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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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10226 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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2013-02-10 12:50:51 AM

BronyMedic: felching pen: Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

That's a little bit of a slippery slope there. The idea of the mandate is to have the equipment available to use appropriately by people trained to use it. The problem with creating a legal duty to respond in a case which would have otherwise been covered by the Good Samaritan statue is that you remove any protection people have for acting in good faith to aid another person, and open them up to medical malpractice and damage litigation. That is a POWERFUL motivator for people to not do anything but call 911.


This.

I'm trained and certified in advanced first aid and lifesaving... in a combat environment or MASH setting. Could I adequately determine whether or not I should use the AED? Yes. If a doctor (of any sort--they all went to medical school) and a med student are on scene, then guess what? They take charge. Period, end of story. Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.

Now, if I think the doc is being a farktard, I'll take the chance of using the AED. Sorry about the expense, but I don't place dollar signs on someone's life (massive potato clocks that we are...you owe me a keyboard, Brony!). But the fact that we live in a world where you can sue me for saving your life (I've seen cases where people have sued for getting broken ribs during CPR... sweetie, if your ribs aren't broke from CPR, something is very, very wrong) makes me sympathize with anyone whose gut instinct is to pick up the phone, call 911, and wait for a professional.
 
2013-02-10 12:53:05 AM

Aigoo: 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?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.


Actually, you take a pair of shears, cut the ribs up each side, take out that section of the sternum, cut through the bag-thing that holds all the organs, and  grip the heart in your hand and start squeezing it like a stress ball.
 
2013-02-10 12:54:46 AM

CruiserTwelve: 3StratMan: Please, by all means, explain to us, with a full dose of overcomplicated hyperbabble, exactly what it means.

It means the police do not have a legal obligation to protect individual people. Example: Let's say the cops are legally required to protect each individual person. You get robbed and murdered. Your family could sue the police for failing to protect you. Every crime victim would have a case against the government for failing to protect them from the criminal.

Note that I said a "legal" obligation. The police still have a moral and ethical obligation to uphold the law, and they still have a legal obligation to enforce the law within the confines of the constitution.

You can also sue the police for failing to act. This occurs when the police know there is a violation and fail to take action when they have the immediate ability to do so. Let's say the cops see you getting your ass kicked by another person and they stand there and watch without taking action. You have a case against them.

If you read the case that brought about this ruling, you can see why the ruling was made as it was. Had the court ruled that the police were at fault for not enforcing a restraining order when they did not have the immediate ability to act, it would have meant anytime a person violated a restraining order the police would be liable. That's an impossible responsibility.


Yeah Warren v DC kinda threw that one out of the window too.
 
2013-02-10 12:55:07 AM

ZackDanger: Wait... What?

What did you read? Because BronyMedic is right... there is no legal duty to act for non-proffessional responders.


Slight nitpick, in VA at least, as of ~2006 when I was a Red Cross CPR for the Professional Rescuer Instructor, you only have a duty to respond if you are IDENTIFIABLE as a medical professional/first responder.  If you're a nurse wearing a track suit around a bunch of strangers, you don't have a duty.  If you are a nurse wearing your hospital garb who stopped at the Kroger to buy some bread on the way home, you do.

/YMMV, especially state-to-state.
//As of 2006, according to the Red Cross, no one holding a current Red Cross certification who followed procedure has ever been successfully sued for intervening medically in an emergency.  Good Samaritan laws are usually pretty good in every, or almost every state.
 
2013-02-10 12:57:10 AM

Aigoo: Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.


I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.
 
2013-02-10 01:00:47 AM

BronyMedic: davidphogan: I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.

I'm really honored about that then. I didn't even know why they made you do that until I asked a Zoll Rep a few months back when eh was doing our initial training on the new ProPaqs we went to. We weren't taught the "why" we do a lot of things in school as EMT-Basics, just the how and when.

As far as djh0101010 goes, he's gone on several bizarre diatribes in which he uses improper and blatently wrong terminiology, incorrect assumptions that only someone who has never been in the EMS profession could make (like NREMT Licensure), and has constantly claimed to be better at, well - everything, since he's been a volunteer "EMT" for 10 years. I called him out as a fake in a thread a few weeks ago, and he abandoned ship.


I saw the link you posted. I can't imagine why someone would pretend to be an EMT to troll Fark, but there it is.
 
2013-02-10 01:06:53 AM

vygramul: I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.


It's not that they're useless - they're Doctors after all - it's that their not in their environment in a prehosptial setting. Many of the things a doctor would do in a hospital for a patient in an emergency situation are impractical or impossible to perform in the field. A surgeon is not going to open someone up for abdominal trauma in the field, or crack a chest to check for a pericardial tamponade. The interventions and maneuvers a Paramedic or EMT performs are geared around doing as much as possible to stabilize while minimizing on scene time and optimizing rapid transport to a definitive care facility in a critical patient.

If a physician doesn't specialize or work in the Emergency Field, they may actually perform an incorrect or inappropriate intervention and cause harm. Most doctors do not deal with spinal immobilization, for example, outside of an orthopedic, neuro, or ER setting. I've seen nurses placing pillows and towels under the head of an ejection patient before without even considering immobilization of the neck.

On our end, the problem with having someone come up and claim to be a doctor is one of verifying they actually are one. We have very, very specific guidelines (Control-F and skip to Protocol 606, at page 100) at the state level when this happens, and typically when a doctor is told about it, they step back or stop barking orders. Even if this occurs, a Paramedic is still responsible for ANYTHING that happens on scene, even if it's done by a bystander.
 
2013-02-10 01:13:45 AM

djh0101010: crap

Just stop. Being a medic means that at minimum you've read through many thousands of pages of dry medical text, completed several hundred hours of classroom, practical clinical time, field time, and have picked up the lingo and slang from spending a lot of time around *actual* ems and medical workers. You can't fake that without a huge amount of work: It's like pretending to be ex-military or a doctor -- a real one's going to spot you instantly.

From djh0101010's bio:
Not shy about telling people when they're full of it.

Oh, the irony.

JonPace: Oh boy a ricky rescue

Nice alt.

BronyMedic: Oh good, I was hoping the guy who was impersonating an EMT to troll

I know it gets old having to type that in every thread you post in, but thanks. His attention seeking is pretty sad: I guess some people never work past their shiatty childhood. Beyond pointing out he's a (bad) fake, I'd ignore him.
 
2013-02-10 01:21:12 AM

UsikFark: 3StratMan: Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.

[US Supreme Court] "Justices Rule Police Do Not Have a Constitutional Duty to Protect Someone"


Well, you really don't. That is a state issue. It never should have gotten to the Supreme Court.
 
2013-02-10 01:43:28 AM

vygramul: Aigoo: Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.

I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.


As Brony said, depends on the doc. I've been on a scene where a guy damn near cut his hand off in a generator fan--both an ortho and I were on the scene, buying gas. As you say, ortho gets this "oh shiat" look on his face, I look at the dude behind the counter and start telling him what I need (and when he doesn't have 80% of it, what I'll settle for...because I just cannot sit and watch someone bleed all over the place needlessly when I'm trained and capable of doing something about it). Other times, I've seen pediatricians handle MVAs like pros until the paramedics arrived on scene. It honestly depends on the doctor, and, as Brony says, you're way better off with Emergency Medicine guys, but sometimes, you do get pleasantly surprised.
 
2013-02-10 01:44:50 AM

UsikFark: Aigoo: 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?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.

Actually, you take a pair of shears, cut the ribs up each side, take out that section of the sternum, cut through the bag-thing that holds all the organs, and  grip the heart in your hand and start squeezing it like a stress ball.


And now I'll brb. Need to clean the Dr. Pepper off my monitor...
 
2013-02-10 01:49:51 AM

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


You're right about the rhythm,  but "false sense of security" is nonsensical.  How many gym members even notice AEDs?  If I saw one, it would remind me that I might have a heart attack, and that thought would not make me feel any more secure.  Nobody says to himself, "Hah - AED!  I can work myself as hard as I want and not worry about the heart attack!'
 
2013-02-10 02:00:37 AM

Aigoo: UsikFark: Aigoo: 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?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.

Actually, you take a pair of shears, cut the ribs up each side, take out that section of the sternum, cut through the bag-thing that holds all the organs, and  grip the heart in your hand and start squeezing it like a stress ball.

And now I'll brb. Need to clean the Dr. Pepper off my monitor...


Squeeze to the beat of "Papa Was A Rolling Stone," live version only. Pressing with your pinky & ring fingers on the 2, and index and middle on the 4. It's called the wakka-chikka.
 
2013-02-10 02:05:41 AM

UsikFark: Squeeze to the beat of "Papa Was A Rolling Stone," live version only. Pressing with your pinky & ring fingers on the 2, and index and middle on the 4. It's called the wakka-chikka.


You know what's awesome? Another one bites the dust totally syncs up with the rate of CPR per minute.
 
2013-02-10 02:08:07 AM

UsikFark: 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 image 320x240]

Want to see something really scary?


Bender: Welcome to the future, human slave. [The man trembles and Bender laughs.] Ah, relax, chum. I'm not really a giant fly! [He takes the cape and head off.] I'm a horrible robot! [The man backs into the freezer and Bender walks towards him, turning his head and outstretching his arms.] Kill all humans!

[The old man clutches his chest.]

Terry: Dear God! He's having a heart attack!

[Bender pushes the old man into the freezer, turns the dial and freezes him.]

Bender: Ah, they'll probably find a cure for that in the future.

Terry: We have a cure for it now!

Bender: Oh, good. Then you won't mind if I use this.

25.media.tumblr.com
 
2013-02-10 02:21:03 AM

BronyMedic: UsikFark: Squeeze to the beat of "Papa Was A Rolling Stone," live version only. Pressing with your pinky & ring fingers on the 2, and index and middle on the 4. It's called the wakka-chikka.

You know what's awesome? Another one bites the dust totally syncs up with the rate of CPR per minute.


Apparently the target is 100-120 BPM.

Don't be so quick to- walk away.
 
2013-02-10 02:23:12 AM

ZackDanger: UsikFark: ZackDanger: 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?

Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.

Maybe the trainer accidentally checked the pulse on a guy lifting weights *next* to the victim... and then the doctor did CPR on a punching bag that was laying in the corner and THERE NEVER WAS A VICTIM.

The paramedics were just milk men.


But were they Dead Milkmen?

All joking aside though, when I was trained on an AED some years ago, I was taught never to put one on someone who was breathing or had a pulse since even though it would automatically allow, and adjust for, what every arrhythmia was present if the patient had a pulse applying the AED could interfere with the body's natural responses to anomalies.  Essentially an if it ain't broke don't try to fix it.

Some very good points in here on the use of AEDs though. I'll have to see if I can get a refresher course in CPR since it is a handy skill to have just in case.
 
2013-02-10 02:27:47 AM

JWideman: 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.


My lodge is looking into getting one of those things.  Several of our lawyer members have stated that anybody trying to sue over the use of one of the things will not win.  Period.  The machines are designed to only work when they'll actually do some benefit.  The victim will die either way.  At least you used the best technology available to try to to save them.  Any asshole who sues ought to be hung and their estates stripped.  Sorry kids, your parent was an asshole.  Sucks to be you.
 
2013-02-10 02:54:53 AM
ZackDange

You shouldn't just be "giving [the aed] a chance"... you should be demanding someone brings you one.

Agreed.  And also demanding (a good way to say that) someone to call 911 and report an unconcious person without a pulse.  And for someone to help me do CPR.

The day I find someone dead on the ground will be the day I need the help of any and all human beings within earshot.

I really hope the AED works, but my gut feeling is it won't.  Because in my experience, the more you need some electronic doodad to work, the more likely it won't.  So I'll take a time out while they do the drill, but I won't expect anything other than me just starting CPR again.
 
2013-02-10 03:14:34 AM

felching pen: Smgth: 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.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.


"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)

That duty may apply to the gym.  However, the dissenting judge notes, NY has a "Good Samaritan" law that shields would-be rescuers from liability except when they are grossly negligent.  If you do what the proverbial "reasonable person" would do  under the circumstances, you can't be sued.  Your actions have to be far from reasonable to be considered grossly negligent.

The trainer found a pulse and breathing, so he decided the AED was unnecessary.  Is that far from what a reasonable person would do?  This what the case hinges upon, as far as we know.  (The plaintiffs seem to plan to contradict the trainer's testimony.)

It will also matter whether the trainer was trained in AED use or not; what a reasonable person would do depends on his training.  A trained person would know that using the AED properly could do no harm; an untrained person would not be expected to know that.  The judges said that there must be "trained staff" on the premises but not that everyone has to be trained.  In some AED laws, only one AED and one trained staffer are required; IDK about NY's law.

The majority ruled that there is no duty to rescue in the statute, as plaintiffs argued.  But plaintiffs can go back to lower court and try the common law duty described above.  They may run afoul of the Good Samaritan law.
 
2013-02-10 03:17:04 AM

Aigoo: 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?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.


Automatic External Defibrillators measure heart rhythm and tell the operator whether to hit the "shock" button or not.  The correct thing to do in this case was to  apply the AED's sensor to the patient and do whatever the LED screen said to do.
 
2013-02-10 03:19:29 AM

BarkingUnicorn: felching pen: Smgth: 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.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)


Can they argue an ethical duty to act? IANAL so I'm curious.
 
2013-02-10 03:34:36 AM

BronyMedic: BarkingUnicorn: felching pen: Smgth: 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.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)

Can they argue an ethical duty to act? IANAL so I'm curious.


Can someone be persecuted for being unethical? If so would anyone be left?

This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.
 
2013-02-10 03:36:25 AM

BarkingUnicorn: Automatic External Defibrillators measure heart rhythm and tell the operator whether to hit the "shock" button or not. The correct thing to do in this case was to apply the AED's sensor to the patient and do whatever the LED screen said to do.


An AED only works for a few pulseless rhythms. An AED is a machine, and like all machines it can (very, very rarely) fail and cause a person harm. It's a very minor risk, but if the AED isn't going to help (and has a very slight chance of causing harm) then it's use is contraindicated. All the CPR classes/refreshers I've taken have made a point of *not* using an AED on someone with a pulse.
 
2013-02-10 03:39:48 AM
Gym staff called 911, broadcast an in-house request for anyone with medical training and brought the club's Automated External Defibrillator to Miglino's side, where a trainer detected breathing and a pulse and didn't use the AED, according to court affidavits. A doctor and medical student began cardio-pulmonary resuscitation, then paramedics arrived and shocked Miglino, but he died.

It sounds like they did basically all they could do. I don't think you're supposed to use those things if there is a pulse because shocking a 'stabilizing' heart could just throw it into defibrillation again.

Then, it depends on the patient and the type of heart attack. I worked in a hospital for years and even with all of the advanced equipment, we lost patients when heart attacks struck -- even in the ER.

Now, the AED is supposed to be idiot proof. I looked them over when they came out, having had a heart attack myself, and considered buying one. The instructions were basic and easy. The machine would fire on it's own when it detected certain indicators of a heart attack or it could be triggered by someone. It was designed even for a person having an attack to quickly apply it.

I was driving when I had my heart attack. Delivering freight. I just kept on going, figuring it was just stress pains. Later, I was diagnosed as having an attack and had a dead spot on my heart. I got lucky.

I don't think you can force laymen to operate a defibrillator, even one as simple as the AED. Imagine the whole new world of lawsuits that would open up if someone screwed up.

Besides, back then the device was expensive. No doubt it needs to be tested and calibrated now and then. Still, it's a step in the right direction for fast response for heart attack victims.

I also recall when the EEG machine that recorded the electrical activity of the heart was a huge device, with ink fed wands tracing over a roll of paper. Now, they're small, little devices about the size of a laptop.
 
2013-02-10 03:40:00 AM

Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.


You cannot mandate someone with no formal licensure or certification, and no formal duty to render care under the tenents of a financhial or volunteer relationship do so. The laws are actually in place, and written the way they are to protect non-professional, every day people who have decided to get a CPR or First Aid Card, and don't want to worry about having the pants sued off them for doing so for the slightest thing they may have done wrong in a situation which they were never meant to encounter even with that training.

If the gym decided to employ a formal "emergency response team" of people who are CPR/AED and First Aid trained, it would be different, or if they decided to employ someone certified in Athletic Training or sports medicine, it would be different.
 
2013-02-10 03:40:49 AM
the CORRECT way to defribrillate a person is to turn on STAYING ALIVE by the BEEGEES and shocking them at random intervals
 
2013-02-10 03:49:22 AM

BronyMedic: Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.

You cannot mandate someone with no formal licensure or certification, and no formal duty to render care under the tenents of a financhial or volunteer relationship do so. The laws are actually in place, and written the way they are to protect non-professional, every day people who have decided to get a CPR or First Aid Card, and don't want to worry about having the pants sued off them for doing so for the slightest thing they may have done wrong in a situation which they were never meant to encounter even with that training.

If the gym decided to employ a formal "emergency response team" of people who are CPR/AED and First Aid trained, it would be different, or if they decided to employ someone certified in Athletic Training or sports medicine, it would be different.


But they're mandating someone be there who can use the machine...to what end? If you can't mandate it's use, why bother insisting it be there with someone to who knows how to use it?

I understand protecting Good Samaritans from prosecution, I'm all for it. But I don't see how forcing the building to contain life saving measures will help anyone if there's no obligation.

/Sorry if I'm missing something here, but I just don't get it.
 
2013-02-10 04:06:53 AM

Smgth: But they're mandating someone be there who can use the machine...to what end? If you can't mandate it's use, why bother insisting it be there with someone to who knows how to use it?


All the New York state law says, and IANAL, is that the gym has to make available the machines for use, and that they have to provide CPR and AED training to their personel there. That's different than a legal mandate for their people to provide care under their employer. Every state has provisions in place which throw out the good samaritan protections a person has if they are required as a course of their employment or volunteer position to provide any type of medical care, from first aid to open heart surgery, and require anyone acting as an emergency response team to maintain a certain level of liability insurance on that person, and require a certain level of certification beyond basic first aid.

Smgth: I understand protecting Good Samaritans from prosecution, I'm all for it. But I don't see how forcing the building to contain life saving measures will help anyone if there's no obligation.


Because in an emergency, you're more than likely going to have SOMEONE trained in a modern society in AED/CPR, and more than likely you're going to have someone who's altruistic to step up and help. It's the same reason we have them in airports, large resteraunts, stadiums, and the like.
 
2013-02-10 04:27:58 AM

BronyMedic: BarkingUnicorn: felching pen: Smgth: 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.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)

Can they argue an ethical duty to act? IANAL so I'm curious.


Sure, if they can find a court of ethics.
 
2013-02-10 04:34:15 AM

Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.


TFA says nowhere in the U. S. are you mandated to use an AED.  So take your pick:

1. First AED  law was written poorly and everyone else just copied it.
2. Every legislature decided after careful deliberation that mandated use was a bad idea.
 
2013-02-10 04:41:25 AM

mllawso: BarkingUnicorn: Automatic External Defibrillators measure heart rhythm and tell the operator whether to hit the "shock" button or not. The correct thing to do in this case was to apply the AED's sensor to the patient and do whatever the LED screen said to do.

An AED only works for a few pulseless rhythms. An AED is a machine, and like all machines it can (very, very rarely) fail and cause a person harm. It's a very minor risk, but if the AED isn't going to help (and has a very slight chance of causing harm) then it's use is contraindicated. All the CPR classes/refreshers I've taken have made a point of *not* using an AED on someone with a pulse.


I guess it depends on what "use" means.  Using it to measure heart rhythm or taking the next step of using it to shock.

I assume an AED would not recommend shock if it detected a pulse that a rescuer could detect.

Or maybe I'm wrong and the AED simply won't shock unless it detects one of these special arhythmias.  That relieves the operator of all decision-making responsibility.
 
2013-02-10 04:52:13 AM

BarkingUnicorn: I assume an AED would not recommend shock if it detected a pulse that a rescuer could detect.


AEDs will not check for a pulse. They only analyze electrical activity from an anterior-posterior lead placement, and determine if the waveform of the lead matches with the software waveforms for two specific kinds of lethal arrhythmias - Ventricular Tachycardia and Ventricular Fibrillation. The reason that it's important to not put it on a patient who is spontanenously circulating (has a pulse to the HCP, or has signs of circulation and effective breathing to the layperson) is that if the patient has a perfusing pulse, but IS in ventricular tachycardia, the machine will detect this, sense it, and shock - and kill the person you're trying to help

There is also a risk, especially with the older models, that movement and muscle artifiact from the patient - for example analyzing going down the road or if the patient is having a seizure or shivvering - can cause the software to mistakenly detect ventricular fibrillation and deliver an erronious shock. EMTs have been taught for years that they have to pull over to deliver a shock with an AED on a patient because of this, and there are areas in Memphis that I can drive through with a patient on a Lifepak 12, a relatively modern monitor, with good EKG placement on a 4-lead and still trigger the Ventricular Fibrillation alarm because of the bumps.

BarkingUnicorn: Using it to measure heart rhythm or taking the next step of using it to shock.


They actually stopped making AED models, for the most part, that displayed the rhythm the A+P lead placement was showing because it was considered a legal risk for BLS personel, and it was acting as a distraction, and adding to the costs of the machines. Our ALS volunteers at the fire department I started at carried keys on their keychains that switched our PD1700s from AED into manual mode, for example, and it would convert the display from text only to one lead waveform display.

BarkingUnicorn: Or maybe I'm wrong and the AED simply won't shock unless it detects one of these special arhythmias.


An AED won't shock anything but those two rhythms. You can still be in arrest from PEA, which is where the heart is electrically organized but not muscularly beating, and you can have an SVT where the heart beats so fast that it cannot effectively pump blood or perfuse itsself. Even things like Atrial Fibrillation and flutter can cause abnormally fast rhythms. The treatment for that is usually drugs, or synchronized cardioversion where the monitor delivers a very specifically timed energy dose during the depolarization phase. This can actually induce VFib if you try to do it without synchonizing. And in Atrial rhythms greater than 24 hours, you have to worry about the risk of throwing a PE or causing a stroke from emboli formation.

In slow heart rhythms, the treatment is either removing the underlying cause, or pacing - either chemically or electrically. No AED can do this.
 
2013-02-10 04:52:53 AM

Smgth: I understand protecting Good Samaritans from prosecution, I'm all for it. But I don't see how forcing the building to contain life saving measures will help anyone if there's no obligation.


You want to help this dying guy, but there's no AED in the building.  That's the problem the law addresses.

Would you want somebody sending electricity through you who didn't want to do so?
 
2013-02-10 04:58:53 AM

BronyMedic: AEDs will not check for a pulse. They only analyze electrical activity from an anterior-posterior lead placement, and determine if the waveform of the lead matches with the software waveforms for two specific kinds of lethal arrhythmias - Ventricular Tachycardia and Ventricular Fibrillation. The reason that it's important to not put it on a patient who is spontanenously circulating (has a pulse to the HCP, or has signs of circulation and effective breathing to the layperson) is that if the patient has a perfusing pulse, but IS in ventricular tachycardia, the machine will detect this, sense it, and shock - and kill the person you're trying to help


Thank you.  I thought maybe AEDs were more foolproof than that.

So, human judgment is required.  A trained AED operator would not have shocked a guy with a pulse.  A layperson could reasonably be expected not to use the AED if he felt a pulse. End of lawsuit, unless plaintiffs can prove that the trainer didn't detect a pulse.  Good ,luck with that.
 
2013-02-10 05:08:47 AM

Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.


^^^^^^^

What we're seeing here is the collision of "Let's look like we're being prepared, so we can't be sued for not being prepared," with "What actually happens when something happens and you actually have to be prepared to do something."

People (and tort lawyers) will sue for any plausible reason, so either being prepared OR not being prepared is grounds for suit these days. The more technology makes it easier for less-trained personnel to perform tasks, the easier it is for lawyers to "reasonably ask" why the hotel/theme park/grocery store didn't have such simple technology available. As our resident medic has indicated, an AED is hardly "simple technology", but the average jury isn't going to realize it; they're going to wonder howcome someone died because Safeway couldn't be bothered to have one bolted to the back door so Fred could be saved at the push of a button. Cha-Ching!

Then, of course, when Safeway gets AEDs bolted to every door, and ol' Fred dies because the stockboy used that amazing push-button lifesaver and killed him--"Why weren't your people trained correctly on how to use these complex and sensitive devices?" Cha-ching!

Back in the day when only paramedics could be legally allowed to do all this fancy crap, the hotel's responsibility ended with calling 911, which is as it should be imo. They've got the skills, extra equipment, and experience to do what needs doing and to know what not to do; and unless you live anywhere but Outer Mongolia, they can get there in enough time to save poor old Fred, and if they CAN'T, he was dead anyway. I know whereof I speak, because I worked for The Mouse back when we got sued for not having paramedics actually ON DL property, and so they couldn't get to the victim in under 8 minutes. Disney paid, at great expense (passed on to the guests, might I add) to have medics stationed in the park during operating hours year-round, and it cut their response time to eight minutes. What it did not do was increase anybody's survival rate. Nor did it decrease the number of lawsuits against Disneyland.
 
2013-02-10 08:37:23 AM

Smeggy Smurf: JWideman: 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.

My lodge is looking into getting one of those things.  Several of our lawyer members have stated that anybody trying to sue over the use of one of the things will not win.  Period.  The machines are designed to only work when they'll actually do some benefit.  The victim will die either way.  At least you used the best technology available to try to to save them.  Any asshole who sues ought to be hung and their estates stripped.  Sorry kids, your parent was an asshole.  Sucks to be you.


Of course they won't win. That won't stop them from suing.
 
2013-02-10 08:48:55 AM

BronyMedic: ZackDanger: As a point of clarification from something posted earlier in the thread, I also want to point out that an AED can shock a person who is conscious, not in VFIB, and not even moving. AEDs are designed to shock a variety of rhythms, one of which can support life in some cases and thus it is not benign to put an AED on a person who is awake.

I've even heard of EMTs proactively placing electrode pads on someone who is awake and experiencing Chest Pain "just in case." Not only is this directly in contradiction to manufacturer's guidelines, it is very dangerous and potentially deadly.

THIS.

Not only that, if someone reports an EMT for doing that, they can lose their license for practicing outside of their scope of practice, and open themselves up to a lawsuit.

All the AED sees is this: Ventricular Tachycardia.



The AED cannot determine if it has a pulse or not with it. It is quite possible to be in V.Tach and have a perfusing blood pressure at the same time (I had a patient the other day who was refractory to adenosine, amioderone and synchronized cardioversion, and lidocaine was contraindicated), and you WILL kill them by delivering an unsynchronized shock.

This is why EMT-Basics are taught NOT to apply an AED to a patient with a pulse and a rapid heart rate.


There is only about a .12 second window (or less) where you have a chance of hurting someone with an unsynchronized shock, which is the relative refractory period.

You are correct that shockable rhythms with a pulse, excluding polymorphic VT should be synchronized.
 
2013-02-10 09:26:55 AM
This is why you don't let rookie EMTs have shock paddles, they view the world like this:
i7.photobucket.com
 
2013-02-10 09:46:50 AM
Can I point out that personal trainers are technically healthcare providers. I know that healthcare provider means something very specific in CPR, but I'm a BLS provider personal trainer. Unfortunately, some of the healthcare staff in my BLS class seemed too stupid to tie their own shoes.

IMHO most trainers should be able to correctly identify if a client is respirating and has a pulse, and shold not apply an AED if a pulse is detected. I'm inclined to believe that either the trainer was incompetent or the sick person's condition deteriorated. Unless the gym is back tracking and making shiat up, it doesnt sound like a case of negligence. Just because the equipment is there, doesnt mean its use is always appropriate.

/also the case for a lot of gym equipment
 
2013-02-10 10:37:53 AM

Gyrfalcon: Back in the day when only paramedics could be legally allowed to do all this fancy crap, the hotel's responsibility ended with calling 911, which is as it should be imo.


That's how it is all over the country, as TFA says.

The problem for  defendants is that we have no way of summarily dismissing a lawsuit before they have to spend a lot of money.
 
2013-02-10 10:50:26 AM

elysive: Can I point out that personal trainers are technically healthcare providers. I know that healthcare provider means something very specific in CPR, but I'm a BLS provider personal trainer. Unfortunately, some of the healthcare staff in my BLS class seemed too stupid to tie their own shoes.

IMHO most trainers should be able to correctly identify if a client is respirating and has a pulse, and shold not apply an AED if a pulse is detected. I'm inclined to believe that either the trainer was incompetent or the sick person's condition deteriorated. Unless the gym is back tracking and making shiat up, it doesnt sound like a case of negligence. Just because the equipment is there, doesnt mean its use is always appropriate.

/also the case for a lot of gym equipment


Like the hidden cameras in the bathrooms? :-)
 
2013-02-10 11:09:49 AM

Whole Wheat: There is only about a .12 second window (or less) where you have a chance of hurting someone with an unsynchronized shock, which is the relative refractory period.

You are correct that shockable rhythms with a pulse, excluding polymorphic VT should be synchronized.


Well, it's still preferable to synchronize cardiovert Torsades... The problem is that some monitors won't be able to depending on the morphology, and unsymchronized cardioversion is a necessary evil.
 
2013-02-10 12:16:04 PM

MythDragon: This is why you don't let rookie EMTs have shock paddles, they view the world like this:
[i7.photobucket.com image 800x600]


I wonder if there are any good servers left.
 
2013-02-10 12:19:00 PM

vygramul: MythDragon: This is why you don't let rookie EMTs have shock paddles, they view the world like this:
[i7.photobucket.com image 800x600]

I wonder if there are any good servers left.


Jesus, it's been
 
2013-02-10 02:01:49 PM
Those machines are used just for abnormal heart rhythms. They do not nor are the used for restarting a heart. Why they're placed for that purpose is beyond stupid.
 
2013-02-10 06:44:21 PM
Has to wear this so getting a kick:

http://www.youtube.com/w atch?v=SlYe1VvE_Uo
 
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