One for the Heart

You can die. Suddenly, without warning. Cardiac arrest can strike those who may not have a diagnosed heart condition, unexpectedly killing them shortly after the onset of symptoms. According to a recent report from the Centers for Disease Control and Prevention, anywhere between 400,000 and 460,000 people die from sudden heart attacks in the U.S. each year.

If boards care about saving the lives of their residents, read on, because now there's equipment that can help. It's called a defibrillator, a machine that blocks fibrillation - the state of rapid, irregular heart contractions that can cause fatal attacks - and a number of properties are using it to save lives.

Scott Resnick, the president of Jack Resnick & Sons, a Manhattan-based property owner, is providing defibrillators in fourteen of his commercial buildings and four of his residential buildings. Dennis Brady, a managing director with the company, says that, along with about 100 other employees at the firm, he has received training in both CPR and the use of defibrillators.

Moreover, staff members in the firm's buildings were also trained, including superintendents, security guards, and handymen, "so that we always have someone on-site with this medical device training." Brady is not aware of any incidents of sudden cardiac arrest in any of the Resnick buildings, but adds: "These are good skills to have. If you do save just one life, then the training was worth it."

Randy Kohana agrees. The chairman of the RAK Group in New York, he had his life saved by one of the machines. Notes he: "Defibrillators are it."

Because of potential liability, boards might be wary of using defibrillators. But thanks to the so-called "Good Samaritan" law, defibrillator users who have been properly trained are safeguarded against liability. Recent legislation at the state and federal levels has helped to increase awareness for the need for early defibrillation and to mitigate any liability on the part of Automated External Defibrillator (AED) owners and users. This is in addition to coverage already provided by Article 30 of the New York State Public Health Law. The Sudden Cardiac Arrest Survival Act, which President Bill Clinton signed into law in November 2000, extends Good Samaritan coverage to AED users who have been properly trained, thereby protecting them from liability.

"While one of our original concerns was liability, the Good Samaritan law relieves us of that, so I feel there are no drawbacks to using AEDs," says Brady.

How does a defibrillator work? The most common cause of sudden cardiac arrests, ventricular fibrillation, is a lethal arrhythmia or irregular heartbeat, characterized by rapid, chaotic contractions of the heart. The defibrillator fights this by delivering an electric shock. To work at all, defibrillation must occur immediately (survival rates decrease by 10 percent with every minute that defibrillation is delayed). Some defibrillators automatically assess a patient's cardiac rhythm once the electrodes are in place and direct the user through each step of the rescue process with simple voice prompts. If a shockable cardiac rhythm is detected, the medical device will direct the rescuer to press a button to deliver a shock.

While the average on-site building defibrillator device costs about $3,000, according to Claudia King, a territory manager with Cardiac Science, a manufacturer of defibrillators, training and medical oversight for each program can cost from $500 to $5,000, depending on the defibrillator program a building chooses and the number of on-site personnel it trains. Those costs include medical oversight as well as training. For tax year 2000 and beyond, there is a $500 per AED New York State income tax credit for corporations and individuals (there is no limit on the number of AEDs purchased as long as they are not for resale).

Most experts say the costs are worth it. Why? Without residential defibrillators on-site, the average response time for a defibrillator-equipped emergency medical vehicle (such as an ambulance) in New York City is about 12 minutes and can take longer because of traffic congestion, according to the American Heart Association.

Bill Lown, associate director of business development at the Center for Corporate Wellness at Mount Sinai Hospital, notes that a number of co-op buildings on Park and Fifth Avenues and Central Park West have purchased the hospital's defibrillator services through two of its program offerings, AED Protection Plus and AED Essential. Each provides buildings with "one-stop shopping" when implementing their own defibrillator program, and each is designed to help businesses and residential building employees respond more effectively to incidents of sudden cardiac arrest.

In terms of how co-op boards should go about installing defibrillator programs, they must have a collaborative agreement with an emergency healthcare provider, Lown says. He explains that any board director should find a medical director who must follow certain regulatory procedures to implement defibrillators, oversee the training, and complete the proper paperwork with state agencies. It generally takes any building about four or five weeks to purchase and implement either one of Mount Sinai's programs.

"We try to be proactive with these sorts of things - especially in buildings with fitness centers where someone may go into cardiac arrest," says Toni Hanson, managing director of Insignia Residential, about Mount Sinai's programs. She notes that she has been successful in reaching out to about six buildings that now have Mount Sinai defibrillator programs.

Possible downsides for co-op and condo buildings using an AED program include the potential for theft and the risk that volunteers will use the device in place of calling 911. Calling 911 is the first thing someone should do before using the defibrillator.

Other criticisms raised against the machine concern equipment upkeep and training. Some users have complained that it is difficult to keep the defibrillator well-maintained and handy. More significantly, during training sessions, volunteers frequently forget where to place the device's chest pads. (If they are not placed correctly, the shock will not go through the heart and defibrillate it.)

An article in a British medical journal, BMJ, raised other concerns. In it, the authors concluded that survival rates in Scotland, where the study occurred, would improve only marginally, to 6.3 percent from 5 percent, if the machines were made available to the public.

"I think it's worth asking the question whether our health dollars are being well-spent by doing this," Dr. Stuart M. Cobbe, one of the study's authors, told the New York Times. "Our feeling is that a better way of spending it would be improving the response times for mobile defibrillators and adding new responders, such as police or fire departments."

Nonetheless, the defibrillator's proponents argue its many plusses. "We see using defibrillators on-site as a plus-plus situation," says Brady. Using AEDs supplements emergency assistance, but it never eliminates the role of 911. "In any medical crisis, the first thing you should do is call 911 because they are the pros," observes Brady. "But then you must do what you can to keep the victim alive."

While Hanson doesn't know if cardiac arrests occur more often in people's offices or homes, she notes: "Our thought process was that if they happen at home, and we can cut down on the 15 or 20 minutes it takes an ambulance to come, it's a service that the building deserves."

Efforts like Mount Sinai's may become more common after results are tabulated from 45 New York City

co-ops and condos that are participating in a Public Access Defibrillation (PAD) trial to test the effectiveness of

defibrillators. The trial, which began in 24 cities, including New York, across the U.S. and Canada, originated in Seattle at the University of Washington's School of Public Health and Community Medicine.

"Will this trial show that lives are being saved?" asks Jennifer Holohan, project director of the New York City PAD trial at Mount Sinai School of Medicine. "It's too soon to tell." Holohan notes that there will be no conclusive evidence about the general usefulness or cost-effectiveness of the defibrillator in terms of saving lives until the data collection period of the trial ends. The PAD trial is scheduled to end in spring 2003.

Heart attack survivor Kohana created a campaign to install these medical devices in as many New York co-op and condo buildings as possible. To date, his efforts have resulted in such devices being in more than 200 properties throughout the city. "I know a lot of managers, so I instantly canvassed certain neighborhoods. So far, no one is saying no to defibrillators," Kohana notes, adding: "Every day, in the newspaper, someone dies of a heart attack."

Since sudden cardiac arrests are one of the two main killers in the U.S., he believes that defibrillators are tools that should be widely available to the general public. Just as they are now located in Chicago's O'Hare Airport and even in Grand Central station, Kohana feels they should be located in residential buildings, especially those with gyms.

"We think defibrillators offer a valuable service that can save someone's life," Lown agrees. "Our goal is to make as many buildings as possible aware of it." He notes that trained residents or building staffers can get to a victim within two to four minutes, and that one of the Mount Sinai programs has been installed in roughly ten high-end buildings. "Residential buildings have sought us out and said they would like to have this equipment installed to protect their residents."

To date, there have been no reported instances in which civilian rescuers have been successfully sued for using defibrillators. There have, however, been a growing number of lawsuits successfully filed against businesses failing to have these medical devices on-site. Should defibrillators become the standard of care, residential co-ops and condos without them could be the next frontier to be cited for negligence.