Q.

We have received a donated (new) AED (automatic external defibrillator). We have certified Red Cross trainers that currently train in house staff inCPR. Prior to installation of the device, all clinical staff that are CPR trained will receive additional training on the AED, and then annually as part of our CPR recertification.

Some senior managers are concerned that placement of the device will raise our liability and invite litigation. Others believe that not having the device available on inpatient and residential facilities is sub-standard care. Also, we have two physical locations and only one device. If we place it at one location, are we setting a standard that will require purchase and placement at the other location?

A.

A standard of care is not established by what is actually done. The standard of care requires that a health care professional exercise that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar healthcare providers. The standard may or may not be met by a particular practice. A particular practice may be a factor in establishing the standard of care.  

Therefore, simply because a defibrillator is used does not establish its use as the standard of care and does not necessarily require that a defibrillator be used in the other location. Your inquiry should be whether a reasonably prudent similar healthcare provider would install a defibrillator in the other location.  

It is prudent risk management practice to obtain outside consultation from an expert in the field. You could ask an outside expert in emergency care and in-house experts their opinions on whether a defibrillator should be installed in the other location.  

Among the factors you could consider are the following: the distance between the two center locations, differences in characteristics of the patients served, the likelihood that a defibrillator will be needed, the distance to the nearest medical facility which provides appropriate cardiac care, ambulance response times, whether staff competent to operate the defibrillator will be available, whether staff will have sufficient time to practice use of the defibrillator and your ability to provide ongoing defibrillator training.  

There is an increased risk of liability only when you violate the standard of care. The standard of care for use of the defibrillator would require that you use it in a way that is acceptable and appropriate by reasonably prudent similar healthcare providers. Thus, you could be expected to place a defibrillator where appropriate, to provide appropriate training for your staff and to monitor your staff to be sure that they are following guidelines taught in training.