This question comes from a paramedic student (hopefully this isn’t an assignment question). This student says:

I have been doing some research into automated external defibrillators (AED) and why despite over 30,000 sudden cardiac arrests occurring in Australia every year, legislation does not require our large public businesses (shopping centres, libraries, etc) to have an available AED. I was referred to you by my Law and Ethics lecturer as an expert in Emergency Law.

I was hoping you may be able to point me in the right direction as far as the current national legislation relevant to AED’s and any other legislation, etc that may prove helpful in my review of current standards.

A search of current legislation (Acts and Regulations) for the word ‘defibrillator’ shows that there is very little relevant legislation. ‘Defibrillator’ appears in the following current Acts and Regulations;

  • Health Insurance (General Medical Services Table) Regulation 2015 (Cth) – Schedule 1 General medical services table – providing for a payment for medical practitioners conducting an ECG ‘on premises equipped with mechanical respirator and defibrillator’;
  • Non Emergency Patient Transport Regulation 2005 (Vic) providing that a vehicle used for transporting ‘medium and high acuity’ patients is to be equipped with a defibrillator (Schedule 9 and reg 51) and that staff are trained in how to use it (reg 24);
  • Aviation Transport Security Regulations 2005 (Cth) reg 1.09 which exempts a defibrillator from the definition of a ‘weapon …capable of being used to administer an electric shock’;
  • Cremation Regulations 1954 (WA) Appendix A, form 7 – where a medical practitioner is required to answer the question ‘At the time of death was the deceased fitted with a cardiac pacemaker, defibrillator or other battery operated implant or device?’; and
  • Workers’ Compensation and Injury Management (Scales of Fees) Regulations 1998 (WA) – Schedule 1 which provides for payment for ‘Anaesthesia for… insertion of automatic defibrillator …’

Relevant legislation with respect to standards will be standard consumer and product legislation such as the Competition and Consumer Act 2010 (Cth) requiring that products are fit for purpose and properly designed and manufactured.

Other relevant legislation would be the relevant work health and safety laws. For example, the Work Health and Safety Regulation 2011 (NSW) requires an employer to ensure that there is provision for first aid at the workplace. As with other aspects of this Act, this requires a risk assessment. Some workplaces such as shopping centres may well consider that there is a sufficient risk to warrant putting in a defibrillator.

So why isn’t it compulsory for large public businesses (shopping centres, libraries, etc) to have an available AED? I’m speculating here but I can think of a number of issues.

First I’m told that there are 30 000 sudden cardiac arrests a year in Australia. That would equate to about 82 per day.  The chance that on any given day there will be a sudden cardiac arrest we can assume is 1. But the chance that it will happen in any given location, shopping centre or library is very small.   To give a personal anecdote, I’ve been trained in first aid since I was 13 years old. I have never had to do CPR simply because I was the right person at the right spot at the right time.  Putting an AED in a spot, even a high traffic spot like a train station or shopping centre does not mean it will ever be in the right spot.

Even if the AED is close to a person with a cardiac arrest it does not mean it will be used.   Someone would have to know that the AED is there, or likely to be there.   An untrained person may not know what an AED is let alone to look for one.  Even if they can see it they are unlikely to know what it is or that it is something that could be used without training.  The chance that there is an AED and a trained person at the right place at the right time is even lower.

Having an AED does cost. Not only the purchase price but maintenance and training staff.   Requiring premises to have an AED adds compliance costs, ie some process to ensure that the rules are being complied with.

None of this is to suggest that they are not a good idea, but one can see why businesses may not be willing to invest and more importantly, why governments may not want to compel business to invest in the equipment that imposes a cost with limited chance that it will be used.

The next issue is that this would require extensive cooperation within government. The Department of Health does not regulate shopping centres and whatever government department is regulating those places is not necessarily aware of the issue.

Regulating to impose an obligation upon private citizens and businesses to invest in equipment that may not ever be used may not be politically prudent and could well fail to meet the standards set by the Office of Best Practice Regulation. Although that office is about Commonwealth law, states are also required to consider the impact of regulations and whether the costs warrant the benefits.

It is likely that making the installation of an AED compulsory would impose significant costs to achieve limited benefit, would be politically unpopular and would be inconsistent with current trends to reduce red tape and compliance costs; but as I say this is mere speculation.