The Council has received many enquiries from organisations about the obligation to provide a defibrillator at a facility, (e.g., a shopping centre, gym, or leisure centre) in order to treat a member of the public who might sustain a cardiac arrest while present on the premises. A prerequisite of providing such equipment is the necessity to have trained staff available who would be able to use the device.

Some enquiries have been for information about the potential legal liability of failing to provide an automated defibrillator (AED). These have sometimes been stimulated by the well-publicised cases in the USA of airlines successfully sued for not carrying such equipment. There is well-documented, published, evidence about the relative frequency of cardiac arrest during aircraft flights and the effectiveness of defibrillators used by the cabin crew in this situation.

At present there is no statutory legal requirement under English and Welsh law to provide a defibrillator, but liability may arise under common law for failure to take adequate safeguards to protect the public present at a facility. The risk of a member of the public sustaining a cardiac arrest at any given facility can reasonably be balanced against the cost of purchase, installation, and maintenance of AEDs, and of initial and ongoing training of staff to use the devices.

Important factors to consider when assessing the risk of cardiac arrest will include the number of people using a facility and the risk of cardiac arrest occurring at the site. Current international resuscitation guidelines advise that evidence supports the establishment of public access defibrillation programmes (with the installation of an AED) when:

• The frequency of cardiac arrest is such that there is a reasonable probability of the use of an AED at least once in two years.
   
  
• The time from call out of the conventional ambulance service to delivery of a shock cannot reliably be achieved within 5 minutes (For practical purposes, this means almost the entire UK).
   
  
• The time from collapse of a victim until the on-site AED can be brought is less than 5 minutes.

Current experience, that includes data from the UK, suggests that in certain public places there is a higher risk of cardiac arrest than in others. Transport facilities, particularly airports and railway stations, gyms, leisure centres, and other venues where exercise is undertaken are high-risk sites. Those attending cardiac rehabilitation programmes are a particularly high-risk group.

The responsibility for deciding whether to provide a defibrillator and train staff in its use lies with an individual organisation. A decision should be made after conducting a well-documented risk assessment at the site in question, having taken the above factors into account. If a decision is made to provide defibrillators for use by trained lay staff, responsibility must also be taken for adequate initial training and on-going refresher training.

It is advised by authoritative bodies on resuscitation throughout the world that a system of medical advice is established to oversee all systems where defibrillators are provided for use by the lay public. This may be provided by the medical adviser to the individual organisation or facility. Further advice about this is available in the section on AEDs in Guidelines 2005. Additional information may be found in the Resuscitation Council (UK)'s booklet entitled "The Legal Status of those who Attempt Resuscitation".  

Revised March 2006
 
 
References:

1. 2005 International Consensus on Cardiopulmonary Resuscitation with Treatment Recommendations. Resuscitation 2005:67;157-341
    
2. Resuscitation Guidelines 2005. Resuscitation Council (UK)
    
3. The Event Safety Guide: A guide to health, safety and welfare at music and similar events. HSE Books, 2005.

	© Resuscitation Council (UK)  2006   This page last updated: 20 March 2006