A Day at the Spa

The pressing question in this case is can automated external defibrillators save lives.  The answer is yes.  The secondary question is how many.  With no other considerations the addition of defibrillators to a gym’s first aid protocols will help save additional lives.

But in order to adequately determine how many more lives defibrillators can save, one must examine factors such as the overall health condition of the recipient, personnel knowledge, and response time.

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Based on the details of this case, an on-sight defibrillators at Silver’s Gym may save the majority of those expected 100 incidents.  Of the 30 that would die before paramedics arrive, 24 will live with the use of the defibrillator.  Of the remaining 70 that would otherwise live, improper use of the defibrillator may cause 2.1 deaths, saving 67.9 lives.  The total expected number of lives saved with the on-sight defibrillator  is 91.9.

The estimates cannot be accurate, however, when considering the health issues that are evident in this case.  Beginning with Tommy, high cholesterol and high blood pressure changes the probability that a defibrillator would be effective.  Also, as people exercise in the gym their heart rates and blood pressures increases making them prone to a sudden cardiac arrest.

If the increased rates from exercise are compounded by poor health conditions, like Tommy’s that changes the estimates to a much lower figure as well.  The use of CPS and EMT response time also change those figures.   Finally, the actual condition that makes the person need medical assistance - heart attack, sudden cardiac arrest, or other condition - changes the figures.

Untrained personnel cannot properly assess  what aid to administer.  Obviously CPR is appropriate in some cases, the AED in others, and in some cases both CPR and use of the AED will be indicated.  Untrained personnel may not know how to check for devices such as a pacemaker which affects the use of the defibrillator.

Pacemakers could compound the improper use factor.  There is a chance of improper use on a person who has no pacemaker.  There may be a higher chance of improper use when a pacemaker is present.

In Tommy’s case, since he was not breathing, CPR was a proper response to help restore his breathing.  Without proper oxygen to the brain and heart the defibrillator may not have worked.  Silver’s Gym was not negligent in Tommy’s death.  Gym personnel administered CPR upon finding that he was not breathing.

A proper and expected response.  Had there been no personnel with CPR training, that would be a case for negligence.  Without knowing how quickly the call was made, a 12 minute response from EMTs was reasonable, so there was no negligence on the part of gym personnel calling, nor on the part of EMTs for poor response time.  Also, it appears that the gym personnel immediately responded to Tommy’s situation.  Had there been no one in the lobby where Tommy was sitting, or had they not responded in a timely manner, there would be a case for negligence.

The case states that “CPR alone is not effective in treating SCA.”  From that statement it is safe to assume that CPR is effective in treating SCA if accompanied by the correct use of a defibrillator.  However, in this case CPR and AED combined may not have been effective in countering the effects of high blood pressure and high cholesterol in a person who is overweight and does not exercise.

CPR and AED treat symptoms, not underlying causes.  Tommy had too many health risk factors - age, weight, sedentary lifestyle, and two severe health conditions - to justify a case of negligence against Silver’s Gym.

Defibrillators can and do help save lives.  When gyms and sports facilities have defibrillator equipment on-sight, proper use of the equipment can prevent some unexpected deaths.  It is important that there be trained personnel on sight who know how to administer first aid and life saving procedures such as CPR.

It is also important that they be trained in proper defibrillator use.   Individuals also have a contributing factor in how well life saving procedures work for them.  When people take more responsibility and become more active in ensuring their personal health, they increase the likelihood that CPR, defibrillators, and EMT protocols will save their lives in extreme emergencies.

Negligence occurs when gyms and athletic facilities do not have personnel properly trainedCPR and first aid.  Or when there are not enough personnel on hand to monitor and respond to medical emergencies in those facilities.  However, one cannot expect anyone, even well trained and highly skilled doctors to prevent death when several risk factors exist in one person.

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