In a slightly convoluted series of events, I wore the all-caps, red “MEDICAL TEAM” credentials at the annual New York City Marathon this past weekend. Full disclosure: I am not a doctor. Nor a paramedic. While I do have my Red Cross First Aid certification (though what I remember from that weekend bonanza is mostly obscured by my tripping over a mannequin on day 2, which left me with a fractured ankle) , and I was a lifeguard in my high school days, my CPR is definitely rusty.
Before you unmask me a-la Wizard of Oz, let it stand on the record that my capacity on the MEDICAL TEAM was clearly delineated as “Foreign Language Translator/Interpreter”. While I did my fair share of running blood samples and iSTATs, my duty was to translate cramps, nausea, dizziness and thirst from French/Spanish/Italian (and even, for one hot-second before a native speaker interpreter arrived on the scene, Chinese) for the New York doctors.
However, despite my mostly side-line position to the IVs and latex gloves of the gigantic white medical tent, turns out I can save a life. And so can you.
Few weeks ago, I went to the scheduled MEDICAL TEAM training, thinking I would be ushered to a room where us interpreters would be prepped on walkie-talkie radio etiquette and covert cross-language medical code lingo. Instead, they herded all medical volunteers -young, tall, experienced, new and small- into a cramped auditorium and ran us through a crash course in marathon medicine. This translates to: lots of pictures of blistered feet; chanting, “If you STOP, you DROP”; and the advantages of carrying salt packages in any and all of your pockets.
And then, they pulled out the AED (automatic external defibrillator) machine.
We’ve probably all seen one; that unassuming orange (or red, yellow, or black?) box littered around airports, universities, shopping centres, and office buildings. Your friendly neighbourhood one-stop-solution to cardiac arrest. They’re an ‘older’ technology, dating back to the 1980s; ubiquitous today and largely integrated into society.
So why am I bringing up the AED?
Because the AED is an empowering technology. It gives the layperson the power to save a life. A skill which was previously beyond someone without access to (or time for) medical training can now be performed by all. Consider it crowd-sourcing of medical assistance. However, as we know, spastic reactions abound when new technology offers to take out the human technician; we start crying out about the singularity and a Skynet robot-apocalypse. If the AED can provide rapid response to victims of cardiac arrest, do we even need doctors?
We can think of an AED as a medical robotic device. Consider this: you’re in waiting area C4, wondering if you’ve accidentally seated yourself near the event horizon of a black hole because time has definitely slowed down. Then, right in front of you, Bruce Willis collapses in cardiac arrest. You jump up, grab the shiny AED next to you and fall to your knees next to his prostrate body. Hurdle #1: you’ve never used an AED (or even seen one up close) before. No worries! You press the big green button and the AED springs into action for you. It tells you in a suave automated voice to take the defibrillator pads and place them on Bruce Willis’s chest. This done, the AED springs into action: it automatically diagnoses the heart rhythm and determines if a shock is needed. He does, so the AED goes ahead and administers the shock, without even requiring your command. And ta-daaaa, Bruce Willis is back on his feet, ready to die hard some other day.
The AED made the decisions necessary to saving Bruce. It diagnosed and administered the shock on its own. Some AEDs, the semi-automatic models, will tell the user that a shock is needed but actually require the user to tell the machine to actually administer it. The automatic ones fly solo. The decision-making step on whether to administer the shock or not has been fully delegated from humans to machines.
Two issues jump out: one, who is liable if the AED fails, and two, what regulation is in place for these medical robotic devices?
Let’s concentrate on the US. AEDs are covered by Good Samaritan laws, which give immunity to individuals -acting outside the medical profession- from any harm or death of a victim that may result from having provided improper or inadequate care. The aim of Good Samaritan laws is to encourage laypersons to use AEDs in public settings by reducing liability risks. When the legal community grappled with the advent of the modern AEDs in the mid-1990s, the move was made for legislatures throughout the US to enact AED public policy with the aim of reducing liability risks facing organizations and individuals deploying, placing and using AEDs. Two general flavours of laws exist with respect to AEDS: highly controlled regulation and a more open-access, any-willing-user regulation.
Over the last two decades, it is the open-access laws that protect any-willing-rescuer which have withstood the test of time. While looking up these laws, I came across a study conducted by Readiness Systems (developer of the National AED Program Design Guidelines) that graded state AED laws based on four criteria. One, laws should qualify both untrained and trained AED users for immunity protection. Second, for the immunity laws to meaningful, they should protect misconduct that rises at least to the level of ordinary negligence; protection all but “acts of gross negligence or wilful or wanton misconduct”. Third, AED laws should cover not only actions associated with the use of an AED, but also activities which take place within an AED program long before the AED is ever even called into action. This includes stipulations as to maintaining equipment, training and developing policies in areas which house AEDs. Following this vein, the fourth criteria favours states which include operational requirements on AED programs.
These last two criteria are particularly interesting. Regulation which encourages an updated training program for medical technology will allow the law to develop alongside the technology, in actual time. Instead of having to go back to drawing board every time TechKid#5 has a bright new idea for a flashier new AED, these laws foresee the inclusion of these developments in training programs and within basic operational requirements for those training programs. Just as the AED crowd-sourced a crucial life-saving skill, these laws crowd-source the details to an environment more capable of adapting to new changes while still protecting the people using the machines.
Let’s go back up a level.
The advantages of the AED are precisely the advantages of medical robotic devices: they give actual doctors time to concentrate of more complex situations and problems that we as laypeople do not have the education and experience to handle or help with. More broadly, medical technology allows us to package skills in such a way that they can be used in remote areas of the world that may have a shortage of medical professionals. They reduce inequalities and help us towards a global goal of accessible and adequate healthcare (if you allow me to show my UN-blue for a moment).
We can use the ubiquitous AED as a model for the adoption of newly-minted and in-development medical technology. Yes, the FDA is currently considering (having issued a final order this past February) reclassifying AEDs as class III premarket approval devices (meaning that the filing of premarket approval applications would be required to put an AED on the market). [see: https://www.federalregister.gov/articles/2015/02/03/2015-02049/effective-date-of-requirement-for-premarket-approval-for-automated-external-defibrillator-systems] But the key is that AEDs are out there, easily accessible and the legal system surrounding them is an enabling one.
I didn’t have to whip out the AED at any point during my day at the Central Park med tent. Vomit bags, salt packages, soup, hot chocolate and lots of space blankets kept the discharge of our runners steady. Plus, interpreters were in high demand. The New York marathon really is an international affair. Nevertheless, I kept my eye on the Défibrillateur Automatisé Externe (DAE), ready to push that green button if called upon.
…and if you can’t find an AED, here is a crash two-minute course on hands-on only CPR:
Now go save some lives.