Shock and Law

What if a fire erupted in a large retail store and no attempt was made by the employees to quench the still small fire because fire extinguisher use was restricted to trained firefighters only? Or, some state laws protected only fire department–trained responders from potential liability? Or, owning a fire extinguisher brought with it a concomitant requirement for fire department supervision? And what if every state had a different law? Although these scenarios seem preposterous, they do accurately reflect the current environment in the United States for automated external defibrillators (AEDs). Despite the intuitive design of modern AEDs, and the clear relationship between sudden cardiac arrest (SCA) survival and time to defibrillation, AEDs are not extensively disseminated in public places. In this report, we describe how disparate state laws impede AED adoption, and we present a blueprint for a national legislative initiative to facilitate widely accessible public access defibrillation. Despite the manifold advances in cardiovascular medicine over the past 2 decades, survival from out-of-hospital SCA remains unlikely; it varies regionally in the United States from 3.0% to 16.3%.1 In 1991, in an effort to improve SCA outcomes, the American Heart Association introduced the “chain of survival” concept stressing 4 “links”: early activation of emergency medical services (EMS), early cardiopulmonary resuscitation (CPR), early defibrillation, and early advanced cardiovascular care.2 The most crucial of these links appears to be prompt defibrillation, because, in the early minutes following SCA, the culprit arrhythmia most often is ventricular fibrillation. In a series of 157 patients who experienced SCA while wearing an ambulatory ECG monitor, 84% of patients were found to have a ventricular arrhythmia, usually ventricular fibrillation.3 The survival rate for ventricular fibrillation–related SCA is time-dependent. Every minute in delay to defibrillation results in a 7% to 10% decline in survival.4 …

如果一家大型零售商店发生火灾，而员工因为灭火器仅限受过训练的消防员使用而不尝试扑灭尚小的火势，会怎样呢？或者，一些州的法律只保护受过消防部门训练的响应人员免受潜在责任呢？又或者，拥有灭火器会带来消防部门监管的相应要求呢？如果每个州都有不同的法律又会怎样呢？尽管这些情形似乎荒谬，但它们确实准确反映了美国自动体外除颤器（AED）当前的环境。尽管现代AED设计直观，且心脏骤停（SCA）存活率与除颤时间之间关系明确，但AED在公共场所并未广泛普及。在本报告中，我们描述了不同的州法律如何阻碍AED的采用，并提出了一项全国立法倡议的蓝图，以促进广泛可及的公众获取除颤器。 尽管在过去20年中心血管医学有诸多进步，但院外心脏骤停的存活率仍然很低；在美国不同地区从3.0%到16.3%不等。1991年，为了改善心脏骤停的结果，美国心脏协会引入了“生存链”概念，强调4个“环节”：早期激活紧急医疗服务（EMS）、早期心肺复苏（CPR）、早期除颤和早期高级心血管护理。2这些环节中最关键的似乎是及时除颤，因为在心脏骤停后的最初几分钟，罪魁祸首的心律失常最常见的是心室颤动。在一组157名佩戴动态心电图监测仪时发生心脏骤停的患者中，84%的患者被发现有心律失常，通常是心室颤动。3与心室颤动相关的心脏骤停的存活率是与时间相关的。除颤每延迟一分钟，存活率就会下降7%到10%。4 ……