Cardiac Arrest Survival Act and the Rural Access to Emergency Devices Act

The American Board of Chiropractic Sports Physicians has endorsed the American College of Sports Medicines Stand on AED’s. This essay looks at what AED’s mean to the sports chiropractor and the chiropractic profession as a whole. We acknowledge that equipment alone does not save lives, but the proper equipment in the hands of a trained individual with a plan does make a big difference.

While this position paper really is specific to fitness facilities we can draw some great information in regards to Cardiac Events and Chiropractic. You might be wondering what all the fuss is about. The bottom line is that the survival rate for victims of witnessed ventricular fibrillation cardiac arrest is as high as 90% when defibrillation is applied within the first minute of collapse. Survival rates decline with every minute that defibrillation is delayed to the point that a cardiac arrest victim without defibrillation beyond 12 minutes has only a 2–5% chance of survival. The numbers speak for themselves. If we had an AED in our offices and out on the athletics field outside the office lives would be saved.

In the sporting arena the candidate for need of defibrillation could very well be in the stands. There are conditions that are seen in the athletic environment that would really benefit from the sideline doctor having an AED on site.  One of the condition that really surfaces is Commotio Cordis.  Normal life-saving techniques like CPR can do little to correct the rhythm. If a heart defibrillator is not available immediately, there is little else that can be done.

Quick Links
Summary of Key Points of the Paper
Chain of Survival
Programming Requiring an AED
Applying it to the Chiropractic Office
How Much Does an AED Cost
Where Do I Buy an AED

SUMMARY OF KEY POINTS OF THE POSITION STAND WITH COMMENT

• The Cardiac Arrest Survival Act and the Rural Access to Emergency Devices Act, as components of the federal Public Health Improvement Act of 2000, as well as Good Samaritan laws passed in 47 states, expands Good Samaritan legal protections to users of AEDs throughout the nation. So first responders are protected when using the AED
• The placement of AEDs in selected locations for immediate use by trained laypersons may be the key intervention to significantly increase survival from an out-of-hospital cardiac arrest
• Well-trained health/fitness facility staff members are essential to maintain strong links in the chain of survival for their clients.
• Effective placement and use of AEDs at all health/fitness facilities (Table 1: levels 1–5) is encouraged, as permitted by law, to achieve the goal of minimizing the time between recognition of cardiac arrest and successful defibrillation. Until further definitive data are available, AED placement is strongly encouraged in those health/ fitness facilities with >2500 members and those facilities that offer special programs to clinical populations.

The Chain of Survival is a series of identified actions that are designed to reduce mortality associated with cardiac arrest.

Programs That Should Have an AED Include:

1. Programs for the elderly or those with medical conditions
2. Health/fitness facilities in which the time from the recognition
   of cardiac arrest until the first shock is delivered
   by the EMS is anticipated to be 5 minutes.
3. In unsupervised exercise rooms ( hotels, apartment complexes, or office buildings, the AED should be part of the overall PAD (Public Access to Defibrillation) plan for the host facility.)
4. Health/fitness facilities should coordinate their PAD program with the local EMS.
5. Emergency drills should be practiced at least once every 3 months or more often when staff changes occur.
6. PAD programs must comply with local or regional
   regulation and legislation.

How Does This Apply to the Chiropractic Office or the Chiropractor Covering Sporting Events?

The endorsed paper identifies the different level’s of health care facilities. Health/fitness facilities are defined as organizations that offer exercise-based health and fitness programs as their primary or secondary service or that promote moderate-to vigorous-intensity recreational physical activity. These range from level 1 (unsupervised exercise room) to level 5 (medically supervised exercise program). This definition would include the majority of chiropractic offices that recommend or prescribe exercise prescriptions and all the clinics that have exercise facilities associated with them.

Other important notes include all health/fitness facilities must have written emergency policies and procedures that are reviewed and practiced regularly, and that in all supervised facilities, exercise leaders must be trained in basic cardiopulmonary resuscitation (CPR). It is a good thing that all sports chiropractors are required to keep that CPR policy up to date.

How Much Does An AED Cost?

Details regarding the technical aspects of AEDs are available on the internet.  When the position paper was written in 2002 the cost of an AED was approximately $3000–$4500 per unit. These cost have dropped significantly.

Where to Buy an AED
I have found that Fran Morales of Rescue Partners has very good prices for a great Welsh Allen AED.  You can purchase an AED for well under $2,000.
 LINK TO AED DISTRIBUTOR