Health Clubs Need Defibrillators for Seniors

A scientific statement urging fitness clubs to install automated external defibrillators (AEDs) and train staff to use them was released by the American Heart Association and the American College of Sports Medicine.

“Many more Americans are now exercising at health and fitness clubs, including more senior citizens and people with undiagnosed heart disease who may be at higher risk for cardiac arrest," says Gary Balady, M.D., who chaired the writing group.

The joint position statement, “Automated External Defibrillators in Health/Fitness Facilities,” advises larger facilities and those with special seniors programs to be equipped with the devices and to provide training. The statement appeared in the March 4, 2002, issue of Circulation: Journal of the American Heart Association.

An AED is about the size of a large textbook and is used to analyze the heart’s rhythm and tell a bystander responding to an emergency whether to deliver an electrical shock to a victim of sudden cardiac arrest. This shock can lead to defibrillation that allows the heart to resume normal rhythm. "The first few minutes after cardiac arrest are critical to survival,” says Balady.

“The good news is that if people are fit and they keep exercising, they decrease their risk of suffering a cardiovascular event. The bad news is that we have many people visiting fitness centers with undiagnosed coronary heart disease. Overall the risk is low, but it’s important that health and fitness centers are prepared in case of an emergency. In the chain of survival, every minute counts,” says Balady, professor of medicine at Boston University School of Medicine and director of preventive cardiology at Boston Medical Center.

The chain of survival includes four steps: 1) early access to care/calling 9-1-1; 2) early cardiopulmonary resuscitation (CPR); 3) early defibrillation and 4) early advanced care.

All known heart diseases can lead to cardiac arrest. Most cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become extremely rapid or chaotic or both. This irregular heart rhythm causes the heart to suddenly stop beating.

The joint statement is a supplement to recommendations issued in 1998, in which fitness facilities were advised to screen clients for cardiovascular disease, train staff members to recognize and respond to cardiac arrest, have in place written emergency response policies and procedures for cardiac emergencies, conduct regular cardiac drills, and ensure that trainers and exercise team leaders know CPR.

The number of Americans who exercise regularly at fitness clubs has increased steadily in recent years, as has their age. As many as 30 million people now visit health and exercise centers and about 55 percent of these people are over age 35, according to one survey. It is reasonable to assume that the number of members with cardiovascular disease is rising as well.

The number of fatal events at health clubs is unknown. However, in one large database of more than 2.9 million members of large commercial health club chains, 71 deaths were reported during a two-year period.

In another survey of 65 randomly chosen facilities in Ohio, 17 percent reported having a club member who had a sudden cardiac death or heart attack during a five-year period. Only 3 percent of these clubs had AEDs at the time of the emergency.

The new joint position statement encourages AEDs in facilities with membership of 2,500 or more, those with special programs for the elderly or for people with medical conditions, and those where the local emergency medical services response is likely to be five or more minutes. The statement also advises that AEDs should be part of a public access to defibrillation (PAD) plan at any host facility with unsupervised exercise rooms, such as those at many hotels, apartment complexes and office buildings.

All health and fitness centers are also encouraged to implement PAD plans, including written emergency policies that are reviewed at least every three months. Programs should be coordinated with area emergency medical services, most of which also can help plan programs and train staff.

Most portable AEDs cost $3,000 to $4,500. The price is expected to decrease as their use becomes more widespread. Provisions in the Cardiac Arrest Survival Act and the Rural Access to Emergency Devices Act, both of which became law in 2000, and the Community Access to Emergency Defibrillation Act, which is now before Congress, are expected to increase access to the lifesaving devices in public places.

In addition, Good Samaritan laws in all 50 states now provide legal protections to citizens who respond to medical emergencies. “With the recent approval of the use of AEDs by trained first responders and adoption of Good Samaritan laws, it is time to get these lifesaving devices in all fitness facilities,” he says.

At the very least, unsupervised exercise rooms should have a telephone for emergencies, according to the recommendations.

Following ventricular fibrillation cardiac arrest, survival rates drop about 7 percent to 10 percent for every minute that defibrillation is not delivered, and a person has only a 2 percent to 5 percent chance of survival if defibrillated beyond 12 minutes. Survival rates as high as 90 percent have been reported where defibrillation is achieved within the first minute after cardiac arrest.

The statement was also published in the American College of Sports Medicine Journal: Medicine and Science in Sports and Exercise.