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When exercise turns deadly: fitness clubs should not rely on CPR to revive patrons who suffer sudden cardiac arrest. Automated external defibrillators save lives, and they are easy to use - but many gyms don't have them.



You are having lunch with colleagues when a probate lawyer from your firm mentions that John Doe John Doe

formerly, any plaintiff; now just anybody. [Am. Pop. Usage: Brewer Dictionary, 329]

See : Everyman
 a 50-year-old client, died yesterday while exercising at a health club. Club employees began CPR Cardiopulmonary Resuscitation (CPR) Definition

Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac
 within a minute or two of John's collapse and phoned 911 for paramedics, who arrived six to eight minutes later. The paramedics took him to the emergency room, where he was pronounced dead--a victim of sudden cardiac arrest cardiac arrest
n.
Abbr. CA A sudden cessation of cardiac function, resulting in loss of effective circulation.


Cardiac arrest
A condition in which the heart stops functioning.
 (SEA).

"What a shame," says another lawyer at the table. "I guess John's time had just come."

"Maybe not," you say. "Did the health club have an AED AED - Automated Engineering Design ?"

"An AED?" asks the probate lawyer "What's that?"

You explain: All automated external defibrillator automated external defibrillator Emergency medicine A portable device designed for use by first-response personnel for out-of-hospital emergency treatment of Pts suffering from cardiac arrest. See First-response personnel.  (AED) is a battery-operated device, about the size of Black's Law Dictionary Black's Law Dictionary is the law dictionary for the law of the United States. It was founded by Henry Campbell Black. It has been cited as legal authority in many Supreme Court cases (see Secondary authority). , used to administer an electric shock to a heart in cardiac arrest. SCA (Single Connector Attachment) An 80-pin plug and socket used to connect peripherals. With a SCSI drive, it rolls three cables (power, data channel and ID configuration) into one connector for fast installation and removal.  is caused by an electrical malfunction mal·func·tion
v.
1. To fail to function.

2. To function improperly.

n.
1. Failure to function.

2. Faulty or abnormal functioning.
 of the heart that causes an abnormal heart rhythm--or arrhythmia--the most common of which is ventricular fibrillation ventricular fibrillation

Uncoordinated contraction of the muscle fibres of the heart's ventricles (see arrhythmia). Causes include heart attack, electric shock, anoxia, abnormally high potassium or low calcium in the blood, and digitalis or epinephrine poisoning (
 (VF). A person suffering from VF will die unless the heart's normal rhythm and pumping action are restored. Cardiopulmonary resuscitation cardiopulmonary resuscitation (CPR), emergency procedure used to treat victims of cardiac and respiratory arrest. CPR can be done in a hospital with drugs and special equipment or as a first-aid technique.  (CPR) may buy extra minutes by circulating some blood to the brain and other organs, but it cannot reverse sudden cardiac arrest. An AED can.

Studies have shown that defibrillation Defibrillation Definition

Defibrillation is a process in which an electronic device sends an electric shock to the heart to stop an extremely rapid, irregular heartbeat, and restore the normal heart rhythm.
 within the first few minutes of SCA gives the victim an 80 percent to 90 percent chance of survival. (1) Survival rates drop by 7 percent to 10 percent for each minute that goes by without defibrillation. (2)

AEDs are relatively inexpensive (between $2,500 and $3,000), and they are virtually foolproof. The machines are so simple to use that even untrained elementary-school children operated them in a study reported in Circulation, the journal of the American Heart Association American Heart Association (AHA),
n.pr a national voluntary health agency that has the goal of increasing public and medical awareness of cardiovascular diseases and stroke, and thereby reducing the number of associated deaths and disabilities.
 (AHA). (3) An AED has a "start" hut, ton: Pushing it activates a voice recording that tells the user exactly what to do.

Health club operators know that SCA can happen in their facilities. Nearly 1 in 4 U.S. adults has some form of cardiovascular disease Cardiovascular disease
Disease that affects the heart and blood vessels.

Mentioned in: Lipoproteins Test

cardiovascular disease 
, (4) and SCA kills about 350,000 Americans a year. (5) People are 15 to 20 times more likely to die of SCA during vigorous exercise vigorous exercise A form of exercise that is intense enough to cause sweating and/or heavy breathing/ and/or ↑ heart rate to near maximum; VE is formally defined as that which requires > 6 METs; there is a graded inverse relationship between total physical , or within 30 minutes following it, than when not engaged in vigorous exercise. (6)

Health and fitness clubs--which provide equipment and a controlled environment for exercise--know their patrons are at increased risk for SCA. Most keep records of such incidents and have come to expect them. (7) One health club executive has testified in deposition that his gyms expect 1 cardiac event cardiac event Coronary event Cardiology Any severe or acute cardiovascular condition including acute MI, unstable angina, or cardiac mortality  for every 100,000 person-hours of exercise. (8) Even if this estimate is too high, busy facilities can have well over 100,000 person-hours of exercise a year. (9)

Back to your hypothetical lunch: You suggest that the probate lawyer advise John's widow that she might have a cause of action against the health club for wrongful death The taking of the life of an individual resulting from the willful or negligent act of another person or persons.

If a person is killed because of the wrongful conduct of a person or persons, the decedent's heirs and other beneficiaries may file a wrongful death action
. The gym should have had an AED. If health club employees had used one on John within the first four minutes of his SCA, he probably would have survived.

Points of proof

To prove a cause of action against a health club for injury or death arising from its failure to have or use an AED, you must prove the following.

The victim suffered sudden cardiac arrest, and his or her heart rhythm Noun 1. heart rhythm - the rhythm of a beating heart
cardiac rhythm

regular recurrence, rhythm - recurring at regular intervals

atrioventricular nodal rhythm, nodal rhythm - the normal cardiac rhythm when the heart is controlled by the
 required--and would have been corrected with timely defibrillation. You can probably prove this by examining the cardiac rhythm Noun 1. cardiac rhythm - the rhythm of a beating heart
heart rhythm

regular recurrence, rhythm - recurring at regular intervals

atrioventricular nodal rhythm, nodal rhythm - the normal cardiac rhythm when the heart is controlled by the
 strips generated by the paramedics who tended to the victim. Paramedics often have a defibrillator defibrillator, device that delivers an electrical shock to the heart in order to stop certain forms of rapid heart rhythm disturbances (arrhythmias). The shock changes a fibrillation to an organized rhythm or changes a very rapid and ineffective cardiac rhythm to a  with an electrocardiogram electrocardiogram /elec·tro·car·dio·gram/ (-kahr´de-o-gram?) a graphic tracing of the variations in electrical potential caused by the excitation of the heart muscle and detected at the body surface.  (EKG EKG: see electrocardiography. ) screen, which charts the heart rhythm. The paramedics simply print a copy of the EKG and make it a part of their records.

Most SCA events result from VF or from pulseless ventricular tachycardia Ventricular Tachycardia Definition

Ventricular tachycardia (V-tach) is a rapid heart beat that originates in one of the lower chambers (the ventricles) of the heart.
, both of which can be corrected with defibrillation. If the victim's heart rhythm cannot he shocked, it may be that a shockable rhythm deteriorated to a non-shockable one before help arrived.

You will need to interview eyewitnesses and obtain their testimony concerning how the victim appeared and behaved from the time he or she was first discovered until paramedics generated heart rhythm strips. A victim of SCA with a shockable heart rhythm would have been unconscious with no pulse and not breathing. Although it might be impossible to obtain 100 percent proof that the victim's heart rhythm was shockable when he or she first collapsed, medical experts I have worked with generally agree that a victim had a shockable rhythm if his or her physical symptoms were consistent with a shockable rhythm and if the first rhythm strips revealed a shockable rhythm.

The victim was in an area of the health club where employees could see him or her collapse. You must prove this to show that reasonably trained staff should have been able to react in time to save the victim with defibrillation.

Obviously, your case will be stronger if he or she collapsed in the middle of the exercise floor and not in a locked bathroom stall, yet gym users often lie on the floor to exercise and stretch. The victim could have been on the floor for seconds or minutes after collapsing before anyone noticed and tried to help. Witness testimony about the timing of events is vital; so is whether staff was trained to monitor the gym and identify trouble.

The health club had a duty to have an AED on the premises. This will be the primary battle in most cases. AED technology has advanced rapidly in the past decade, making it increasingly difficult for health and fitness clubs to deny this duty. In general, the more recent the victim's injury or death, the stronger your case will be.

The club did not have an operable operable /op·er·a·ble/ (op´er-ah-b'l) subject to being operated upon with a reasonable degree of safety; appropriate for surgical removal.

op·er·a·ble
adj.
 AED, or it had one but did not use it. Litigated cases to date have involved gyms that had no AED. For example, Chai v. Sports & Fitness Clubs of America alleged that the lack of an AED at a club in Broward County, Florida Broward County is a county located in the U.S. state of Florida. As of 2000, the population is 1,623,018; this makes it the second most populated county in the state. According to 2006 U.S. Census estimates, its population had grown to 1,787,636 [1]. , caused brain damage in a member who suffered SCA while exercising. The parties settled before the jury issued a verdict. (10) A few other similar cases are pending. (11)

AED batteries generally last several years, and the machines are designed to indicate when the battery is low. I am not aware of any cases that involved a malfunctioning AED. Manufacturers have such high confidence in their products that some offer indemnification agreements, assuming the purchaser's liability if the device malfunctions.

It is likely that as more health clubs obtain AEDs, one will neglect to use it on a member who is in cardiac arrest. In such a case, discovery will boil down to whether staff received adequate training in emergency procedures; whether new employees had been trained; whether the victim was in a visible location; and whether the victim's symptoms indicated that health club employees should have reasonably determined that they should use the AED.

The absence or delay of defibrillation caused the victim's injuries or death. You can establish this element with testimony and evidence provided by the treating health care providers and medical experts. The longer an SCA victim goes without blood to the brain, the worse his or her brain damage. Lack of blood to the brain can also lead to death.

If the victim is given effective CPR--which health club staff should be trained to perform--some blood will circulate, extending the staff and paramedics' window of opportunity to save the victim from brain injury or death via defibrillation. However, most medical experts agree that even without CPR, a large percentage of victims who receive defibrillation within the first four minutes survive with little or no brain injury. (12)

The defense might try to shift or share liability by scrutinizing and challenging the paramedics' treatment. If the evidence supports an argument that the victim's physical symptoms were consistent with a shockable rhythm only after or shortly before paramedics arrived, the defense will claim that something the paramedics did or didn't do--not the health club staff's failure to use defibrillation--led to the victim's injury or death.

Paramedic par·a·med·ic
n.
A person who is trained to give emergency medical treatment or assist medical professionals.


paramedic 
 response time varies, of course. For example, health clubs in rural areas far from a hospital or paramedic station, and those on the top floor of high-rise buildings--where elevator delays can he anticipated--have a stronger duty to foresee the need for an AED on their premises.

Paramedics will be among the most important witnesses in your case, assuming your medical experts conclude that they responded in a timely manner and acted appropriately. Talk to each paramedic early in your investigation. Assure them that they are not the target of your client's lawsuit, and tell them that you suspect the defense might point a finger at them. You may have to defend their actions in addition to prosecuting your client's claim. Obtain a recording of the 911 telephone call, which can add important information to your case.

Standards

As mentioned earlier, a health club will defend a claim that focuses on its failure to have air AED by asserting that it had no duty to have one. The defense in such cases has been that although using an AED might someday be the standard of care for the fitness club industry, that time has not yet arrived. Combat this argument by pointing out that there is compelling evidence that most reasonable health club operators should have equipped their clubs with AEDs by the late 1990s. If most health clubs do not have AEDs, then the industry as a whole is operating below the standard of care.

Since the early 1990s, several health organizations and fitness industry ,groups have issued standards and statements on the use of AEDs in health clubs.

American Heart Association (AHA). In 1992, the AHA published guidelines that stated, "All personnel whose jobs require that they perform basic CPR [should] be trained to operate and permitted to use defibrillators, particularly automated external defibrillators (AEDs)." (13)

American College of Sports Medicine '''Founded in 1954, the AMERICAN COLLEGE OF SPORTS MEDICINE is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national and regional members are dedicated to advancing and integrating scientific research to provide educational  (ACSM ACSM American College of Sports Medicine. ). Also in 1992, the highly respected ACSM published 353 standards, plus an additional 397 guidelines, for health facilities (it did not specifically mention AEDs). (14)

Many in the fitness industry objected to the large number of standards and guidelines, which they feared could be used as bases for liability claims. Responding to this criticism, the ACSM published a second edition in 1997, consolidating the standards into six that "must be demonstrated by all health/fitness facilities toward their users."" Standard 1 states, "A facility must be able to respond in a timely manner to any reasonably foreseeable emergency event that threatens the health and safety, of facility users. Toward this end, a facility, must have an appropriate emergency plan that can be executed by qualified personnel in a timely manner."

There is ample evidence that sudden cardiac arrest is a "reasonably foreseeable emergency event that threatens the health and safety of facility users." A health club whose emergency plan does not include AED use when a reasonable club administrator should have known of the availability, utility, and effectiveness of the device violates the standard. You can prove this in various ways; the strength of the case depends on the date the SCA occurred.

In March 2002, the AHA and the ACSM released recommendations regarding the purchase and use of AEDs in fitness facilities. These recommendations, published in Circulation and Medicine & Science in Sports Exercise, stated:
   Effective placement and use of AEDs at all
   health/fitness facilities ... is encouraged, as
   permitted by law, machinery the goal of minimizing
   the time between recognition of
   cardiac arrest and successful defibrillation.
   Until further definitive data are available,
   AED placement is strongly encouraged in
   those health/fitness facilities with a large
   number of members (i.e., membership
   greater than 2,500);... those that offer special
   programs to clinical populations (i.e.,
   programs for the elderly or those with medical
   conditions);... and those health/fitness
   facilities in which the time from the
   recognition of cardiac arrest until the first
   shock is delivered by the EMS is anticipated
   to be greater than five minutes. (16)


Most health clubs require their staff to be trained in CPR as part of compliance with the ACSM standards and guidelines. These clubs also fall under the AHA's 1992 guideline on who should be trained to operate and permitted to use AEDs.

YMCA YMCA
 in full Young Men's Christian Association

Nonsectarian, nonpolitical Christian lay movement that aims to develop high standards of Christian character among its members.
. In November 1997, the YMCA USA's Medical Advisory Committee published formal recommendations endorsing the AHA's guideline. The recommendations specified that "YMCA staff should be trained in the procedure and use of the AED." (17)

International Health, Racquet & Sports Club A sports club, athletics club or sports association is an eclectic institution oriented to multiple sports, which fields many teams and has varied sports departments in several sports, working under the same umbrella organization.  Association (IHRSA IHRSA International Health, Racquet and Sportsclub Association ). In October 2001, IHRSA--which represents nearly 6,000 health clubs and works toward the growth, protection, and promotion of the health club industry--announced an agreement with AED manufacturer Philips Medical Systems to promote AED placement, training, and use in more than 3,600 of its U.S. member clubs. The program offered discount pricing, site analysis, an AED response plan, medical direction, and on-site training programs with the American Red Cross American Red Cross: see Red Cross. .

Although IHRSA's official position is that the legal standard of care does not yet require health clubs to install AEDs, its executive director stated that the organization encourages health club operators to consider the advantages of installing them in their facilities. (18) AED manufacturers have advertised the devices to the health club industry at industry conventions since at least 1999. And a 2002 IHRSA convention included a program to educate and encourage member clubs to equip themselves with AEDs.

Many health club chains equipped their clubs with AEDs in the late 1990s, and this fact can bolster your case. They have said that initiating an AED program was neither difficult nor excessively costly and that training of staff was not troublesome. (19) They also reported that many lives have been saved with AEDs. (20)

Federal and state statutes

All 50 states have passed Good Samaritan laws Good Samaritan laws Forensic medicine Legislation tailored to each jurisdiction, for health care professionals and citizens who provide emergency medical care in 'good faith', and act to help a person needing medical attention. See Herd mentality. , which extend to AED users. Similarly, the Federal Cardiac Arrest Survival Act of 2000 states that
   any person who uses or attempts to use an
   automated external defibrillator device on
   a victim of a perceived medical emergency
   is immune from civil liability for any harm
   resulting from the use or attempted use of
   such device; and in addition, any person
   who acquired the device is immune from
   such liability.... (21)


The act also required the U.S. Secretary of Health and Human Services Noun 1. Secretary of Health and Human Services - the person who holds the secretaryship of the Department of Health and Human Services; "the first Secretary of Health and Human Services was Patricia Roberts Harris who was appointed by Carter"  (HHS HHS Department of Health and Human Services. ) to establish guidelines for placing AEDs in federal buildings.

The same year, Congress made these findings when it passed the Rural Access to Emergency Devices Act:
   Because most cardiac arrest victims are initially
   in ventricular fibrillation, and the
   only treatment for ventricular fibrillation
   is defibrillation, prompt access to defibrillation
   to return the heart to normal rhythm
   is essential.

   Lifesaving technology, the automated
   external defibrillator, has been developed
   to allow trained lay-rescuers to respond to
   cardiac arrest by using this simple device to
   shock the heart into normal rhythm....

   Legislation should be enacted to encourage
   greater public access to automated
   external defibrillators in communities
   across the United States. (22)


These factual findings constitute public statutory law, and the Rules of Evidence require a court to take judicial notice of them. This requirement can be an important evidentiary ev·i·den·tia·ry  
adj. Law
1. Of evidence; evidential.

2. For the presentation or determination of evidence: an evidentiary hearing.

Adj. 1.
 tool, given Congress's expressed intent to encourage greater public access to AEDs.

In 2002, Congress enacted 42 U.S.C. [section] 244, entitled Public Access Defibrillation Programs, which allows HHS to award grants to various government entities. (23) With it, Congress adopted a public policy to encourage private companies, including small businesses, to buy AEDs and train employees to use them. A later section of the statute authorizes using the grants to produce written material encouraging private companies to purchase AEDs.

Most states also have passed statutes to encourage the use of AEDs and protect the users from civil liability. For instance, Florida has a Good Samaritan Good Samaritan

man who helped half-dead victim of thieves after a priest and a Levite had “passed by.” [N.T.: Luke 10:33]

See : Helpfulness


Good Samaritan
 act pertaining per·tain  
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.

2.
 to emergency care generally, (24) as well as two statutes that specifically address AEDs. (25)

The various state and federal laws provide further evidence to support the argument that health clubs have a duty to possess AEDs. These laws make it difficult for health clubs to argue that AEDs are not yet recognized as necessary safety devices or that there are legal obstacles to having and using them.

Experts

Use expert witnesses to prove that a duty to possess AEDs existed when the victim was injured or died.

Exercise physiologist. An exercise physiologist who holds a Ph.D. will help establish that the industry is aware of the increased risk of SCA after vigorous exercise. He or she should he familiar with the ACSM standards and the statements issued by the ACSM and the AHA. The expert might also be helpful with facts specific to your case, such as discovery of the victim, training of health club staff, the club's compliance with its own policies and procedures Policies and Procedures are a set of documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. They are often initiated because of some external requirement, such as environmental compliance or other governmental , and industry standard-of-care evidence.

Cardiologist familiar with the AHA's encouragement of public access to AEDs. This expert will establish causation by determining the probable timing of the medical events, based on medical records and eyewitness An individual who was present during an event and is called by a party in a lawsuit to testify as to what he or she observed.

The state and Federal Rules of Evidence, which govern the admissibility of evidence in civil actions and criminal proceedings, impose requirements
 accounts. The timing will affect medical opinions regarding when the victim experienced a shockable rhythm, as well as when, within reasonable medical probability, AED intervention would have saved him or her from brain damage or death.

Health club operator whose facilities had AEDs before the victim's sudden cardiac arrest. This person's testimony should establish that a reasonable health club operator had a legal duty to have an AED at the time of the victim's injury or death. With practical, commonsense testimony as to how, why, and when the expert's facilities decided to purchase and deploy AEDs, the expert should be able to refute the defense that having AEDs is not yet a health club standard of care. The operator should also testify to the ease of obtaining AEDs and training staff to use them. This will dispel defense suggestions that AEDs were unavailable, too expensive, or too difficult to use at the time.

As when the auto industry was reluctant to install seat belts in automobiles and the tobacco industry was resistant to warning smokers, apparently it will take more lawsuits before the health club industry admits its responsibility to patrons and adopts AEDs. Trial lawyers must step forward and litigate these cases. Successful litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute.

When a person begins a civil lawsuit, the person enters into a process called litigation.
 will not only compensate gym patrons injured due to health club negligence (or the families of those who die), but also serve a greater public good, saving countless lives.

Notes

(1.) William Ginsberg William Ginsberg (1930-2006) was an attorney, environmentalist, author and professor of environmental law. Ginsberg served as commissioner of parks and recreation in New York City, to which post he was appointed by Mayor John Lindsay in 1968. , Prepare to Be Shocked: The Evolving Standard of Care in Treating Sudden Cardiac Arrest, 16 AM. J. EMERGENCY MED. 315 (1998).

(2.) Rosarie Lynch et al., Cardiopulmonary Resuscitation, 271 PHARM PHARM Pharmacy . J. 581, 581 (2003), available at www.pharmj.com/pdf/cpd/pj_20031025_ heart9.pdf (last visited Apr. 27, 2004).

(3.) John W. Gundry et al., Comparison of Naive Sixth Grade Children with Trained Professionals in the Use of an Automated External Defibrillator; 100 CIRCULATION 1703 (1999).

(4.) Lisa Schnirring, Fitness Clubs Urged to Do Cardiac Screening, PHYSICIAN & SPORTSMEDICINE, Aug. 1998, at 3.

(5.) Richard F. Gillum, Sudden Coronary Death in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , 79 CIRCULATION 756 (1989).

(6.) James Rippe & Howard Pomerantz, Saving Lives in the Fitness World, IHRSA 21ST ANNUAL INTERNATIONAL CONVENTION (Mar. 8, 2002).

(7.) Pamela J. Stoike, Automated External Defibrillators, ACSM'S HEALTH & FITNESS J., July/Aug. 2001, at 22.

(8.) Anthony A. Abbott, Are You Prepared? Handling Emergency Situation, s, PERSONAL FITNESS PROF., Nov. 2000, at 38.

(9.) Id.

(10.) Chai v. Sports & Fitness Clubs of Am., No. 98-16053 CA (05) (Fla., Broward County Cir. Ct. Aug. 2000).

(11.) See, e.g., Fruh v. Wellbridge Club Mgmt., Inc., No. 02-CV-10689 (D. Mass filed Apr. 11, 2002); DeLibero v. Q Clubs, Inc., No. 02-018309 CACE CACE Center for Adult and Continuing Education
CACE Center for the Analysis of Commercialism in Education (now Commercialism in Education Research Unit)
CACE Canadian Association for Community Education
 21 (Fla., Broward Count, Cir. Ct. filed Sept. 20, 2002).

(12.) CPR: RESUSCITATION resuscitation /re·sus·ci·ta·tion/ (-sus?i-ta´shun) restoration to life of one apparently dead.

cardiopulmonary resuscitation
 OF THE ARRESTED HEART 53-55 (Max Harry Weil et al. eds., 1999).

(13.) Emergency Cardiac Care Comm. & Subcomms., Am. Heart Ass'n, Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care Part III: Adult Advanced Cardiac Life Support Advanced Cardiac Life Support See ACLS. , 268 JAMA JAMA
abbr.
Journal of the American Medical Association
 2199 (1992).

(14.) AM. COLL. SPORTS MED., ACSM'S HEALTH/FITNESS FACILITY STANDARDS AND GUIDELINES (Neil Sol & Carl Foster eds., 1992).

(15.) AM. COLL. SPORTS MED., ACSM'S HEALTH/FITNESS FACILITY STANDARDS AND GUIDELINES ix (James A. Peterson & Stephen J. Tharrett eds., 2d ed. 1997).

(16.) Gary J. Balady et al., Automated External Defibrillators in Health Fitness Facilities, 105 CIRCULATION 1147, 1148-49 (2002).

(17.) YMCA OF THE USA MED. ADVISORY COMM., THE USE OF AUTOMATED EXTERNAL DEFIBRILLATORS IN YMCAS (1997).

(18.) INT'L HEALTH, RACQUET & SPORTS-CLUB ASS'N, BRIEFING PAPER: DEFIBRILLATORS (AEDS) IN HEALTH CLUBS (2002).

(19.) Deposition of Art Curtis, Past Chief Operating Officer Chief Operating Officer (COO)

The officer of a firm responsible for day-to-day management, usually the president or an executive vice-president.
, Wellbridge Cos., in Fruh, No. 02-CV-10689 (Dec. 16, 2002).

(20.) Id.

(21.) 42 U.S.C. [section] 238Q (2000).

(22.) 42 U.S.C. [section] 411 (2000).

(23.) 42 U.S.C.A. [section] 244 (2004).

(24.) FLA. STAT. ch. 768.13 (2004).

(25.) FLA STAT. ch. 401.2915 (2004); FLA. STAT. ch. 768.1325 (2004).

HOWARD L. POMERANTZ is a partner with Abramowitz & Pomerantz in Sunrise, Florida Sunrise is a city in Broward County, Florida, United States. Originally called "Sunrise Golf Village,"City of Sunrise History the name did not sit well with the retirees whom developers wanted to attract, so a change was made to "Sunrise. .
COPYRIGHT 2004 American Association for Justice
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:cardiopulmonary resuscitation
Author:Pomerantz, Howard I.
Publication:Trial
Date:Jun 1, 2004
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