Judiciary Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-687

Title:

AN ACT CONCERNING AUTOMATIC EXTERNAL DEFIBRILLATORS.

Vote Date:

3/17/2008

Vote Action:

Joint Favorable Substitute

PH Date:

3/14/2008

File No.:

SPONSORS OF BILL:

Judiciary Committee

REASONS FOR BILL:

People working out at a health club or participating at an athletic event may be at greater risk for sudden cardiac arrest during and after vigorous exercise. By requiring health clubs and athletic departments of institutions of higher education to provide and maintain at least one automated external defibrillator (AED) and trained employees in cardiopulmonary resuscitation will increase the survival rate for persons exercising cardiac arrest.

SUBSTITUTE LANGUAGE:

● Section 1 (a) (2) (B) of Section 21a-223 deletes the requirement that the applicant for a licensed health club “make reasonable efforts” to ensure that at least one employee is on the premises in line 14

● Section 1 (a) (2) (B) of Section 21a-223 deletes “staffed” before business hours in line 15

● Section 2 (b) (2) deletes “certified “ trainer in line 70

● Section 3 of 52-557b deletes “the limit of liability provided in this subsection shall not apply to acts or omissions unrelated to the rendering of emergency care.” (See lines 109-110.)

RESPONSE FROM ADMINISTRATION/AGENCY:

Leonard Guercia, Department of Public Health-Supports the bill. DPH recognizes the importance of early defibrillation for sudden cardiac arrest victims and encourages the proliferation of automatic external defibrillators (AED) throughout Connecticut.

Under Sections 1 and 2 of the bill, each health club and each athletic department of an institution of higher education in Connecticut will provide and maintain at least one AED on the premises. This will have a positive effect on public access to AED, which will increase the survival rate for cardiac patients.

Section 2 of the bill states that the athletic department of each institution of higher education shall develop and implement a policy concerning the availability of AED (s) during athletic activities and events. However, the creation of policies with higher education institutions is the responsibility of the University trustees. DPH therefore, requests changing the language to require university trustees develop and implement the policy.

The American Heart Association (AHA) states that approximately 335,000 people in the United States die each from coronary heart disease before reaching a hospital. Most of these deaths result from sudden cardiac arrest and the changes of survival for a victim of cardiac arrest decrease 7-10 percent for each minute that elapses after the arrest, and very few resuscitations are successfully performed after ten minutes. People working out at a health club or participating in an athletic event may be at greater risk for sudden cardiac arrest during and shortly after vigorous exercise. A health club or athletic department with an ED on site will be able to deliver potentially life saving care immediately after an arrest, which will increase chances of survival.

These individuals will be able to react quickly and initiate the “Chain of Survival” which includes immediate notification of emergency medical services, CPR, utilization of an AED and advanced life support care. Additionally, AED training consists of a short training session that anyone can participate in and no previous medical or emergency training is required.

The bill achieves DPH's goals regarding Public Access Defibrillation Programs such as increasing the number of AEDs in Connecticut, integrating public AED programs with local emergency medical service providers, encouraging CPR/AED training, ensuring an organized and constructive maintenance program, and expanding the liability protection under the Good Samaritan law to include the person or entity providing or maintaining the AED.

NATURE AND SOURCES OF SUPPORT:

Joni Czajkowski, Senior Director of Government Relations/Advocacy, American Heart Association-Supports the bill. Although this bill only speaks to athletic departments of an institution of higher education, AHA suggests the section be expanded to include all Connecticut schools.

AHA's priority is to have Good Samaritan Immunity protections for both the user and entity by 2010. Connecticut currently only protects the user. Connecticut businesses, organizations and individuals who are involved in the placement and usage of an AED must be provided with Good Samaritan Immunity protection in order to properly expand public access to AEDs.

AHA seeks clarification on the following language “the limit of liability provides by this subsection shall not apply to acts or missions unrelated to the rendering of emergency care, “ and consider preferred Good Samaritan substitute language that passed out of the General Law Committee from HB. 5503.

The AHA supports the placement of AEDs in health clubs and institutions of higher education but cannot support these mandates if the entity that owns/houses the AED is not covered under the Good Samaritan statute. Removing liability barriers for public access to defibrillation for both the user an entity is a crucial component to expanding and mandating placement of AEDs.

Scott Myrick, Athletic Trainer & Chair, Connecticut Athletic Trainers' Association-Supports the bill. The incidence of sudden cardiac arrest in physically active, apparently healthy populations can strike anyone at any time. Sudden cardiac arrest is not the same thing as a heart attack. It results from an electrical disturbance in the heart that causes the heart to go into an abnormal rhythm (ventricular fibrillation) and cease to function. This can occur to infants, young children, teenagers, college students, and adults of all ages and physical conditions.

Approximately 5% of victims of sudden cardiac arrest survive, due in small part to the fact that most people do not receive defibrillation within 3 to 5 minutes. Without early defibrillation, the survival rate will not improve. It is unrealistic to expect that an ambulance or other emergency crew will be able to provide defibrillation in this time period, so the necessity for AEDs on the premises of health clubs and athletic departments is clear.

CATA also encourages amending the bill to include a requirement for elementary and secondary schools in Connecticut to have an AED accessible both during and after the school day. Legislation requiring schools to have AEDs has been implemented in a dozen states, and others are presently considering similar bills. In 2002, the state of New York implemented legislation requiring schools to have AEDs. At least 38 children in New York have been saved since then because there was an AED at their school. Since Ohio implemented legislation, 13 children have been saved because they received early defibrillation.

Catherine DiMeola, Special Member Tolland Fire Department & Chairman, Tolland Community AED Project- Supports the bill. Her full time job is teaching lay responders and bystanders, in businesses and industry and communities how to strengthen the Cardiac Chain of Survival. Tolland has over 40 AEDs in the community. Successes are directly related to trained bystanders who recognize Sudden Cardiac Arrest (SCA) and who are willing to help by calling 911, immediately begin CPR and using an AED. Time is crucial, for every minute that passes with out a life saving shock, the victim loses a 7-10% chance of survival, and therefore public access to the AED is an essential link to survival.

In an article published in Circulation, the Journal of the American Heart Association, January 14, 2008 titled Reducing Barriers for Implementation of Bystander-Initiated CPR, the author recommends government agencies at the local, state and federal level provide CPR education. When AEDs are placed where the public has access to them, such as community lay responder AED programs, survival rates from SCA have been reported as high as 49% to 74%. In various studies over the past 15 years survival without an AED is 1.4% to 2%.

The article also noted fear of legal liability as a barrier, bystanders were not aware of the Good Samaritan Laws and companies were fearful as the laws did not specifically address the entity. The article recommends information about Good Samaritan Laws be included in all CPR training program and material posted prominently near AED installations. Heart Safe Workplace, Harvard University provides an excellent model of this concept.

Lawrence Pontbriant & Michael Giannelli, Norwich, CT-Support the bill. Mr. Pontbriant's son Larry, a varsity letter in lacrosse his freshman year, would have been alive if an AED been available. His son collapsed with a Sudden Cardiac Arrest during a community athletic event in Norwich. His heart had gone into ventricular fibrillation halfway through a 3 mile road race. He was given CPR at the scene and was eventually revived by paramedics using an AED, only to die three days later due to brain swelling. The swelling was due to damage caused by the amount of time Larry's brain had reduced oxygen. CPR under the best condition is effective to add precious minutes to a rescue, however if the victim's own heartbeat is not restored within 6-10 minutes, the chances of survival are low. In Larry's case the AED arrived on the scene too late to save his life. The fact that Larry's heart was restarted by an AED and pumped strongly for three days demonstrates that early defibrillation could have saved his life.

The reliability of AEDs as life saving devices is demonstrated in a New York case. In 2002, the state of New York passed “Louis Law” after a young athlete, passed away from sudden cardiac arrest while playing lacrosse and as a result, AEDs are placed in New York schools. 40 lives have already been saved.

There are many athletic activities and events that do not occur at institutions of higher education or even at public schools. Many organizations, leagues and towns have their own athletic farcicalities for multiple events that occur almost daily. Most of these facilities do not fall under the mass gathering statute and would not require the presence of EMS equipment or personnel. If the definition of institution of higher education means elementary schools even then it still does not cover the entire spectrum of athletic events in our communities.

They have concerns with the definition of “Institution of Higher Education. “ Many of the facilities where youth sports are played are usually not at “institutions of higher learning.” Public access can not happen until those who own and operate the device are covered under the Good Samaritan statute. Currently, state statute only covers the user, therefore amending the statute to include Good Samaritan Immunity protection for the entity that houses the device is requested to expand public access to AEDs.

Teri Bruce, Director of Student Services, Norwich Free Academy- Supports the provision of the Raised Bill that removes liability from a person or entity in the event of AED usage. The language regarding removing liability barriers is in accordance with actions being taken by other state legislatures. See the National Conference of State Legislatures that notes “recent state laws encourage broader availability, rather than creating new regulatory restrictions.” http://www.ncsl.org/programs/health/aed.htm. This is important for municipalities, independent schools such as Norwich Free Academy, and other entities to be protected form liability if the necessity of AED usage arises.

Vicky Graham, Assistant Athletic Trainer, Wesleyan University- Supports the bill with concerns. She has 20 years experience as an athletic trainer, including more than 15 years working in intercollegiate athletics, and 5 years working in a high school athletic setting.

She requests the bill be amended to include a requirement for elementary and secondary schools in Connecticut to have an AED accessible both during and after the school day. She also urges clarification of the immunity protection language and consider replacing it with substitute language in H.B. 5503.

Areas of other concern include:

● The requirement of at least one “certified or licensed athletic trainer” on the premises of such athletic department during “hours of operation.” An Athletic trainer must be licensed by DPH in order to practice as an Athletic Trainer in Connecticut. National board certification is a prerequisite for eligibility for Connecticut licensure. An individual can be certified (nationally), but not licensed in Connecticut. Suggestion: language should be amended to read “licensed Athletic Trainer in Section 2, lines 69-74.

● Hours of operation should be more clearly defined. This definition is broad and raises a number of questions, i.e., times of scheduled games, business hours, activities occurring on the premises.

● Section 2, lines 79-82, the terms “physical contact” and “on the premises” raises ambiguities with sports that do not involve physical contact between players.

David Boomer, The Kowalski Group on behalf of the International Health, Racquet & Sportsclub Association-Supports the bill with concerns. The International Health, Racquet & Sportsclub Association (IHRSA) agrees that AEDs are wonderful devices and save lives. Heath clubs have not opposed them; in fact a number of clubs in the state already installed them. Their only concern relates to liability issues.

The bill as raised provides some of the liability protections needed-immunity to the facility management (“entity”) as well as staff if an AED is used. The bill however, does not provide this same protection in the event an incident occurs and the AED is not used, which could leave health clubs open to crippling lawsuits. The raised bill prohibits liability protection in non-use situations.

IHRSA proposes the adoption enacted into law by Massachusetts, which provides liability protection for health clubs regardless of whether AEDs is or is not used. Therefore, it is recommended the non-use prohibition language in lines 110-112 of the raised bill be replaced with the following language: Absent a showing of gross negligence or willful or wanton misconduct, no cause of action against a health club or its employees may arise in connection with the use or non-use of a defibrillator.

NATURE AND SOURCES OF OPPOSITION:

Connecticut Trial Lawyers Association- Opposes the bill. The bill as raised expands the Good Samaritan immunity for the use of AEDs and would expand the immunity in 52-557b (a) to “entities.”

The Good Samaritan law was passed to give individuals who voluntarily and gratuitously render emergency medical attention immunity from liability for ordinary negligence. The raised bill would extend that immunity to any corporation, limited liability company, partnership or other entity that happened to have an AED on its premises. Section 1 of the bill requires health clubs to provide AEDs and trained personnel on their premises to use them in emergency situations, and it does not follow that these clubs, corporate entities created to make a profit should be given immunity under the Good Samaritan statute for something they are bound by law to provide to their customers.

Second, authorized citizens acting as Good Samaritan are already covered under 52-557b (a) by affording immunity to any person trained to use an AED and does so voluntarily to save a life. Under the raised bill, any health club that purchased an AED would be shielded as a Good Samaritan, even though they could not be doing so voluntarily or graciously because they are bound by law to provide the machine by section 1 of the bill.

Finally, immunity should be reserved for trained individuals, not afforded to profit-making corporations. Immunity for liability should be reserved for those well trained and certified to perform the tasks required in emergency situations. This is evidenced by the need for certification presently included in sections 28-13 and 52-557b. In both instances immunity is afforded to trained individuals who can reasonably be expected to successfully perform the emergency task, not to corporations or other entities.

Reported by: Laurie Julian

Date: March 26, 2008