Don’t Go Breaking My Heart

At her very first board meeting, Jacqueline Stein announced that her building needed more protection. The wife of a cardiac electrophysiologist, she knew a certain, sudden killer when she saw one. Once she shared her knowledge, the rest of the board did, too. So the co-op’s managing agent signed them up for a three-year, all-inclusive package that included a small, battery-powered device called an automated external defibrillator (AED), certified CPR training, and a whole lot of peace of mind.

Sudden cardiac arrest, which occurs when the electrical signals that power the heart’s pumping mechanism suddenly become irregular or stop, knows no age, gender, or social or economic strata. It kills almost half-a-million people each year in the United States before they can even reach the hospital, according to the American Heart Association. Although risk factors include previous heart disorders, there is no absolute way to tell when – or who – it will strike. It can seem to appear out of nowhere, and chances of survival fall by 10 percent with each passing minute. But an automated external defibrillator has been shown to increase survival rates by 50 percent or more.

Medical, legal, and property experts agree your building should have one. “The bottom line is, most people do cardiac arrest in their home environments,” Dr. Neal Richmond, deputy medical director for the New York City Fire Department, says. “Ideally, the best thing to do is have a defibrillator very nearby to where people [suffer] cardiac arrest.” And in traffic-plagued New York City, Richmond says, despite best efforts, rescuers can take 10 minutes or more to reach a property. Once there, they must often waste life-saving minutes dealing with intercoms, elevators, and a myriad of apartment doors before finding their patient. Having someone on hand to initiate cardiac pulmonary resuscitation and administer defibrillation until rescuers arrive could mean the difference between life and death.

Ira M. Meister, president of Matthew Adam Properties, signed up Stein’s co-op, the 235-unit York River House, in June. He says that many boards have been reluctant to enter a public access defibrillation (PAD) program, because of the potential liability in case something goes wrong. But, he points out, boards may not realize that federal and state Good Samaritan legislation can help provide immunity for properly trained rescuers.

Not only that, but AEDs are no longer huge, paddle-laden machines that require a Ph.D. in blip reading. Today’s portable defibrillators average less than one square foot, weigh about five pounds, and actually talk the operator through the process from start to finish. Some even sense and apply needed shocks, so the operator does not need to push a button.

Costs vary, depending on inclusions and contract span, from about $3,000 for a basic AED machine to up to $7,000 or more for a package deal that includes state paperwork submission, required medical prescriptions, and training and refresher courses.

Stein notes that cost is certainly no reason to avoid entering a program. “I just think in this day and age, when you have all these technological advancements, and you actually have the ability to prevent sudden cardiac death, for goodness’ sake, spend a few thousand dollars,” she says. “You know, if you ever have to use it once, it pays for itself.”

Indeed, in these litigious times, can a building afford not to have one? “It’s a double-edged sword,” adds Stein, who is also an attorney. “It’s not a standard of care you are required to uphold. But, God forbid, something happens and you don’t have one. Heaven forbid, somebody sues.”

The law already requires office buildings, airports, and even public schools to have them, and some experts feel AEDs may soon become as common as fire extinguishers. Stein advises against waiting until a potential legal requirement generates a massive rush toward purchasing and training.

Julien Studley agrees. The board president at 118 East 60th Street, a 325-unit co-op, he recalls his fellow board members discussed the program for about 10 minutes before voting into it. “There don’t appear to be any negatives,” he says. The building was scheduled to be set up by mid-October.

Much is involved in obtaining and maintaining an AED; it cannot just be purchased off the shelf at Wal-Mart. But a provider such as Medtronic, which Meister uses, offers a package deal that includes the machine and American Heart Association-approved training for up to five people. The company will also secure the medical prescription needed to purchase the unit, complete required state forms, pay registration fees, provide refresher training and 24-hour support lines, and conduct post-event follow-ups and maintenance. “It’s a life-saving thing,” Meister says. “Why people don’t go for it is beyond me.”

Once a building is set up, experts suggest at least one and preferably two trained staff members should be on duty at all times. Housed in a wall cabinet, the unit should be placed in an easily accessible public area location. While chance of theft exists, the unit should not be locked. Instead, the wall cabinet is typically protected by an alarm.

Because the Federal Sudden Cardiac Arrest Survival Act, which President Bill Clinton signed into law in 2000, requires proper CPR training to protect from liability, good training is essential. For example, Richmond says, staff members need to know that after five minutes of cardiac arrest, at least 90 seconds of CPR should first be administered before shocks are applied so the heart is more open to receiving them. And while the results of a recent American Heart Association study show PAD greatly enhances survival rates, the program is by no means a substitute for professional medical care.

“I think the best thing we could do in this city and state is to require CPR training,” says the manager, noting that all city ambulances, police cars, and fire department engine-company vehicles now carry AEDs.

Meister, just one of several building managers convinced of PAD’s effectiveness, expects today’s uncertain environment to push its popularity. “It’s the stress of living in New York these days,” he says. “Once you’ve educated the buildings and they have a chance to see it and what it’s all about, people want it.”