Public Access to Defibrillation (PAD) Around the World

Iridia Medical is a proud partner of the Heart and Stroke Foundation’s PAD program. Over the past decade and a half many countries have worked to develop programs that facilitate the public’s access to Automatic External Defibrillators (AEDs). In order to develop an innovative public access to defibrillation program for BC, the Heart and Stroke Foundation surveyed a variety of national and international PAD programs. We are excited to be part of this exceptional project that will ultimately save the lives of countless British Columbians. To celebrate BC’s PAD Program, we decided to take a look around the globe to see how different Public Access to Defibrillation programs were able to create positive impacts in their communities.

Public Access to Defibrillation

Canada

Canada has a few provincial PAD programs. The Ontario PAD program has been active since 2007, and they have installed around 3000 publically accessible AEDs. Over the next few years, and with the help of additional provincial funding Ontario is planning on installing another 2500 Public AEDs. Today, over 40 lives have been saved by publically accessible AED’s in Ontario.

United States

In the United States, many cities have developed their own PAD programs. San Diego started “Project Heartbeat” in 2001. The initial goal of their program was to place 250 AEDs in public places throughout the city in time for the 2003 Superbowl. San Diego managed to exceed their goal by placing 550 publically accessible AED units in that time frame. San Diego is working to make AEDs prevalent in public places as Fire Extinguishers currently are. San Diego’s AED of choice is the Powerheart AED G3 Automatic; an AED that Iridia Medical is also proud to carry in our product line. Today, Project Heartbeat has saved 107 lives in the Greater San Diego area.

Powerheart AED G3

In Florida, the City of Miami/DADE fire-rescue department developed the “Team for Life” program in an effort to promote public access to defibrillators in the region. The fire-rescue department provides funding, training, equipment and program management for the public AED program. Miami/DADE has also worked to create one of the largest public access to Defibrillator initiatives in the world by equipping 1900 Police vehicles with Lifepak 500 AEDs.

Spain

In 2011, Spain became the first country in the European Union to start a PAD Program. The Territory of Girona, Spain intends to install 500 fixed AEDs and 150 portable AED units throughout the region. Spain has chosen to install the Powerheart G3 Plus Automatic AED on busy street corners and in public buildings. 

Australia

Meanwhile in the Southern hemisphere, Saint John’s Ambulance Australia started the community based “Heart Start” program. This program was begun in 2004 and provides guidance for public institutions seeking to incorporate an AED into their facilities. To date, this program has saved 19 lives. In 2012, Saint Johns Ambulance began offering subsidized AED’s to the public. They have received an overwhelming amount of public support for their program and they are hoping to see it grow dramatically in the future.

Hong Kong

Moving into Asia, on March 11th 2007, the Hong Kong College of Cardiology in conjunction with the Lan Kwai Fong Association installed their first AED in a public place, as part of their “Heart-Safe Place” program. In the program’s first year, over 100 AEDs were installed in places ranging from community centers and sports arenas to amusement parks.

Japan

Since 2004, Japan has been working to incorporate AED’s into their communities. When the program began there were approximately 9906 publicly accessed defibrillators in Japan. Due to a number of public and private initiatives, by 2007 the number of community based AEDs had risen to about 88,265. A study conducted on the Japanese PAD initiative found that the increase in public access to defibrillators was shown to dramatically improve an individual’s chances of surviving a cardiac event .

Iridia Medical is very proud to be part of the BC-PAD program and we are very excited to be joining these other locations in an effort to bring accessible AEDs to the public.

[1] Kitamura, T., et.al. “ nationwide Public-Access to Defibrillators in Japan” New England Journal of Medicine, (March 18, 2010) http://www.nejm.org/doi/full/10.1056/NEJMoa0906644

Specialist Physicians Realize the Future Lives in Surrey

Mayor Dianne Watts talks to media outside the Jim Pattison Outpatient Care and Surgery Centre in Surrey on June 8, 2011.

Mayor Dianne Watts talks to media outside the Jim Pattison Outpatient Care and Surgery Centre in Surrey on June 8, 2011.

If you talk to people who work in, or alongside, the healthcare industry, you will no doubt pick up a common theme related to physician resources — they are scarce and recruiting them is a veritable challenge. The situation is so serious that attracting specialist physicians is often identified as one of the major threats to success when opening a new hospital or adding additional beds to an existing facility.

It is precisely this contextual backdrop that makes what is happening in Surrey so intriguing.

Physicians are realizing that Surrey has the necessary ingredients to be one of the best places to practice the craft of medicine. Indeed, the historic trend that has seen Vancouver be the bigger draw when compared to communities such as Surrey is reversing as I write.

But, why Surrey? Quite simply, it is the patients. Canadians have made Surrey one of the fastest growing communities in Canada. The population growth has accelerated a healthcare infrastructure investment of over $750 million just in the last few years. Leading the way has been visionary Mayor Dianne Watts and her team, who are helping physicians, like many other Canadians, realize that, per the city slogan, “the future lives here.”

The specific appeal for physicians, in my opinion, is the combination of a unique patient population mix and the following characteristics:

1. A focus on culture

The major driving force bringing physicians to Surrey is the concerted effort to promote a new culture of healthcare innovation and excellence. A significant shift is now underway which is seeing Surrey positioning itself firmly among the traditional major players such as Vancouver General, St. Paul’s and Royal Columbian Hospitals.

This shift from its traditional role as a community hospital will see Surrey become a leading academic centre of excellence with enhanced research, academic and educational opportunities. This shift is attracting not only practicing physicians but also more and more physician learners who, once their training is completed, will plan to set up practice in Surrey.

2. The practice opportunities at the Pattison centre

jim pattison outpatient care and surgery centre

Many physicians have been afforded the unique opportunity to practice in the Jim Pattison Outpatient Care and Surgery Centre, the first stand-alone dedicated outpatient facility of its kind in Western Canada. What is making physicians so enthusiastic about the Jim Pattison centre? Well like the name implies, only outpatients are seen.

Here physicians can focus directly on the patients at hand without the constant interruptions for emergency and urgent cases that comes when clinics are located within hospitals. This allows a cardiologist, radiologist, or orthopedic surgeon to be highly efficient in the delivery of their care. The design of the Jim Pattison centre was heavily influenced by LEAN methodology, which reduces the inefficiencies in patient flow and maximizes the effectiveness of care delivery. In short more order, less chaos.

3. The Surrey redevelopment and expansion project

A major redevelopment and expansion effort is underway in Surrey including the building of an eight-storey Critical Care Tower on the Surrey Hospital campus. This state of the art facility will add 120 beds to the Surrey campus including much-needed emergency department capacity as well as both adult and neonatal critical care beds. This development is bringing some of the latest technology, equipment and care models to Surrey and the physicians are anxiously awaiting the opening of this new facility.

With the population mix that it has, and the traits outlined above, it is no wonder that Surrey has managed to attract some of the best physicians to the city.

And this certainly bodes well for the future, as in my experience, once doctors begin to practice in Surrey, they often remain committed to the region for their career. With an opportunity to raise their kids in a thriving and vibrant community and to practice great medicine, why would they move?

So while many people from within and around the healthcare industry will make commentary about the challenges associated with securing quality physicians, it is refreshing to have a story like Surrey’s to brighten the picture ever so slightly.

Dr. Allan Holmes grew up in Surrey and has spent the last 20 years working within the Fraser Health Authority in a variety of capacities. Recently he served as the hospital medical co-ordinator of the Jim Pattison Outpatient Care and Surgery Center and his current role is the physician resource planning consultant for the Surrey Memorial Hospital Redevelopment and Expansion Project. Dr. Holmes is also the founder of Iridia Medical, a continuing medical education provider and regional distributor of automated external defibrillators.

Defibrillator Liability: Do You Have All the Facts?

Introduction

Sudden cardiac arrest (SCA) strikes over 45,000 Canadians per year. The only proven treatment for SCA victims is early defibrillation. If no defibrillation is administered within ten minutes of the attack, the chances for survival approach zero.

The latest guidelines from the Heart & Stroke Foundation call for lay responders trained in the use of Automated External Defibrillators (AED’s) as well as CPR.

Organizations that implement early defibrillation programs demonstrate a commitment to the advancement of public health and the welfare of their staff and co-workers.

Defibrillator Liability

Defibrillator Liability

As medical technologies go, public access to defibrillation is relatively new and it is not uncommon for people worrying that novel plans may lead to unexpected problems: problems that can land them in court.

The truth is that legal liability risks associated with early defibrillation programs are remote. Liability concerns should not deter those considering the purchase and use of an AED.

Relevant trial court verdicts suggest that organizations that adopt AED programs face a lower liability risk than those that do not. This includes the US states of Florida and California, which have the highest medical litigation rates in North America.

Many provinces also have laws that limit the types and scope of negligence lawsuits permissible against individuals who render emergency medical care including tort limitation, Good Samaritan laws and a variety of immunity laws.

Defibrillator Liability and the Law

Only two US cases on record directly address the issue of early defibrillation by non-healthcare professionals¹, and both complaints alleged negligence for not having an AED available. Because they were both dismissed on technical grounds, neither case offers much guidance on how future appellate courts might address issues surrounding public access defibrillation.

Future trial court cases will likely revolve around society’s view of reasonableness when businesses are faced with ill or injured patrons.

Courts examining notions of reasonableness in other medical contexts have historically resisted requiring businesses faced with ill or injured patrons to do anything more than summon an ambulance. However, the AED legal and regulatory landscape is evolving.

Action (or inaction) that the courts view as reasonable today may be viewed as unreasonable tomorrow.

Advances in AED technology, their relatively low cost and the now proven ability of these devices to save lives may persuade trial and appellate courts to sanction businesses that do not adopt AED programs.²

A Word on Causation

Defibrillator Liability

A successful negligence lawsuit involving defibrillator liability requires proof that the alleged misconduct caused legally recognized damages such as death or injury. That means any case will allege harm through one of three possible causation theories:

  • Failure to purchase and make available an AED
  • Failure to use an available AED
  • Improper use of an available AED

Businesses that do not deploy AEDs at the scene of an SCA are at the greatest risk in terms of proof of causation.

Next in order of risk are those situations in which an AED is available but not used or improperly used. Modern AEDs are both easy to use and difficult to misuse. These systems have been extensively tested in thousands of cases without a single recorded case of accidental shock. Companies that purchase and train their staff to properly use AEDs assume the lowest causation risk.

Left untreated, a sudden cardiac arrest will always kill the victim. A properly used AED can only help. Therefore, proving medical causation of harm in any early defibrillation case would be extremely difficult.

The most likely causation question to be considered is whether death could have been prevented with –not caused by– the availability and use of an AED.

Minimizing Legal Defibrillator Liability

There are a variety of ways to manage the lawsuit liability risks associated with early defibrillation programs:

1. Design a careful program

The development of a detailed plan for having a trained rescuer quickly arrive at the side of an injured or sick person will reduce the stress burden of any responder, and lead to improvements in administering care.

General rules governing negligence cases suggest organizations that implement a plan for their early defibrillation programs face lower legal liability risks than those that do not.

2. Promote Good Samaritan laws

Most provinces have Good Samaritan laws³ that protect individuals from legal liability flowing from the provision of emergency medical care.

A growing number of laws specifically protect responders to medical emergencies from legal liability under certain circumstances. A review of local laws will help determine whether, and to what degree, liability immunity protection exists.

Summary

Certain types of businesses can actually reduce their exposure to claims of negligence by adopting an AED program.

The notion held by many companies that buying and deploying AEDs increases risk is not borne out in the courts. No one in North America who had used an AED to render aid has ever been sued for that deployment. Moreover, liability risks impacting businesses that implement AED programs can be further reduced by Good Samaritan laws.

Having an early defibrillation program is the right thing for business and the lower risk option to not having one.

Iridia can provide any organization with the components for a comprehensive AED Program including acquisition of the AED and its accessories; physician-led training and certification, response planning and oversight; and liaison with health care agencies.

Our experience as pioneers of occupational AED programs, and our passion for universal public access defibrillation put us in a unique position to offer a high-value program.

1 Somes v. United Airlines, [1995]; and Talit v. Northwest Airlines, [1995]
2 Richard A. Lazar, “Understanding AED Program Legal Issues” [White paper], (2007)
3 British Columbia Good Samaritan Act, chapter172, 1996; Ontario Good Samaritan Act, chapter 2, 2001; Quebec Civil Code, article 1471, 1991; Nova Scotia Volunteer Services Act, chapter 497, section 3, 1989
4 Yukon Territory Emergency Medical Aid Act, chapter 70, 2002; Alberta Emergency Medical Aid Act, chapter E-7, 2000; Northwest Territories Emergency Medical Aid Act, chapter E-4, 1988; Saskatchewan Emergency Medical Aid Act, chapter E-8, 1978

Cardiac Re-synchronization Therapy

As part of our mission here at Iridia to promote heart disease, we are constantly drawing awareness to Automated External Defibrillators (AEDs) and their importance in fighting Sudden Cardiac Arrest (SCA). One area we haven’t talked is  the “what comes next area.” What happens when you survive a SCA or are diagnosed with heart disease? There are treatment options available and Cardiac Resynchronization Therapy (CRT) is one of them.

Cardiac Re-synchronization Therapy

CRT is used to treat the delay in heart ventricle contractions that occur in some people with advanced heart failure.

In other words, CRT is a therapy to provide a weakened heart with the ability to be re-synced and restore proper pumping functions.

Currently, CRT is one of the most advanced cardiac treatment options available for heart disease sufferers.

In order to re-sync the heart, a CRT pacing device (also called a biventricular pacemaker) is surgically implanted under the skin. This specially designed pacemaker stimulates the lower chambers of the heart to contract at the same time, making the heart more effective and efficient.

How does a Biventricular Pacemaker work? When a heart rate drops below a set rate (programmed by a doctor), the pacing device generates small electrical impulses that pass through the leads to the heart muscle. Theseimpulses make the lower chambers of the heart muscle contract, causing the right and left ventricles to pump together. In many cases, the end result is improved cardiac function.

Cardiac Re-synchronization Therapy

Studies have shown CRT improves symptoms of heart failure in about 50% of patients. Many of these patients had previously been treated with medications but still suffered severe or moderately severe heart failure symptoms.

CRT not only improves survival, but also quality of life, heart function, ability to exercise, and helps decrease hospitalizations in many patients with severe heart disease.

The procedure itself is generally very safe. Given the success of CRT, if an individual is a good candidate for the procedure, CRT will give them an increased chance at a normal life.

Cleveland Clinic, a non-profit academic medical research centre, has shown that on average, CRT improves the amount of blood pumped out with each heart beat by 5% to 10%. In some cases, patients with a CRT device can even develop normal ventricular function. It is not rare for a patient to see an increase of blood pumped out by each beat by up to 40%.

Given the health benefits, it is unfortunate that CRT is not available to all heart disease sufferers. CRT is only appropriate for people who:

  • have severe or moderately severe heart failure symptoms
  • are taking medications to treat heart failure
  • have delayed electrical activation of the heart 
  • have a history of cardiac arrest or are at risk for cardiac arrest

What does the future hold for CRT? According to recent studies, allowing implantation of CRT devices in patients with moderate heart failure could help stem progression of heart failure.

Kamloops This Week Picks Up Our AED Giveaway!

February has been an exciting month here at Iridia. Our AED giveaway is in full swing and we are thrilled at all the great responses we have received so far. We are very excited at making a difference and being able to give away such an important device as an AED. Heart Month comes, only but once a year, and it is really great to see others taking up this cause and generating awareness.

Here’s the story by Tim Petruk in Kamloops This Week . . .

“Iridia Medical, a leading Canadian distributor of automated external defibrillators (AEDs), is giving away an AED to help raise awareness for sudden cardiac arrest (SCA).

The promotion is being held in conjunction with February’s designation as Heart and Stroke Month.

In Canada, SCA claims up to 45,000 lives each year, which translates to one cardiac arrest every 12 minutes.

The only effective treatment for SCA is the early delivery of an electric shock by an AED.

Unlike a heart attack, which is caused by a blockage in an artery and requires surgery, SCA results from an electrical malfunction of the heart.

For every one-minute delay in defibrillation, the survival rate of a sudden cardiac arrest victim decreases by seven to 10 per cent.

The major risk factor for SCA is coronary heart disease.

Other risk factors for SCA include a personal or family history of SCA or inherited disorders that makes one prone to arrhythmias, a personal history of arrhythmias, heart attack, heart failure and drug or alcohol abuse.

“Iridia Medical Services is excited about awarding an AED to a deserving winner,” said Tom Puddicombe, director of business operations at Iridia.

“We hope that this contest will generate more awareness about SCA and the value of having AEDs accessible in a cardiac-arrest emergency.”

AED Giveaway

Businesses, organizations and individuals can enter the contest by visiting the Iridiawebsite by Feb. 28 at:
www.global-medical.ca/content/giveaway.

Once there, a form can be accessed on which the entrant can share why they would benefit by winning the AED.

The contest winners will be short-listed by Iridia staff.

Five winners will be posted on Facebook and the public will vote to determine who wins the prize.”

AED Giveaway

Source:
http://www.kamloopsthisweek.com/community/138972739.html

What an AED Save Really Looks Like

I am sure you have read the stats before, but here they are again:

  • In Canada, 35,000 to 45,000 people die of sudden cardiac arrest each year. 
  • Early defibrillation is the only effective treatment for Sudden Cardiac Arrest (SCA). 
  • For every one minute delay in defibrillation, the survival rate of a cardiac arrest victim decrease by 7 to 10%
  • After more than 12 minutes of ventricular fibrillation, the survival rate of adults is less than 5%.

These statistics do not paint a pretty picture, and even now, with all the technology at our disposal, AED saves are frighteningly rare. There is no “good time” to have an SCA, but when an individual does survive, it is usually a combination of having an SCA at the “right place and the right time.”

At Iridia, it is one of our goals to increase access to Automated External Defibrillators (AEDs), as well as create more awareness of these devices. Again, the only cure for SCA is early defibrillation.

It’s one thing to hear about a statistic, it’s another to see it in action:

[youtube=http://www.youtube.com/watch?v=ICODRFoWZkw]

With increased access and widespread awareness, hopefully we will see an increase in  similar outcomes.