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Preparing for Sudden Cardiac Arrest in Remote Environments: Strategies for Successful Camp AED Programs
Last summer, two Silver Springs, Maryland, YMCA employees saved the life of a camp member who experienced sudden cardiac arrest (SCA) by quickly using an automated external defibrillator (AED). This year, a sixteen-year-old Boy Scout died from sudden cardiac arrest at an Oregon camp despite efforts to revive him with an AED and CPR. What do these two stories have in common? Both camps possessed AEDs which were used quickly when SCA struck.
AEDs are easy-to-use medical devices designed to enable citizen AED users to rapidly deliver life-saving therapy to the more than 350,000 people, including as many as 19,000 children under the age of 18, who experience SCA annually in the U.S. A growing number of SCA episodes are being reported in camp environments. The rapid use of AEDs is essential to save the lives of camp members who may experience SCA.
More and more camps are buying and deploying AEDs in an effort to prepare for sudden cardiac arrest emergencies. AEDs alone, however, do not save lives. Rather, the rapid retrieval and use of AEDs is critical for the devices to be effective. In addition to making preparations for AED use, camp managers must also take steps to manage liability risks surrounding camp AED programs. The following strategies are designed to help camp managers save lives and manage risk.
Strategies to Help Save Lives
Successful camp AED programs must be designed to ensure that operational AEDs are ready and rapidly retrieved and used when needed. Many elements associated with a camp AED program must be considered and implemented for this objective to be achieved. While numerous factors should be taken into account, following are key essential elements that should be included in camp AED programs:
- Proper number of AEDs in the right locations: Each camp should deploy a sufficient number of AEDs such that one can be retrieved and used within four to five minutes. This may require that AEDs be moved to different camp locations depending on the nature of camp member activities.
- Visible and widely known AED placement locations: AEDs should be placed in known locations that are accessible to everyone. Situations involving locked, "invisible," or otherwise inaccessible AEDs should be avoided. Inform everyone at camp of the presence and locations of nearby AEDs and place AED signs in proximity to each device. All employees, guests, and visitors should know what AEDs are, what they are for, and that they are easy to use.
- Proper AED inspection and maintenance: AEDs are easy to maintain. However, each AED should be inspected at least monthly and serviced if needed. Batteries and electrodes that are within ninety days of expiring should be replaced.
- Sufficient number of AED responders: AEDs are safe and are specifically designed to be easy to operate by formally trained users as well as untrained users. While a core group of camp employees should receive formal training in the use of AEDs, everyone within the camp environment should be permitted to retrieve and use the device. This approach is supported by the easy-to-use nature of AEDs and the fact that the devices are designed to deliver a shock only to those who need it — if an AED does not detect an abnormal heart rhythm, it will not deliver a shock. Efforts to use an AED cannot worsen an SCA victim's condition.
- Adequate AED response communications: Make sure that camp employees are able to rapidly communicate the need for an AED, and the SCA victim's location, so that an AED can be quickly retrieved to that location.
These strategies, if implemented properly, increase the chances an AED will be available, ready for use, and retrieved when needed. This, in turn, increases the chances sudden cardiac victims will survive.
Strategies to Help Manage Risks
Camp organizations are mindful of the many liability risks surrounding camp programs. Camp lawyers and risk managers are responsible for taking steps to manage such risks. Similar strategies should be considered in the context of AED programs.
AED program risk management strategies generally fall into the following categories:
- Liability insurance
- Good Samaritan immunity
- AED manufacturer indemnification
- Carefully designed and operated AED programs
Liability insurance: As with any safety program such as this, camp organizations should carry liability insurance of the right types and with the right coverage limits to adequately protect against reasonably foreseeable claims. Camp managers should check with their insurance brokers to confirm that coverage for emergency medical response activities is included. Appropriate coverage should be added if necessary.
Good Samaritan immunity protection: Each state and the District of Columbia have Good Samaritan immunity laws specifically applicable to AED-related activities. Unfortunately, these laws vary widely and do not protect everyone.
Many state AED immunity laws contain conditions that must be met in order for the camp organization to qualify for protection. Following are examples of administrative and operational conditions found in AED Good Samaritan laws:
- AED maintenance
- Physician supervision
- Agency notification
- Program documentation
To clearly understand whether, to what degree, and on what conditions AED Good Samaritan immunity coverage may help protect your camp AED program, review applicable state and local laws. If necessary, consult with your organization's attorney and/or risk manager to ensure legal and operational requirements are clearly defined.
AED manufacturer's indemnification: Some AED manufacturers offer liability indemnification coverage as a component of AED program services. This can add another layer of liability protection to a camp's AED program. When considering such programs, it is important to have your legal and risk management professionals review the terms of indemnification carefully to ensure that all aspects of AED program operations are protected.
Carefully designed and operated AED program: Perhaps the best strategy for managing risk is to ensure that your camp AED program is reasonably designed and operated. While not all lives will be saved — as illustrated by the two examples at the beginning of this article — by identifying and configuring key characteristics necessary for a reasonable AED program, camp organizations can effectively and defensibly prepare for and respond to sudden cardiac arrest emergencies prior to the arrival of traditional emergency medical services resources. This proactive risk management approach is most likely to reduce the threat of lawsuits associated with sudden cardiac arrest events at your camp facilities.
AED programs represent an important component of overall camp safety. Overall, camp AED programs should be structured to:
- Ensure that the camp AED program design recognizes and meets the intent of applicable laws and regulations in each state in which the organization operates;
- Be capable of meeting reasonable life-saving response time goals within the context of properly balanced program costs, benefits, and risks;
- Encourage prompt life saving action; and
- Ensure that the program is "reasonable" and that all essential administrative and operational AED program elements are documented in camp policies and procedures.
It must be kept in mind that, by their very nature, AED programs are established in an effort to quickly deliver treatment to victims of sudden cardiac arrest. While AED programs can improve the chances of survival, AED programs cannot guarantee survival. Clearly, camp AED program sites are not hospital emergency departments, and the people who volunteer to help SCA victims are generally not trained health care professionals. As a result, even well-designed AED programs will not function as designed every time they are needed. For example, people may be unable or unwilling to act due to the stressful nature of the circumstances.
The camp AED program design process should recognize the nature of the environment and include reasonable program elements that are most likely to increase the chances of success. Success, however, cannot be assured. When success happens and lives are saved, the value of camp AED programs pays dividends to all affected.
© 2006 Richard A. Lazar
Originally published in the 2006 Spring issue of The CampLine.