and he couldn’t find the key (it later came out in evidence that the cabinet had not been locked).

DiGiulio’s family sued the gym. Although New York state law requires AEDs in health clubs with more than 500 members, and requires employee AED training, the court found that the club was not liable in DiGiulio’s death.

Liability, responsibility, and AEDs

This article, republished in Sport Waiver, which covers waivers and risk management for recreation, fitness, and sports businesses, concludes from the DiGiulio case that  “There is apparently no statutory requirement that such devices actually be used in the event of need for which there could be corresponding liability.”

U.S. law encourages rather than requires AED use. The federal Cardiac Arrest Survival Act (2000) includes a Good Samaritan provision that protects from liability people who purchase a defibrillator and people who use a defibrillator in good faith during a rescue attempt. Some states have additional AED liability laws, including laws that protect organizations that place AEDs on their premises from liability stemming from their use during an emergency. The intent of most of these laws has been to encourage organizations to provide AEDs and to encourage individuals to use them. As the Sports Waiver article suggests, there does not appear to be legal precedent requiring people to use AEDs when they are available.

It’s worth noting that in many European countries the law takes a different approach to regulating bystander conduct in emergencies. European law refers to the concept of “duty to rescue,” and in some countries it is a criminal offense to fail to come to a victim’s aid.