Legislation Gets to the Heart of Health & Safety
Preparedness Critical to Three-Minute Response
By Barbara Carss
Manitoba is the first Canadian province to mandate automated external defibrillators (AEDs) in facilities that attract a high volume of patrons and/or where recreational pursuits occur. Property owners and managers are still awaiting the Regulations that contain the precise instructions, but the general requirements of the Defibrillator Public Access Act are commonly known.
By January 2014, premises designated for the first phase of compliance must have on-site AEDs (also commonly known as public access defibrillators or PADs) registered with the Heart & Stroke Foundation in Manitoba and the capability to respond to a cardiac incident within three minutes. This is expected to include: shopping malls; educational facilities; airports, bus and train stations; gyms, arenas and other indoor recreation venues; golf courses; casinos; museums; libraries; and various other provincially and municipally owned/operated buildings.
“They will have had plenty of time to comply. The Act was passed in June 2011 and, with the public consultation, they will know the places that are likely to be designated for phase one,” observes Jackie Zalnasky, Vice President, Health Promotion and Research, with the Heart & Stroke Foundation in Manitoba.
PLAN BEFORE PLACEMENT
The Heart & Stroke Foundation advises that an AED, alone, costs in the range of $1,500 to $2,000. Services related to installation, associated supplies and ongoing maintenance should also be factored into the total capital outlay.
The sheer number of devices is not necessarily the key to effectively deploying resources, however. Emergency responders emphasize the importance of planning, trained on-site personnel, signage and associated awareness campaigns so that people know where to find an AED and who to call if an incident occurs.
“We are looking for a three-to-four-minute round-clock time. If it’s kept in a central staffed location, like the school or mall office, it can be dispatched with one-way travel time rather than from the patient to the AED and back to the patient,” explains Gayle Pollock, Commander of the Cardiac Safe City Program overseen by the City of Toronto’s Emergency Medical Services (EMS). “That needs to be determined ahead of time and stated in the plan.”
Site assessments and emergency response plans are required initial steps for the voluntary participants in the Toronto EMS program. Approximately 1,300 AEDs have thus far been placed, primarily in public, but also in some privately owned buildings. (Pollock projects that number will grow to about 1,500 by the end of 2012, partly due to funds from Ontario’s $10-million province-wide Defibrillator Access Initiative, which will underwrite installation of AEDs in all of the Toronto Catholic District School Board’s elementary schools within the next six months.)
Devices registered through the program are integrated into Toronto’s 911 database so that emergency medical dispatchers will immediately see there is an AED on-site when they key in address information and can inform callers as part of the pre-arrival instructions. The registry to be maintained by the Heart & Stroke Foundation in Manitoba will provide the same kind of resource for EMS paramedics in that province as they receive 911 calls.
RESPONSIBILITY & PROTECTION
Manitoba-based property owners/managers must register every AED on-site and update the information any time the location of an AED is moved. Other elements of legislation set rules for signage, regular testing and the documentation of testing and maintenance. The Act also provides protection from liability to all who meet its stated requirements.
“That’s important if facilities are not designated to comply with the legislation, but they still want to do it,” says Leandro Zylberman, a lawyer practicing with Thompson, Dorfman, Sweatman LLP in Winnipeg. “The legislation is based on the idea of the owner/occupier acting in good faith in terms of where AEDs are located, the signage and maintenance, and it will protect them if they comply with everything.”
Meanwhile, even though health and emergency services experts underline the benefits of trained personnel who can step in with little or no hesitation, it is not mandatory under the Act.
“Training is not prescribed in our legislation because if you require people to be trained then you don’t really have public access,” Zalnasky notes. “We do, however, recommend CPR and AED training, if possible.”
The Heart & Stroke Foundation in Manitoba has produced the Community AED Toolkit to guide facility owners/managers through the steps of choosing, installing and maintaining the devices and being prepared to respond. Many suppliers/distributors also offer site assessment, training and follow-up maintenance services, which can relieve pressure on in-house resources and the need for expertise, but property owners/managers are advised to be aware of what services they will need when making their choices.
“We have that all summed up in a checklist that tells you the questions to ask,” Zalnasky says.
Though not enshrined in the legislation, trained staff will invariably be an element of any facility’s emergency plan – and more than one trained staffer per shift is recommended. “What if it’s the person who is trained who is in cardiac arrest?” Zalnasky asks.
“AEDs are very simple and anybody from the general public could use one and manage just fine, but, in an emergency, you don’t know how people are going to react so there is an advantage in having trained people on hand,” Pollock concurs.
Even with AEDs within a three-minute range, trained intervention is still recommended. “Bystander CPR is the best treatment that a cardiac arrest patient can receive until a defibrillator and advanced medical care arrive,” states the Heart & Stroke Foundation’s Position Statement on Public Access to Automated External Defibrillators.
Manitoba’s legislation is the first in Canada, although not the first attempt among provinces. A private member’s bill, the proposed Defibrillator Access Act, received all-party support for first and second reading in the Ontario legislature in the spring of 2010, but did not make it onto the order paper for third reading before the session ended and an election was called for October 2011.
Legislation has not yet been reintroduced in Ontario’s current parliamentary session, but informed observers expect to see similar Bills there or elsewhere, possibly next in British Columbia. AEDs are also mandated in several U.S. jurisdictions.
“It doesn’t seem like an onerous piece of legislation and it seems like owners generally recognize the benefits outweigh the costs. It’s going to look great when people are saved,” Zylberman reflects. “Leaving the law aside, there is the business aspect of it. Who wants the negative publicity if an incident occurred and they didn’t have an AED or it wasn’t working properly? It just doesn’t make business sense.”
Likewise, the Building Owners and Managers Association (BOMA) of Manitoba reports no notable concerns expressed by its membership.
“We started quite a few years ago with awareness and we haven’t really ever had negative feedback,” Zalnasky affirms. “I was really pleased with how relatively easy this went in Manitoba and, certainly, the government was right onside.”
In the future, AEDs may be just another status quo component of any building’s health and safety regimen.
“They are all required to have fire extinguishers and no one ever questions that,” Zalnasky says. “It’s far more likely that there will be a cardiac arrest in a building than cause to use a fire extinguisher.”
For more information, see the Heart & Stroke Foundation of Manitoba web site at www.heartandstroke.mb.ca or Toronto’s Cardiac Safe City web site at www.torontoemssafecity.com.