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(CBS New York)   Victim's family shocked that even though a gym is require to have defibrillator, and staff trained to use it, they don't actually have to use it   (newyork.cbslocal.com) divider line 147
    More: Stupid, Long Island, Jonathan Lippman, negligence, gyms, Appeals Court, automated external defibrillators  
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10230 clicks; posted to Main » on 09 Feb 2013 at 10:11 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-02-09 05:06:25 PM
If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.
 
2013-02-09 06:17:44 PM

cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.


They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.
 
2013-02-09 07:19:29 PM
  This is inherent risk.  If not at the gym, this would have happened at some point.  Can't hold the gym responsible for the inevitable.  Infarction builds up over decades, not over 10 minutes on a treadmill.
 
2013-02-09 08:08:23 PM
a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?
 
2013-02-09 08:10:39 PM
This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.
 
2013-02-09 08:18:39 PM
I imagine if the doctor that was there doing CPR thought it was needed, he would have said to use it.
 
2013-02-09 08:28:47 PM

fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

nmrsnr: This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.


Unless they were professional responders or healthcare professionals, they had no duty to act legally. Technically, they could do nothing and still be completely kosher for doing so.
 
2013-02-09 09:09:04 PM

vygramul: They treat a very small subset of shockable rhythms to begin with. Like fewer than 20% of them.


yep

fusillade762: Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


Yes, you don't use an AED on someone with a pulse. The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

How a defibrillator works
 
2013-02-09 09:09:54 PM
FTFA: A doctor and medical student began cardio-pulmonary resuscitation, then paramedics arrived and shocked Miglino, but he died.

And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".
 
2013-02-09 09:18:31 PM

cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.


They can and will if they detect artifact and the software reads it as ventricular fibrillation.

rtboardreview.com

That run of artifact there can be read by an AED as V Fib, and shocked inappropraitely. It's why even EMTs have to pull over if they use an AED during a transport before they can analyze, but a PAramedic can make a manual reading of the EKG and determine if it's needed.

American Heart and Red Cross standards both state that you do not apply an AED to a patient who has signs of circulation. Lay Rescuers do not check for a pulse anymore, and have not since the 2005 standards were released. The only people who are legally covered if they do so are Advanced Life Support personel, i.e. Paramedics, Registered Nurses, and Doctors/Mid-Level Providers who do so in a peri-arrest situation where they anticipate a patient is about to code.

If you apply an AED to someone who you know has a pulse, you have just lost ANY coverage against lawsuits as a layperson or BLS Healthcare Provider, and could actually face professional and civil sanctions as one.

Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".


Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.
 
2013-02-09 09:19:26 PM
cdn.videogum.com
Maybe he'd had the Kick-Ass Cajun dressing.
 
2013-02-09 09:22:30 PM

BronyMedic: Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.


I'm not questioning anything anyone did, or why. I would have no idea what to do in that situation. I just pictured the paramedics walking in with gorilla masks on and scaring the guy. I was much funnier in my head, I assure you.
 
2013-02-09 09:24:10 PM

Ed Finnerty: I'm not questioning anything anyone did, or why. I would have no idea what to do in that situation. I just pictured the paramedics walking in with gorilla masks on and scaring the guy. I was much funnier in my head, I assure you.


NOOO! That's not what I was insinuating! I was just illustrating what is poorly worded journalism.

Besides, everyone knows we come up to the patient like this.
 
2013-02-09 09:25:11 PM
Damn you images!

bloximages.chicago2.vip.townnews.com
 
2013-02-09 09:37:46 PM
CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.
 
2013-02-09 09:54:11 PM

serial_crusher: CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.


that's farked up.
 
2013-02-09 09:56:31 PM

serial_crusher: CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.


I'm pretty sure that's not legal, or a great way to avoid lawsuits. The financhial relationship between a w/c van attendant and their charge creates a legal duty to act to provide first aid care under the state statutes that regulate them, at least in Tennessee.
 
2013-02-09 10:09:11 PM

BronyMedic: They can and will if they detect artifact and the software reads it as ventricular fibrillation.


You need a better AED.. Ever download the data after they've been deployed? We provide a LifePak 500 for our local PD. It analyzes twice before deciding whether to deliver a shock or not. You aren't as likely to see artifact in both segments.  Movement detection is also built in, but it does need to be turned on. The Lifepak 12 does the same thing if left in auto mode, but that may have more to do with the software version.
 
2013-02-09 10:16:58 PM

fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


Logic has no place when OUTRAGE is the only answer.
I was lucky that hospital employees knew I needed to be defibed 3 times when my heart actually stopped after a rattlesnake bite.
 
2013-02-09 10:17:15 PM
Sounds like the club did the absolute best they could do under crappy circumstances.
 
2013-02-09 10:17:49 PM
img2.timeinc.net

Zap the son-of-a-biatch again
 
2013-02-09 10:21:44 PM

BronyMedic: cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

They can and will if they detect artifact and the software reads it as ventricular fibrillation.

[rtboardreview.com image 498x155]

That run of artifact there can be read by an AED as V Fib, and shocked inappropraitely. It's why even EMTs have to pull over if they use an AED during a transport before they can analyze, but a PAramedic can make a manual reading of the EKG and determine if it's needed.

American Heart and Red Cross standards both state that you do not apply an AED to a patient who has signs of circulation. Lay Rescuers do not check for a pulse anymore, and have not since the 2005 standards were released. The only people who are legally covered if they do so are Advanced Life Support personel, i.e. Paramedics, Registered Nurses, and Doctors/Mid-Level Providers who do so in a peri-arrest situation where they anticipate a patient is about to code.

If you apply an AED to someone who you know has a pulse, you have just lost ANY coverage against lawsuits as a layperson or BLS Healthcare Provider, and could actually face professional and civil sanctions as one.

Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.


I'm ignorant. Will those things fire if the patient has a pulse?
 
2013-02-09 10:23:30 PM

"...they aren't required to actually use them on a stricken patron, the state's highest court ruled Thursday."


For heaven's sake why not? As Farkers above have said, you can put the pads on a person and the defib won't shock the person unless it detects that the person needs it. And remembering my training, compression is very important, even more than breathing into the person's airway. You have to keep the blood moving and everything oxygenated or the person's brain is screwed.

The funniest part of the training is when they tell you that before pads are applied, you should quickly shave down any hairy chests and remove any body piercing on the victims including nipple piercings. Or else if a shock is applied it will just jump in between the piercings (at least that's how I remember the trainer explaining it).

 
2013-02-09 10:23:58 PM
What's the point of mandating they carry the equipment and mandating they have someone to USE the equipment if you have zero intention of holding them to it's use?!!! Isn't the intention of the mandates to save lives? If you don't insist they ACTUALLY try and save lives, then you're just out to make sure gyms spend money.
 
2013-02-09 10:25:15 PM
So eventually these people came and, somebody, gave him mouth-to-mouth.

media.avclub.com
 
2013-02-09 10:26:08 PM
As mentioned above, AED's are trendy and are not a viable substitute for good CPR, until trained medical personel arrive who can properly interpret the cardiac rhythm. Reliance on that technology is faulty at best.
/Been there, done that, dozens of times.
 
2013-02-09 10:26:18 PM

Notabunny: I'm ignorant. Will those things fire if the patient has a pulse?


There was a chance with the old ones that it would, but after what Cretinbob said I wonder if it's just kept in the guidelines as apopcryphia. I know our SOP with the Zoll PD1700s when I was a first responder said not to attach it if they had a pulse. it also has to do with the fact that those defib/pacer patches are about 150 bucks a pop, and they'd rather you not waste them. AEDs are useless if the patient had a pulse at any rate. Modern AEDs did away with the EKG monitoring screen (you can use the pads to monitor in Lead II) years ago because people realized they were added cost with no added value.

I do know that as of December 2012, a certain large nation-wide ambulance service I work for has in their guidelines that EMTs cannot use an AED while going down the road because of the risk of a false firing event. I've been monitoring patients on a Lifepak 12 that would literally look like they were in ventricular fibrillation when you go over some roads in Memphis, and the v.fib alarm would go off.

When you're dealing with BLS providers, namely First Responders and EMTs, you also have the issue of them performing a skill they are not legally allowed to perform - namely attempting manual cardioversion.
 
2013-02-09 10:26:39 PM
And if they had used it and the guy died anyway - which he surely would have - they'd be suing over that. Yes, it doesn't make sense to require them to have the equipment and be able to use it to save lives, but not require that they use it to save lives. That would be like requiring a public pool have a lifeguard that knows CPR, but the lifeguard can just ignore drowning people. In this case, though, it would be like requiring the lifeguard to give CPR to everyone in the pool.
 
2013-02-09 10:27:08 PM
And just to further mention, the defib machine my job has is pretty foolproof. It verbalizes the instructions and if it detects the person does not need a shock, it will then count off for you in time so you can compress the victim's chest in rhythm, then the machine will tell you when to apply breaths and when to restart compression.
 
2013-02-09 10:29:32 PM
FTFA:  "a trainer detected breathing and a pulse and didn't use the AED " but also " a doctor and medical student began cardio-pulmonary resuscitation."


Was the trainer wrong about the presence of respirations/pulse or was the doctor/med student wrong about the lack of respirations/pulse?  I suppose they both could have been right given a delay between when the trainer checked and when the doc checked for a pulse, but then why didn't the doc apply the AED since it was stated in the article that the AED was already by the patient's side?   Obviously at some point he was in V-fib/pulseless V-tach at some point since the medics shocked him, so it is likely that he was in a shockable rhythm initially.
 
2013-02-09 10:30:17 PM
The court needs to carefully examine this lawsuit.  Society and good Samaritans could be ruined infinitely because of one fark up.  Because this is an extremely small minority of cases, more people could die if the risk/benefit gets skewed by knee-jerk media outrage.
 
2013-02-09 10:32:32 PM
what i couldn't figure out about the article is that it said a TRAINER found a pulse and breathing, but a doctor and medical student did CPR??  personally if you have an unresponsive casualty, hook the damn defib up!  We also have the life pac, and find it pretty infallible.    The paramedics shocked him when they arrived, so there had to be some kind of rhythym when they arrived.  I have had several people confuse agonal resps with "breathing", and be hesitant to start CPR...

i see a few people in this thread who could benefit from a basic first aid course... defib's do NOT start the heart, unless we are talking hospital care settings, and that is usually in conjunction with cardiac meds if i am not mistaken.  (way above my pay grade).  Portable defibrillators like the PAP ones just detect a rhythym that it can disrupt, and hopefully the heart will establish a new, normalized rhythym on it's own...
 
2013-02-09 10:35:00 PM

skinink: "...they aren't required to actually use them on a stricken patron, the state's highest court ruled Thursday."
For heaven's sake why not? As Farkers above have said, you can put the pads on a person and the defib won't shock the person unless it detects that the person needs it. And remembering my training, compression is very important, even more than breathing into the person's airway. You have to keep the blood moving and everything oxygenated or the person's brain is screwed.

The funniest part of the training is when they tell you that before pads are applied, you should quickly shave down any hairy chests and remove any body piercing on the victims including nipple piercings. Or else if a shock is applied it will just jump in between the piercings (at least that's how I remember the trainer explaining it).



Compression just buys time till defibrillation or until the underlying cause can be corrected by keeping the coronary tissue and, to a lesser extent, the brain and end organs perfused. Unless you get a shockable rhythm where the heart can be bullied into a reorganized electromechanical activity, or unless you treat the reason their ticker won't tock, compressions will not bring someone back. The only exception to this is in neonates and children, where they have a primarily respiratory cause for their arrests. (The reason why hands-only CPR is not taught for children)

They have no legal duty to act is the reason the court found their findings, more than likely, since they are not licensed/certified healthcare providers, and they were acting in the capacity of good samaritans, not as rescuers. While it's ethically questionable, legally it's perfectly gold for them to do what they did.

Even Healthcare Providers only have an ethical duty to act when off duty and not on the clock. Alabama was the only state I knew with a law mandating that people who are licensed and/or certified in that state stop to render aid in an emergency, and they struck it off the books three years ago because it was unenforcible.

As far as the shaving thing now, the AHA recommends you keep two pairs of defib patches in each AED. They dont even recommend it anymore, because you have to interrupt CPR to do so. You just jerk the first pair of patches off to rip the hair off their chest, and try to either reattach them, or apply a new set.

Britney Spear's Speculum: The court needs to carefully examine this lawsuit.  Society and good Samaritans could be ruined infinitely because of one fark up.  Because this is an extremely small minority of cases, more people could die if the risk/benefit gets skewed by knee-jerk media outrage.


HAH. People need to check and see if their State's Good Samaritan protections cover them if they have any kind of healthcare training or licensure/certification. Tennessee pretty much gave the middle finger to anyone who did a few years ago when they removed the good samaritan protections for people who had a license or certification - like EMTs and RNs - and held you accountable to act as if you were on the clock.
 
2013-02-09 10:38:56 PM

BronyMedic: It will not do anything.


But, but, but, DO SOMETHING! Save Grandpa!
 
2013-02-09 10:39:00 PM

vygramul: cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.

They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.


the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.
 
2013-02-09 10:41:53 PM
How Dead Dave got his name: Years ago this supervisor at NJ Bell (Dave) treated everybody like shiat. One day Dave had a heart attack in his office right in front of a field tech. The tech said "oh well" and just left. A secretary found Dave near dead not long afterward and called an ambulance.

When Dead Dave came back to work he tried to get the tech fired. But there was nothing in the union handbook or the employee manual stating you had to call an ambulance or notify someone in such an emergency so the guy kept his job. And from that day on a certain dooshbag was forever known as Dead Dave.
 
2013-02-09 10:43:29 PM

Ed Finnerty: FTFA: A doctor and medical student began cardio-pulmonary resuscitation, then paramedics arrived and shocked Miglino, but he died.

And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".


Relevant:

www.wearysloth.com

Want to see something really scary?
 
2013-02-09 10:43:46 PM

UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!


QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.


This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.
 
2013-02-09 10:44:50 PM

BronyMedic: HAH. People need to check and see if their State's Good Samaritan protections cover them if they have any kind of healthcare training or licensure/certification. Tennessee pretty much gave the middle finger to anyone who did a few years ago when they removed the good samaritan protections for people who had a license or certification - like EMTs and RNs - and held you accountable to act as if you were on the clock.


THIS.  There should be a federal standard for Good Samaritan laws if you ask me.  People going into cardiac arrest and the method for which you provide help to them isn't an issue that should be left up to states.
 
2013-02-09 10:45:10 PM

BronyMedic: QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!


Oh boy, Grandpa's having a PUPPY? Mom! MOM!
 
2013-02-09 10:46:05 PM

ltdanman44: vygramul: cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.

They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.

the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.


If it is so damned automated then why didnt it hook itself up to the dead dude?
 
2013-02-09 10:47:11 PM
92 percent of people that  go into cardiac arrest die.
 
2013-02-09 10:47:16 PM
Maybe at that gym, full attempt to save your live in the case of an emergency is only for the platinum members.  Good thing he didn't have a basic membership, they would have just asked him to leave for blocking equipment.  For an extra $5 per month, in the state of emergency a hot trainer of your choice will freshen their breath before performing mouth to mouth and will continue until you ask them to stop.
 
2013-02-09 10:50:41 PM

BronyMedic: UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!

QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.

This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.


Unless you are using another article, by my count you have a trainer at the club who detected a pulse/respirations and therefore no need for the AED.  Then you had the doctor (article doesn't specify which kind of doctor and who knows, it could be a podiatrist) and med student not detect a pulse since they initiated CPR but they also did not apply the AED. Finally you have the medics who used their own monitor and shocked the pt, although it isn't known if that was done right away or after meds were given.  The only layperson was the trainer, unless I missed something.
 
2013-02-09 10:51:04 PM
bmr68: 100 percent of people that  go into cardiac arrest die.

FTFY.
 
2013-02-09 10:51:11 PM
BronyMedic:

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.


What if it's designed to shock VT and is counting on the responder to make sure it's pulseless?
 
2013-02-09 10:51:53 PM

BronyMedic: This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.


And that's why the court should throw this case out.  It will do more harm than good if they rule that the club was negligible.
 
2013-02-09 10:55:14 PM
Risk getting sued for injuries? No thanks.
 
2013-02-09 10:56:32 PM

dark brew: BronyMedic: UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!

QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.

This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.

Unless you are using another article, by my count you have a trainer at the club who detected a pulse/respirations and therefore no need for the AED.  Then you had the doctor (article doesn't specify which kind of doctor and who knows, it could be a podiatrist) and med student not detect a pulse since they initiated CPR but they also did not apply the AED. Finally you have the medics who used their own monitor and shocked the pt, although it isn't known if that was done right away or after meds were given.  The only layperson was the trainer, unless I missed something.


WHAT IF?!!??

If the patient had a run of VTac... The trainer felt the pulse and was right to not start CPR... But then the doc felt for a pulse and it was so rapid he didn't feel one, or only caught it occasionally, or recognized the inadequate perfusion... so started CPR.... then the Medics shocked it when they got there.

OR

The patient didn't have a pulse, but the trainer wasn't sure whether he felt one or not, and just figured he did, or confused his own muscle tremors from his excitement as a pulse and therefore mistakenly didn't start... and then the doctor of some variety was correct in assessing the lack of pulse, but then was too ignorant to think about a defib, etc... and screwed up in this regard and then the medics got on scene and saved the day.

OR

We have no idea what happened because bystanders have no clue about what's going other than some doc started UPS on the guy.
 
2013-02-09 10:57:32 PM
OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?
 
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