Manitoba is the first Canadian province to mandate automated external defibrillators (AEDs) in facilities that attract a high volume of patrons and/or where recreational pursuits occur.
Building owners and managers are still awaiting the regulations that contain the precise instructions but the general requirements of the defibrillator public access act are commonly known.
By January 2014, premises designated for the first phase of compliance must have on-site AEDs (also commonly known as public access defibrillators or PADs) registered with the Heart & Stroke Foundation in Manitoba, and the capability to respond to a cardiac incident within three minutes. This is expected to include shopping malls, educational facilities, airports, bus and train stations, gyms, arenas and other indoor recreation venues, golf courses, casinos, museums, libraries and various other provincially and municipally owned and/or operated buildings.
Plan before placement
The Heart & Stroke Foundation advises that an AED, alone, costs between $1,500 and $2,000. Services related to installation, associated supplies and ongoing maintenance should also be factored into the total capital outlay.
The sheer number of devices is not necessarily the key to effectively deploying resources, however. Emergency responders emphasize the importance of planning, trained on-site personnel, signage and associated awareness campaigns so people know where to find an AED and who to call if an incident occurs.
“We are looking for a three to four minute round-clock time,” says Gayle Pollock, commander of the Cardiac Safe City Program overseen by the City of Toronto’s Emergency Medical Services (EMS). “If it’s kept in a central staffed location, it can be dispatched with one-way travel time rather than from the patient to the AED and back to the patient. That needs to be determined ahead of time and stated in the plan.”
Site assessments and emergency response plans are required initial steps for the voluntary participants in the Toronto EMS program. Approximately 1,300 AEDs have been placed so far, primarily in public but also in some privately owned buildings. Pollock projects that number will grow to about 1,500 by the end of 2012, partly due to funds from Ontario’s $10-million province-wide defibrillator access initiative, which will underwrite installation of AEDs in all of the Toronto Catholic District School Board’s elementary schools within the next six months.
Devices registered through the program are integrated into Toronto’s 911 database so that emergency medical dispatchers will immediately see there is an AED on-site when they key in address information. They can then inform callers as part of pre-arrival instructions. The registry to be maintained by the Heart & Stroke Foundation in Manitoba will provide the same kind of resource for EMS paramedics in that province as they receive 911 calls.
Responsibility and protection
Manitoba-based building owners and managers must register every AED on-site and update the information any time the location of an AED is moved. Other elements of legislation set rules for signage, regular testing and the documentation of testing and maintenance. The act also provides protection from liability to all who meet its stated requirements.
“That’s important if facilities are not designated to comply with the legislation but they still want to do it,” says Leandro Zylberman, a lawyer practicing with Thompson, Dorfman, Sweatman LLP in Winnipeg. “The legislation is based on the idea of the owner/occupier acting in good faith in terms of where AEDs are located, the signage and maintenance, and it will protect them if they comply with everything.”
Meanwhile, even though health and emergency services experts underline the benefits of trained personnel who can step in with little or no hesitation, it is not mandatory under the act.
“Training is not prescribed in our legislation because if you require people to be trained then you don’t really have public access,” says Jackie Zalnasky, vice-president, health promotion and research, with the Heart & Stroke Foundation in Manitoba. “We do, however, recommend CPR and AED training, if possible.”
The Heart & Stroke Foundation in Manitoba has produced the community AED toolkit to guide building owners and managers through the steps of choosing, installing and maintaining the devices and being prepared to respond. Many suppliers and distributors also offer site assessment, training and follow-up maintenance services, which can relieve pressure on in-house resources and the need for expertise. However, building owners and managers are advised to be aware of what services they will need when making their choices.
“We have that all summed up in a checklist that tells you the questions to ask,” says Zalnasky.
Though not enshrined in the legislation, trained staff will invariably be an element of any facility’s emergency plan – and more than one trained staffer per shift is recommended.
Manitoba’s legislation is the first in Canada, although not the first attempt among provinces. A private member’s bill, the proposed defibrillator access act, received all-party support for first and second reading in the Ontario legislature in spring 2010, but did not make it onto the order paper for third reading before the session ended and an election was called for October 2011.
Legislation has not yet been reintroduced in Ontario’s current parliamentary session but informed observers expect to see similar bills there or elsewhere, possibly next in British Columbia. AEDs are also mandated in several U.S. jurisdictions.
In the future, AEDs may be just another status quo component of any building’s health and safety regimen.
Barbara Carss is editor-in-chief of Canadian Property Management magazine.