A SHOCKING PRESCRIPTION: State law provides protection for physicians who write prescriptions for public-access defibrillators

by Arlo Weltge, M.D., M.P.H., F.A.A.F.P.

CPR, cardiopulmonary resuscitation, alone is no longer good enough. For two decades, the American Heart Association has been promoting the concept of the community as the ultimate coronary care unit. This effort has included educating the public about cardiovascular risk factors, early warning signs of a heart attack and CPR skills. By the late 1970s, it was demonstrated that trained paramedics could successfully resuscitate cardiac arrest victims “in the field,” before getting them in a hospital.

However, cardiovascular disease is still the most common cause of death in adults and sudden cardiac death, particularly ventricular fibrillation, the common cause. Following the dictum of “early delivery of definite care,” the treatment for ventricular fibrillation is electrical defibrillation.

It is no longer good enough to just start CPR. The arrest victim needs early defibrillation and trained non-medical individuals using automatic external defibrillators can provide this. This technology and current research support the fact that this can effectively be provided to a large number of individuals by public access defibrillator programs.

In Texas, efforts are underway to provide automatic external defibrillators to locations such as airports, churches and other areas where people gather in large numbers. Public institutions, businesses and other organizations are making the effort to provide this lifesaving resource. Local success stories are accumulating.

However, the Texas affiliate of the AHA is receiving calls that one of the roadblocks for public access defibrillators is a lack of physician willingness to write the initial prescription for an automatic external defibrillator.

House Bill 580 (Texas Department of Health, Bureau of Emergency Management, Section 157.41), adopted by the Legislature in 1999, provides liability protection for physicians writing the prescriptions for automatic external defibrillators. The bill does require individuals or entities acquiring an automatic external defibrillator to provide training on the use of the device, to notify local emergency medical services responders of the location and type of automatic external defibrillator in place, and to promptly notify the local EMS when an automatic external defibrillator is used for a cardiac arrest.

In addition to providing physician liability protection, there is specific liability protection for the individual or entity that acquires an automatic external defibrillator, that provides training on using an automatic external defibrillator and for individuals who in good faith use an automatic external defibrillator outside of a hospital or other health care facility. Educational programs for automatic external defibrillator training are available through AHA.

If asked, you should consider working with you local organizations to provide public access defibrillators to your community. Further, you should inquire as to whether your local school, church or office building has ready access to an automatic external defibrillator or provides public access defibrillation. n

Arlo Weltge M.D., M.P.H., is a Fellow of the American Academy of Family Physicians and an Associate Professor at the University of Texas Houston. He is currently serving as National Faculty for Texas for Advanced Cardiac Life Support and serves as a member of the AHA, Texas Affiliate, Emergency Cardiac Care Committee.

Further information and a copy of HB 580, may be obtained by calling the AHA Texas Affiliate ECC office at (512) 433-7220 or fax (512) 433-7210 or by visiting the Web site www.americanheart.org. Click on the link “About AUTOMATIC EXTERNAL DEFIBRILLATOR.” A “Physician Oversight Package” is also available as a PDF file from that location.

The American Academy of Family Physicians’ policies support access to emergency medical care and Emergency Medical Services for all people in the community. Policies may be accessed on the AAFP Web site at www.aafp.org.