Shocks That Save Lives.

A new, simplified device can save the life of a person in cardiac arrest. Legislators have been rushing to pass laws to make sure these automated defibrillators are readily available.

One Friday, Bob Adams, age 42, was walking to his train when he collapsed in the middle of Grand Central Station. Station staff could find no pulse when they rushed to his aid. The station's fire prevention manager quickly unpacked a new automated external defibrillator that had arrived just the day before. Setting up the device to analyze Bob's heart, they heard the machine respond "shock advised." They pushed a button on the unit, which applied a 1,700-volt electric shock into Bob's chest. Within four minutes, his heart was beating again.

"I feel so fortunate and thankful to those people who ordered that equipment, because without it I wouldn't have had a chance," the father of three said later.

Each year, more than 250,000 Americans die from sudden cardiac arrest. The key to survival is timely initiation of a "chain of survival," including resuscitation. And now, because of recent technological advances, there is a portable lifesaving device, the automated external defibrillator or AED that saved Bob Adams' life. With training, anybody can use these simplified electronic machines to treat a person in cardiac arrest. The device guides the user through the process with audio or visual prompts, no discretion or judgment required. The American Heart Association asserts that at least 20,000 lives could be saved annually by prompt use of these machines.

"Anyone who can learn CPR can learn to use AEDs," says Dr. Richard Cummins, a pioneer in the treatment of out-of-hospital sudden cardiac arrest. He notes that the ultimate goal for the new technology is "public access defibrillation," which means that people will have access to defibrillators in much used areas, such as office buildings, stadiums, transit terminals and airplanes, where survival rates from sudden cardiac arrest have been less than 1 percent.

The next step could be to place AEDs in apartment buildings and even the homes of high-risk patients and to train family members to use them. Both rural and congested urban areas often have low survival rates because defibrillators don't get to victims in time.

Legislators have moved quickly to become involved with this issue in the past two years. Florida was the first in 1997, adopting a broad public access law. Today, 44 states have defibrillator laws or regulations, 28 of which passed this year. In many cases, the bills were passed with strong bipartisan support and with the endorsement of the medical and health communities.

Most commonly, the recent laws update standards for "traditional" emergency medical services, some of which required hundreds of hours of training, testing or certification. The new laws encourage broader availability, rather than creating more regulatory restrictions. Most bills enacted in the last two years include one or more provisions to:

* Establish legislative intent that an "automatic external defibrillator may be used by any person to save the life of another person in cardiac arrest."

* Encourage or require basic training in the use of AED devices by potential users.

* Require these devices to be maintained and tested to manufacturers' standards.

* Create a registry of the location of all such defibrillators or require notification of a local emergency medical authority.

* Allow a Good Samaritan exemption from liability for any individual who renders emergency treatment with a defibrillator.

* Authorize a state agency to establish more detailed requirements for training and registration.

"These laws will help improve the response time to treating victims of cardiac arrest by enabling more of the general public to use defibrillators," says Representative DuWayne Johnsrud, author of Wisconsin's law, which went into effect in July.

As a next step, legislators may grapple with the question of using state funds to purchase and distribute defibrillators. The latest portable devices cost around $3,000, and prices may drop if sales volumes rise. Should they be treated as a public service, like fire hydrants, or as a private safety device, like fire extinguishers? Rhode Island tried one innovative step in 1998 by appropriating funds for two AEDs for each city, town and college in the state.

Further information on defibrillator laws, including citations and links to text, are available on the NCSL Web site at www.ncsl.org/programs/health/aed.htm.

Richard Cauchi is a policy specialist with NCSL's Health Care Program.