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Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. email
Zoraida Pagett to Elizabeth Drye re: SSN and DOB (partial) (1 page)
05/27/1997
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Devorah Adler
OA/Box Number: 20465
FOLDER TITLE:
Portable Defibrillators
2012-0463-S
rc814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
MEMORANDUM
have
TO:
Tom Freedman, Mary Smith
GN
FROM:
David Hochschild
DATE:
July 8, 1998
RE:
AED's
Who's buying AED's (besides the airlines):
Chicago City Council has proposed an ordinance that would require most city-owned
buildings and high-occupancy areas such as office skyscrapers, apartment buildings and
sports stadiums to purchase AED's.
AED's are becoming much more common in police and fire departments across the
country. The results, however, have not necessarily matched the publicity. In Cincinatti,
32 police cruisers have carried AED's for a year but they have only been used twice and
the patient died in both cases.
Boston, in addition to equipping police and fire personnel with AED's, has installed the
device in two of the biggest highrise buildings downtown (the John Hancock Tower and
the Federal Reserve Bank Building). They have trained the buildings security guards how
to use the equipment. At 24%, Boston's cardiac arrest survival rate is now second only to
Seattle's (at 34%).
Lifeguards, beginning with those in some counties in Florida, are now equipped with
AED's.
Ohio, Illinois and West Virginia are all beginning to use AED's in schools.
Bill Summary & Status
http://thomas.loc.gov/cgi-bin/bdqu.:HR04121:@@@L/bs/dl05query.html
Bill Summary & Status for the 105th Congress
NEW SEARCH I HOME I HELP
H.R.4121
SPONSOR: Rep Stearns (introduced 06/23/98)
RELATED BILLS: S.2196
Jump to: Titles, Status, Committees, Amendments, Cosponsors, Summary
TITLE(S):
SHORT TITLE(S) AS INTRODUCED:
Cardiac Arrest Survival Act
OFFICIAL TITLE AS INTRODUCED:
A bill to amend the Public Health Service Act to provide for the establishment at the National
Heart, Lung, and Blood Institute of a program regarding lifesaving interventions for individuals
who experience cardiac arrest, and for other purposes.
STATUS: Floor Actions
***NONE***
STATUS: Detailed Legislative Status
House Actions
Jun 23, 98:
Referred to the House Committee on Commerce.
Jul 2, 98:
Referred to the Subcommittee on Health and Environment.
STATUS: Congressional Record Page References
***NONE***
COMMITTEE(S):
COMMITTEE(S) OF REFERRAL:
House Commerce
SUBCOMMITTEE(S):
Hsc Health and the Environment
AMENDMENT(S):
***NONE***
54 COSPONSORS:
1 of 3
11/15/98 5:46 PM
Bill Summary & Status
http://thomas.loc.gov/cgi-bin/bdqu.:HR04121:@@@L/bss/d10Squery.html
Rep Gekas - 06/23/98
Rep Serrano - 06/23/98
Rep Waxman - 06/23/98
Rep Frost - 06/23/98
Rep Mink - 06/23/98
Rep Filner - 06/23/98
Rep Hilliard - 06/23/98
Rep McCollum - 06/23/98
Rep Kennelly - 06/23/98
Rep Clement - 06/23/98
Rep Shays - 06/23/98
Rep Faleomavaega - 06/23/98
Rep Hastings, Alcee - 06/23/98
Rep Carson - 06/23/98
Rep Wolf - 06/23/98
Rep Walsh - 06/23/98
Rep Boehlert - 06/23/98
Rep Smith, Linda - 06/23/98
Rep Cook - 06/23/98
Rep Delahunt - 06/23/98
Rep Foley - 06/25/98
Rep Canady - 06/25/98
Rep Meehan - 06/25/98
Rep Bono, Mary - 07/14/98
Rep Slaughter - 07/14/98
Rep Mollohan - 07/14/98
Rep Davis, T. - 07/14/98
Rep Clayton - 07/14/98
Rep Pascrell - 07/14/98
Rep Hoyer - 07/14/98
Rep Eshoo - 07/15/98
Rep Green - 07/16/98
Rep Martinez - 07/20/98
Rep Lofgren - 07/24/98
Rep English - 07/24/98
Rep Thurman - 07/24/98
Rep Greenwood - 07/24/98
Rep Sanchez - 07/24/98
Rep Capps, Lois - 07/30/98
Rep Kind - 07/30/98
Rep Kelly - 07/30/98
Rep Matsui - 07/30/98
Rep Torres - 08/06/98
Rep McHugh - 08/06/98
Rep Murtha - 09/09/98
Rep Rahall - 09/09/98
Rep Price - 09/17/98
Rep LaHood - 09/17/98
Rep Hinchey - 09/23/98
Rep Woolsey - 09/23/98
Rep Kaptur - 09/25/98
Rep DeLauro - 09/25/98
Rep Mascara - 09/25/98
Rep Talent - 10/01/98
SUMMARY:
(AS INTRODUCED)
Cardiac Arrest Survival Act - Amends the Public Health Service Act with respect to emergency medical
services (EMS). Requires programs for emergency medical services and preventive, diagnostic,
therapeutic, and rehabilitative approaches to include: (1) development and dissemination of a core
content for a model State training program applicable to cardiac arrest for inclusion in EMS educational
curricula and training programs that address lifesaving interventions, including cardiopulmonary
resuscitation and defibrillation; (2) a limited demonstration project to provide training in such core
content; (3) identification of cardiac arrest care providers; (4) identification of equipment and supplies
that should be accessible to such providers to permit lifesaving interventions; (5) development of model
State and Federal legislation; and (6) coordination of a national database for reporting and collecting
information on the incidence of cardiac arrest and related issues.
Prescribes guidelines for the core content of the model State training program.
Declares that the purpose of the model legislation is to ensure: (1) access to EMS through consideration
2 of 3
11/15/98 5:46 PM
Bill Summary & Status
http://thomas.loc.gov/cgi-bin/bdqu.:HR04121:@@@L/bss/d105query.hml
of a requirement for public placement of lifesaving equipment; and (2) good samaritan immunity for
cardiac arrest care providers, those involved with the instruction of the training programs, and owners
and managers of property where equipment is placed.
3 of 3
11/15/98 5:46 PM
hearth
American Heart
Association
Fighting Heart Disease
and Stroke
OFFICE OF COMMUNICATIONS
AND ADVOCACY
Heart attack, stroke and other
cardiovascular diseases remain the No. 1
killer in the United States.
More than 1 in 5 Americans suffer from
cardiovascular diseases at an estimated
Office of Communications and Advocacy
cost of $259 billion in medical expenses
1150 Connecticut Ave., N.W., Suite 810
and lost productivity in 1997.
Washington, D.C. 20036
To fight these killers the AHA invests in
research, education and community
service programs.
Date:
10/29
Time:
600
To:
Tom freesman
Fax: 456-7431
From: Rich Handy
Tel: (202) 785-7900
AHA, Office of Communications
Fax: (202) 785-7950
and Advocacy
17
Number of pages including cover sheet:
Message
Cee A previas Pescussion. Pluse
give one a call + discass The
AED issue. Perhaps we CAN S.+ down
Confirmation:
yes
no Face A mtg.
as well.
Than Rak
American Heart
Association
Fighting Heart Disease
und Stroke
Office of Communications and Advocacy
1150 Connecticut Avenue Northwest. Suite 810
Washington, D.C. 20036
Tel 202 785 7900
Fax 202 785 7950
Chairman of the Board
Marilyn Hunn
President
Marths N. Hill, R.N., Ph.D.
Chairman-Elect
May 14, 1998
Edward F. Hines, Jr.. E.g.
President-Elect
The Honorable Lois Capps
Valenrin Purrer, M.D., Ph.D.
Immediate Past
U.S. House of Representatives
Chairman of the Board
Washington, DC 20515
David A. Ness
Immediate Past President
Jan L. Breslow, M.D.
Dear Representative Capps:
Secretary
Henry Morns, Jr., Eisq.
Treasurer
"Police Cardiac Machines Jolt Residents to Life (Greenwich Time)
Mark S. Linsbaugh. Jr.
"Defibrillator Saves Trans-Atlantic Flyer" (Chicago Tribune)
Vice Presidents
"Casino Security Guards Save Slot Player's Life" (Las Vegas Review Journal)
Hugh D. Allen, M.D.
C. William Balke, M.D.
"Town Arms Cops With Defibrillators" (San Francisco Chronicle)
William R.H. Broome, Fsq.
Joy S. Frank, Pn.D.
Donald W. LaVan, M.D.
Perhaps you've seen these headlines in your newspapers and asked yourself what
Janet Maxson, B.S.N./FNP/PA-C
Margaret P. McConnell, I.D.
you can do to facilitate the use of life-saving devices such as the automatic external
Lomic Peterson. R.N.
defibrillator (AED). On behalf of the American Heart Association, 1 am writing to ask
Lawrence B. Sadwin
Joan Ware, R.N., M.S.P.H.
you to become an original co-sponsor of the Cardiac Arrest Survival Act, currently
Chairperson, Advocacy
HR 1679. The bill has bi-partisan support from over 80 members of the House.
Coordinating Committee
J. Walter Sinclair, Eaq.
Chairperson, Marketing
In June, Representative Cliff Steams (R-FL) will be re-introducing this legislation
and Communications
Coordinating Committee
together with Senator Slade Gorton (R-WA). The new draft further simplifies the
John W. (Jack) Butes
existing provisions of the current legislation.
Chairperson. Scientific
Publishing Committee
Elixabeth G. Nabel, M.D.
Each year, more than 350,000 Americans suffer a sudden cardiac arrest. Less than
Chairperson, Scientific Sessions
10 percent will be discharged from a hospital alive. Studies have found that, after as
Program Committee
Rose, Maric Robertson, M.D.
little as 10 minutes, very few resuscitation attempts are successful. Unfortunately,
Members-At-Large
pre-hospital medical care (including training, equipment and standards of care)
R. Wayne Alexander. M.D., Ph.D.
Claire M. Bassett
suffers from state-by-state variation, which condemns the public to inconsistent care.
William 3. Bryant. Enq.
Vincent J. Bufaline M.D.
Louis L. Cregier. M.D.
The Cardiac Arrest Survival Act provides for the:
Charles Dennis, M.D.
Ann E. McPartlin
Nancy Houston Miller, R.N.
development of a model state training program for cardiac arrest care providers
I.E. Chaver. Paisley
Lynn A. Smaha, M.D., Ph.D.
in lifesaving interventions, including the use of AEDs;
Heary M. Someheimer, M.D.
development of model state legislation to ensure access to emergency medical
Junes O. South
Donald A. Trimble, C.P.A.
services; and
Jessic G. Wright, M.S., R.D., I.D.
coordination of a national database to track incidence of cardiac arrest to
Chief Execudve Officer
M. Cass Wheeler
determine whether cardiac arrest care providers can improve survival rates.
Executive Vice President
Corporate Operations
Watter D. Bristol. Jr., C.P.A.
Please call Veronica Crowe in Representative Steams' office at 5-5744 to add your
Executive Vice President
name to the list of co-sponsors of the Card ac Arrest Survival Act.
Marketing
lo A. Dichl
Executive Vice President,
Sincerely,
Corporate Secretary and I
J
David Wm, Livingston Esq.
Martha N. HILL
Exocutive Vice President
Fleid Operations and Development
Cordon L. McCullough
Martha N. Hill, RN, PhD
Executive Vice President
President
Communications and Advocacy
Brigid McHugh Sanmer
Executive Vice President
Science and Medicine
Rodman D. Starke, M.D.
For more information, visit our website at http://www.americanheart.crg
American Heart
Association
Fighting Heart Disease
and Stroke
MEDIA ADVISORY
For Immediate Release: June 12, 1998
Contact: Erica L. Neufeld, 202-785-7927
News Conference Announcing Introduction of
Cardiac Arrest Survival Act
WHAT:
The Cardiac Arrest Survival Act will be introduced in the Senate by Slade
Gorton (R-Wash.) anc. in the House by Cliff Stearns (R-Fla.).
Across the United States, approximately 250,000 people die each year from
cardiac arrest. However, many of these lives could be saved if the general public
had easier access to emergency cardiac care, such as automated external
defibrillators (AEDs). The Cardiac Arrest Survival Act is designed to set a
national standard for training first responders, ensuring access to AEDs, and
tracking incidence of cardiac arrest and effectiveness of bystanders and first
responders.
WHEN:
Wednesday, June 17. 1998
11:30 a.m.
WHERE:
340 Cannon Building
Independence and First St.
Washington, DC
WHO:
Speakers Include:
Senator Slade Gorton (R-Wash)
Representative Cliff Steams (R-Fla)
Paul Berlin, American Heart Association spokesperson
Reed Klanderud. American Red Cross Spokesperson
Chuck Kitchens, American Red Cross Spokesperson
Jennie Collins representing the Congressional Fire Services Institute, will
provide a demonstration of an AED.
Bob Adams, a New York City attorney who was saved by an AED in
Grand Central Station the day after they were installed. will speak about
his experience.
Visual/Interview Opportunities
Bob Adams, survivor from New York, will be available for interview.
Jennie Collins will be demonstrating how AEDs are used and will be
available for interview about the use of AEDs.
Paul Berlin, active in EMS for 27 years, will be available to talk about the
use of AEDs and how their use is changing the face of emergency cardiac
care.
###
READ 1:
CQ's WASHINGTON ALERT
06/29/98
*** FULL REPORT -- DIGEST, LEGISLATIVE ACTION, COSPONSORS, SPEECHES ***
MEASURE:
HR4121
SPONSOR:
Stearns (R-FL)
OFFICIAL TITLE: A bill to amend the Public Health Service Act to provide
for the establishment at the National Heart, Lung and
Blood Institute of a program regarding lifesaving
interventions for individuals who experience cardiac
arrest, and for other purposes
INTRODUCED:
06/23/98
COSPONSORS:
23 (Dems: 13 Reps: 10 Ind: 0)
COMMITTEES:
House Commerce
RELATED BILLS:
See S2196, HR1679
LEGISLATIVE ACTION:
05/20/97 *** Related measure ( HR1673) introduced in House. ***
06/19/98 *** Related measure ( S2196) introduced in Senate. ***
06/23/98 Referred to Committee on Commerce (CR p. H5064)
06/23/98 Original Cosponsor (s) : 20
Boehlert (R-NY)
Frost (D-TX)
Serrano (D-NY)
Carson (D-IN)
Gekas (E-PA)
Shays (R-CT)
Clement (D-TN)
Hastings, A. (D-FL)
Smith, Linda (R-WA)
Cook, M. (R-UT)
Hilliard, E. (D-AL)
Walsh (R-NY)
Delahunt (D-MA)
Kennelly (D-CT)
Waxman (D-CA)
Faleomavaega (D-AS)
McCollura (R-FL)
Wolf (R-VA)
Filner (D-CA)
Mink (D-HI)
06/25/98 Cosponsor (s) added: 3
Canady (R-FL)
Foley, M. (R-FL)
Meehan (D-MA)
1 Washington Aerl - Concressional Quarter
Summary a
1
Bill Summary & Status for the 105th Congress
NEW SEARCH 1 HOME I HELP
S.2196
SPONSOR: Sen Gorton (introduced 06/19/98)
Jump to: Titles, Status, Committees, Amendments, Cosponsors, Summary
TITLE(S):
SHORT TITLE(S) AS INTRODUCED:
Cardiac Arrest Survival Act
OFFICIAL TITLE AS INTRODUCED:
A bill to amend the Public Health Service Act to provide for
establishment at the National Heart, Lung, and Blood Institute of a
program regarding lifesaving interventions for individuals who
experience cardiac arrest, and for other purposes.
STATUS: Floor Actions
***NONE***
STATUS: Detailed Legislative Status
Senate Actions
Jun 19, 98:
Read twice and referred to the Committee on Labor and Human
Resources.
STATUS: Congressional Record Page References
06/19/98 Introductory remarks on Measure (CR S6699)
06/19/98 Full text of Measure as introduced printed (CR S6699-6700)
COMMITTEE(S):
COMMITTEE(S) OF REFERRAL:
Senate Labor and Human Resources
http://thomas.loc.gov/cgi-bin/bdquery/z7d105:SN02196:@@@L/bss/6/29/98ry.htn
Bill Summary & Status
Page 2 of 2
THE CASE FOR SUPPORT FOR THE
CARDIAC ARREST SURVIVAL ACT
Background
Removing barriers to care - In addition,
legislative interventions can substantially
Some time ago, the federal government
affect the delivery of pre-hospital care,
established a program to develop nationally
resulting in increased survival rates. The
uniform standards for training curricula and
value of an unbroken Chain of Survival has
procedures for local emergency medical
been highlighted in cities such as Seattle, WA
services. This program is housed within the
and Rochester, Minnesota, where early
Department of Transportation, in the National
access to EMS, early CPR, early defibrillation
Highway Traffic Safety Administration
and early advanced cardiac life support have
(NHTSA). NHTSA has done an admirable job
dramatically increased survival rates.
in developing training materials that could be
Unfortunately, the broad range of state
voluntarily implemented locally.
statutes has resulted in pre-hospital care
which suffers from state-by-state variation,
Ensuring heart disease and stroke focus -
condemning the public to inconsistent care. A
There is significant concern that, as our
1995 poll of state EMS directors, published in
knowledge about out-of-hospital cardiac
the Journal of Emergency Medical Services
arrest has expanded, NHTSA has not
(JEMS), identified lack of enabling legislation
incorporated a heart disease and stroke focus
(34%) as a prime obstacle to implementation
in the standardized or proposed curricula for
of early defibrillation programs. According to
bystanders and first responders. Bystander
data published in JEMS in 1997, non-EMT
and first responder CPR are essential to
first responders are legally permitted to use
facilitating survival from out-of-hospital arrest,
AEDs in only half the states, and less than
and we believe that the time has come for
one half of EMTs and less than one quarter of
broadening of model EMS program to include
non-EMT first responders in the U.S. are
both clinical evaluation of the results of
trained and equipped to defibrillate. If a
proposed interventions - to ensure timely and
national standard were developed by the
appropriate changes in the curriculum - and
federal government, states would likely be
development of a uniform national standard
more receptive to changes.
on the appropriate use of life-sawing
equipment for first responders, bysta nders
and other persons who may volunteer to
Summary of provisions
resuscitate patients but are not trained
paramedics or EMTs.
The bill directs the National Heart, Lung, and
Blood Institute (NHLBI), in cooperation with
The current program, housed at NHTSA,
NHTSA, to develop and disseminate a model
while superb, has historically not engaged in
state training program for first responders and
Model stateing
these activities because its focus, properly so,
bystanders in lifesaving interventions, including
has been on vehicular and traffic safety.
CPR, and directs the development of model
HPgRM
NHTSA lacks clinical and research
state legislation to ensure access to
infrastructure in heart disease readily
emergency medical services, including:
available at, for instance, the National
consideration of the necessary training in,
Institutes of Health. But, the NHTSA program
placement of, and good samaritan protection
has been developed without significant
for the use of life-saving equipment for those
clinical or scientific input from those
choosing to intervene in out-of-hospital arrest.
components of the federal government
Finally, NHLBI is called upon to coordinate a
directly involved in understanding heart
national database for reporting and collecting
disease and the potential that appropriate
data on the incidence of cardiac arrest and to
local management or, and training for, out-of-
evaluate the effectiveness of bystander and
hospital arrest can have on mortality and
first responder lifesaving interventions.
disability from heart disease.
AHA (May 1998)
ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT THE
CARDIAC ARREST SURVIVAL ACT
Question
Development and dissemination of a core content
Is there organizational support for the proposal?
for a recommended model state training program
for first responders and bystanders (defined as
Answer
cardiac arrest care providers) in lifesaving
Support for the Cardiac Arrest Survival Act in the
interventions, including cardiopulmonary
105th Congress is broad. A diverse cross-section
resuscitation (CPR), throughout the U.S., in a
of national health and safety groups endorse the
standardized fashion using current science, would
proposal, including the American Heart
be an efficient use of federal government
Association, American Red Cross, American
resources.
Academy of Pediatrics, American College of
Emergency Physicians, American Association for
Question
Respiratory Care, American College of Cardiology,
How important is rapid access to basic and
Emergency Nurses Association, International
advanced cardiac life support?
Association of Firefighters, International
Answer
Association of Fire Chiefs, the National Association
of State EMS Directors, and the North American
In a recent study, when CPR was initiated in less
Society of Pacing and Electrophysiology.
than four minutes, and advanced cardiac life
support in less than eight minutes, then the survival
Question
rate of the cardiac arrest patient was 43%. When
Is there congressional support for the proposal?
CPR was initiated in less than four minutes but
Answer
advanced cardiac life support was not initiated for
16 minutes, the rate of survival for the patient
The legislation has over 80 House co-sponsors,
dropped precipitously to 10 percent. In general, it
representing a broad range of bl-partisan support.
is estimated that for each minute of delay in
Senator Slade Gorton is expected to introduce a
administering defibrillation, survival rates drop by
companion bill in June.
10 percent.
Question
Question
Isn't this another burdensome federal mandate to
What are the critical links in the emergency
the states?
treatment of sudden cardiac arrest?
Answer
Answer
The Congressional Budget Office has determined
More people can survive sudden cardiac arrest
that the bill contains no intergovernmental or
when a particular sequence of events occurs as
private-sector mandates as defined in the
rapidly as possible: 1) recognition of early warning
Unfunded Mandates Reform Act of 1995, and
signs, 2) early activation of the emergency medical
would impose no costs on state, local or tribal
system, 3) early basic cardiopulmonary resuscitation
governments.
(CPR), 4) early defibrillation, and 5)early advanced
Question
cardiac life support. The American Heart
Isn't this issue more properly addressed at the
Association has embraced the phrase "Chain of
state level. Aren't we ignoring what the public
Survival" to communicate this concept in a useful
way.
asked for during the 104th Congress when they
voted for less federal bureaucracy?
Question
Answer
Is the Chain of Survival effective?
Pre-hospital medical care (training, equipment,
Answer
standards of care) suffers from state-by-state
In Houston, 40% of patients with ventricular
variation which condemns the public to inconsistent
fibrillation/ventricular tachycardia were discharged
care. A 1995 poll of state EMS directors identified
form the hospital if they had received bystander
lack of enabling legislation as one of the primary
CPR, versus 19% for patients not given bystander
obstacles to implementation of early defibrillation
CPR. Some communities have widely deployed
programs. If a model national standard were
AEDs (Richmond, Seattle, Rochester, MN). In
developed by DHHS, states would likely be more
such places survival rates have reached over 30
receptive to changes.
percent. In other large cities, such as Chicago and
New York, rates run as low as 1-2 percent.
Question
Haven't most states implemented the links in the
Even if first responders are authorized to use
Chain of Survival?
AEDs, won't the costs be prohibitive?
Answer
Answer
According to recent surveys: (1) 31 percent of the
The expense and time involved in equipping
population and 65 percent of the land area in the
emergency vehicles with AEDs and training all
U.S. is not covered by the 911 system; (2) only a
first responders how to use them is minimal in
small percentage - about 10 to 15 percent in most
proportion to the number of lives that can be
studies - of witnessed cardiopulmonary
saved. A report from Richmond, VA found that
emergencies have a citizen attempt resuscitation;
the cost-per-life-year saved from sudden cardiac
and (3) only 28 states allow first responders to use
arrest with defibrillation was about $2,200. Other
an automatic external defibrillator. We have a long
cardiovascular interventions cost up to $50,000
way to go!
per year. The actual cost of some AEDs is now
Question
under $3,000 and training has been incorporated
into basic life support courses.
What is an example of life-saving equipment?
Question
Answer
But what are the chances for long-term survival by
Automated external defibrillators (AED). An AED is
those after suffering a sudden cardiac arrest?
a device that automatically analyzes heart rhythms
and delivers an electric current to the heart if the
Answer
heart is in ventricular fibrillation. In other words, an
People who survive a sudden cardiac arrest have
AED can restart a heart that has stopped beating.
a very good chance at long term survival.
Ventricular fibrillation is an abnormal heart rhythm,
Approximately 83 percent of sudden cardiac
or arrhythmia. When ventricular fibrillation
arrest survivors live at least one year and 57
develops, the heart quivers and ceases its
percent survive for five years or longer.
pumping action. The only effective treatment for
this condition is defibrillation, the delivery of a
Question
powerful electrical shock to the heart.
What if AEDs were more widely available to
cardiac arrest care providers such as police
Question
officers and fire department personnel?
Are AEDs safe in the hands of non-medical cardiac
arrest care providers?
Answer
Answer
Up to 100,000 lives could be saved annually.
AEDs are already being widely deployed to cardiac
Question
arrest care providers. Recent breakthroughs in
technology have resulted in AEDs which are easier
Why does the legislation recommend the
to use and maintain; smaller, lightweight and
expansion of good samaritan protections for those
rugged; and lower in cost. AEDs have built-in
involved in the use of livesaving equipment?
safeguards to protect both patient and user, and
Answer
safety records are excellent. AEDs are
The American Heart Association recommends
programmed to administer a shock only when
providing liability protection to certain individuals
necessary, and have verbal and visual prompts
that tell everyone near the victim to stand back
in order to encourage greater availability and use
before the shock is delivered. Cardiac arrest is. a
of AEDs. It recommends that all designated
responders, premise owners that have an AED,
life or death situation. Without defibrillation, the
prescribing physicians and AED trainers should
patient has very little chance of survival.
have at least some limited protection against
Question
liability for civil damages.
Aren't all ambulances already equipped with
Question
defibrillators?
How much training is required to use an AED?
Answer
Answer
Only about 50 percent of EMTs are trained and
The American Heart Association HeartSaver-D
equipped to defibrillate. Less that 1 in 5 of non-
program, which includes training in CPR and
EMT first responders (individuals trained to the
AEDs, can be completed in about three hours.
U.S. Dept. of Transportation First Responder level
or its equivalent) are trained and equipped.
(May 1998)
O:\BAI\BAI98.F33 6/19
S.L.C.
105TH CONGRESS
2D SESSION
S. 2196
IN THE SENATE OF THE UNITED STATES
Mr. GORTON introduced the following bill; which was read twice and referred
to the Committee on
(mrs nurvay. mr. Grams, mr Bingamin, mr. Faircloth)
A BILL
To amend the Public Health Service Act to provide for
the establishment at the National Heart, Lung, and
Blood Institute of a program regarding lifesaving inter-
ventions for individuals who experience cardiac arrest,
and for other purposes.
1
Be it enacted by the Senate and House of Representa-
2 tives of the United States of America in Congress assembled,
3 SECTION 1. SHORT TITLE.
4
This Act may be cited as the "Cardiac Arrest Sur-
5 vival Act".
6 SEC. 2. FINDINGS.
7
Congress makes the following findings:
O:\BAI\BAI98.F33
S.L.C.
2
1
(1) Each year more than 350,000 adults suffer
2
cardiac arrest, usually away from a hospital. More
3
than 95 percent of them will die, in many cases, be-
4
cause lifesaving defibrillators arrive on the scene too
5
late, if at all.
6
(2) These cardiac arrest deaths occur primarily
7
from occult underlying heart disease and from
8
drownings, allergic or sensitivity reactions, or elec-
9
trical shocks.
10
(3) Survival from cardiac arrest requires suc-
11
cessful early iruplementation of a chain of events,
12
the chain of survival which begins when the person
13
sustains a cardiac arrest and continues until the
14
person arrives at the hospital.
15
(4) A successful chain of survival requires the
16
first person OIL the scene to take rapid and simple
17
initial steps to care for the patient and to assure the
18
patient promptly enters the emergency medical serv-
19
ices system.
20
(5) The first persons on the scene when an ar-
21
rest occurs are typically lay persons who are friends
22
or family of the victim, fire services, public safety
23
personnel, basic life support emergency medical serv-
24
ices providers, teachers, coaches, and supervisors of
25
sports or other entracurricular activities, providers of
O:\BAI\BAI98.F33
S.L.C.
3
1
day care, school bus drivers, lifeguards, attendants
2
at public gatherings, coworkers, and other leaders
3
within the community.
4
(6) A coordinated Federal response is necessary
5
to ensure that appropriate and timely lifesaving
6
interventions are provided to persons sustaining non-
7
traumatic cardiac arrest. The Federal response
8
should include, but not be limited to-
9
(A) significantly expanded research con-
10
cerning the efficacy of various methods of pro-
11
viding inmediate out-of-hospital lifesaving
12
interventions to the nontraumatic cardiac arrest
13
patient;
14
(B) the development of research-based, na-
15
tionally uniform, easily learned and well re-
16
tained model core educational content concern-
17
ing the use of such lifesaving interventions by
18
health care professionals, allied health person-
19
nel, emergency medical services personnel, pub-
20
lic safety personnel, and other persons who are
21
likely to arrive immediately at the scene of a
22
sudden cardiac arrest;
23
(C) an identification of the legal, political,
24
financial, and other barriers to implementing
25
these lifesaving interventions; and
O:\BAI\BAI98.F33
S.L.C.
4
1
(D) the development of model State legis-
2
lation to reduce identified barriers and to en-
3
hance each State's response to this significant
4
problem.
5 SEC. 3. NATIONAL INSTITUTES OF HEALTH MODEL PRO-
6
GRAM ON THE FIRST LINES IN THE CHAIN OF
7
SURVIVAL
8
Section 421 o:l². the Public Health Service Act (42
9 U.S.C. 285b-3) is amended by adding at the end the fol-
10 lowing subsection:
11
"(c) Programs under subsection (a)(1)(E) (relating
12 to emergency medical services and preventive, diagnostic,
13 therapeutic, and rehabilitative approaches) shall include
14 programs for the following:
15
"(1) The development and dissemination, in co-
16
ordination with the emergency services guidelines
17
promulgated under section 402(a) of title 23, United
18
States Code, by the Associate Administrator for
19
Traffic Safety Programs, Department of Transpor-
20
tation, of a core content for a model State training
21
program applicable to cardiac arrest for inclusion in
22
appropriate current emergency medical services edu-
23
cational curricula and training programs that ad-
24
dress
lifesaving
interventions,
including
25
cardiopulmonary resuscitation and defibrillation. In
O:\BAI\BAI98.F33
S.L.C.
5
1
developing the core content for such program, the
2
Director of the Institute may rely upon the content
3
of similar curricula and training programs developed
4
by national monprofit entities. The core content of
5
such program-
6
"(A) may be used by health care profes-
7
sionals, allied health personnel, emergency med-
8
ical services personnel, public safety personnel,
9
and any other persons who are likely to arrive
10
immediately at the scene of a sudden cardiac
11
arrest (in this subsection referred to as 'cardiac
12
arrest cáre providers') to provide lifesaving
13
interventions, including cardiopulmonary resus-
14
citation and defibrillation;
15
"(B) shall include age-specific criteria for
16
the use of particular techniques, which shall in-
17
clude infants and children; and
18
"(C) shall be reevaluated as additional
19
interventions are shown to be effective.
20
"(2) The operation of a limited demonstration
21
project to provide training in such core content for
22
cardiac arrest care providers to validate the effec-
23
tiveness of the training program.
24
"(3) The definition and identification of cardiac
25
arrest care providers, by personal relationship, expo-
O:\BAI\BAI98.F33
S.L.C.
6
1
sure to arrest or trauma, occupation (including
2
health professionals), or otherwise, who could pro-
3
vide benefit to victims of out-of-hospital arrest by
4
comprehension: of such core content.
5
"(4) The establishment of criteria for comple-
6
tion and comprehension of such core content, includ-
7
ing consideration of inclusion in health and safety
8
educational curricula.
9
"(5) The identification and development of
10
equipment and supplies that should be accessible to
11
cardiac arrest care providers to permit lifesaving
12
interventions by preplacement of such equipment in
13
appropriate locations insofar as such activities are
14
consistent with the development of the core content
15
and utilize information derived from such studies by
16
the National Institutes of Health on investigation in
17
cardiac resuscitation.
18
"(6) The development in accordance with this
19
paragraph of model State legislation (or Federal leg-
20
islation applicable to Federal territories, facilities,
21
and employees). In developing the model legislation,
22
the Director of the Institute shall cooperate with the
23
Attorney General, and may consult with nonprofit
24
private organizations that are involved in the draft-
O:\BAI\BAI98.F33
S.L.C.
7
1
ing of model State legislation. The model legislation
2
shall be developed in accordance with the following:
3
"(A) The purpose of the model legislation
4
shall be to ensure-
5
"(i) access to emergency medical serv-
6
ices through consideration of a require-
7
ment for public placement of lifesaving
8
equipment; and
9
"(ii) good samaritan immunity for
10
cardiac arrest care providers; those in-
11
volved with the instruction of the training
12
programs; and owners and managers of
13
property where equipment is placed.
14
"(B) In the development of the model leg-
15
islation, there shall be consideration of require-
16
ments for training in the core content and use
17
of lifesaving equipment for State licensure or
18
credentialing of health professionals or other oc-
19
cupations or employment of other individuals
20
who may be defined as cardiac arrest care pro-
21
viders under paragraph (3).
22
"(7) The coordination of a national database
23
for reporting and collecting information relating to
24
the incidence of cardiac arrest, the circumstances
25
surrounding such arrests, the rate of survival, the
O:\BAI\BAI98.F33
S.L.C.
8
1
effect of age, and whether interventions, including
2
cardiac arrest, care provider interventions, or other
3
aspects of the chain of survival, improve the rate of
4
survival. The development of such database shall be
5
coordinated with other existing databases on emer-
6
gency care that have been developed under the au-
7
thority of the National Highway Traffic Safety Ad-
8
ministration and the Centers for Disease Control
9
and Prevention.".
American Heart
Association
Fighting Heart Disease
and Stroke
m
e
m
0
May 27, 1997
TO:
Elizabeth Drye
FROM:
Rich Hamburg
Acting Director, Public Advocacy
SUBJECT: RECOMMENDATIONS FOR EXECUTIVE BRANCH
Per our previous conversations, what follows is a thumbnail sketch of our perception of favorable
outcomes relative to the AED issue. At the core of our position is that a coordinated federal
response is necessary to ensure that appropriate and timely lifesaving interventions are provided
to persons sustaining non-traumatic out-of-hospital cardiac arrest
Potential Executive Orders:
Direct NHTSA and NHLBI to collaborate in an effort to more effectively address
cardiovascular disease, including sudden cardiac arrest, in a pre-hospital setting, including
the expeditious development of curricula specifically addressing sudden cardiac arrest
Direct the Dept. of Justice to develop model state good samaritan immunity for cardiac arrest
care providers as well as those involved with the instruction of training programs and owners
and managers of property where equipment is placed.
Direct the NHLBI to immediately develop a national database for reporting and collecting
information relative to the incidence of cardiac arrest, rates of survival and whether
interventions, including cardiac arrest care provider interventions, improve the rate of survival
Direct the establishment of a Presidential Commission on Cardiac Arrest Survival to evaluate
and provide recommendations on effective methods to increase survival from cardiac arrest,
including the development of model state legislation to ensure access to EMS through
consideration of a requirement for public placement of lifesaving equipment and for the use of
such equipment by cardiac arrest care providers
Among suggestions for immediate action:
Public announcement of Presidential support for research initiatives that bring together the
collaborative efforts of government, the non-profit sector and industry. This is exemplified by
the broad-based clinical trial to evaluate whether targeted responders who use AEDs can
improve survival of patients with out-of-hospital cardiac arrest compared to implementation of
a usual community-based EMS system alone.
Presidential support and recognition of the expanded role of the police force to better serve
the community. This is exemplified by the groundbreaking work done by the police force in
Rochester, MN under the director of Dr. Roger White, where the prompt use of AEDs the by
police force dramatically improved survival from out-of-hospital sudden cardiac arrest.
MEMORANDUM
health
TO:
Tom Freedman, Mary Smith
FROM:
David Hochschild
DATE:
July 7, 1998
RE:
Improving the nation's response to Heart Attacks
Heart attacks
More than 350,000 adults suffer cardiac arrest each year, mostly away from the hospital. 95% of
these victims die as a result. But studies show that a victim's chance of survival increases
dramatically if advanced life support (defibrillation) is initiated rapidly after a heart attack. There
is a 43% survival rate in cases where advanced life support is given in less than 8 minutes. When
advanced life support is given after 16 minutes, the survival rate falls to 10%. So the loss of life
from cardiac arrest can be greatly reduced by increasing access to defibrillators.
The Forerunner
In 1996, the FDA approved a device called the Forerunner, an automatic external defibrillator
(AED) which is said to have the potential to be the most accessible advanced lifesaving tool yet
developed. The Forerunner itself is light and small, about the size of a large paperback book. It
works by sensing the electrical currents from the heart and deciding whether a heart attack is, in
fact, occurring and whether defibrillation is needed. At $3,000, it's about 40% cheaper than
standard defibrillators. But the most important difference between the Forerunner and its
predecessors is that it can be used with very little training. A recording provides instructions and
there are only two buttons to use. As a result, it can be used by police officers, EMT's, security
guards, flight attendants and other first-responders while most ordinary defibrillators are only used
by doctors and paramedics.
Many major airlines, including American, Delta and Alaska Airlines, are now equipping their
planes with the Forerunner. An American Airlines spokesman claimed that since his company
began putting Forerunners on planes about a year ago, they have been used 49 times but in only
three cases did the device decide that shocks were needed. The victim survived in only one of
these cases (which remains the only documented incident thus far of a life being saved in the air by
Forerunner). But the number is sure to climb as other airlines follow suit. There are roughly 150
heart attacks in the air each year on US carriers.
The American Heart Association estimates that a total of 100,000 lives can be saved annually with
this device if it is made widely available. To make the device more accessible, the AHA is
lobbying for the passage of the Cardiac Arrest Survival Act. A description of this and other
legislation related to AED's follows:
Bill
Date
Sponsors
Description/Status
HR1679 and
5/29/9
House:
Directs the National Heart, Lung and Blood Institute in
S2196 The Cardiac
reintrod
Stearns (R-FL)
cooperation with the National Highway Traffic Safety
Arrest Survival Act
uced on
80 cosponsors
Administration to develop a model state training program
6/22/98
53 Dem
for cardiac arrest care providers in lifesaving interventions,
27 Rep
including the use of automated external defibrillators
Senate:
(AED's). Directs the agencies to create model state
Gorten (R-FL)
legislation to reduce identified barriers to emergency
6 co-sponsors
medical service such as training and placement of AED's
4 Dem
and good samaritan protection for those who help respond
2 Rep
to cardiac arrests. Requires the creation of a
national cardiac arrest database to track the incidence of
cardiac arrest and to determine whether cardiac arrest care
providers can improve survival rates.
House version: 5/20/97 Referred to the House Committee on
Commerce
5/29/97 Referred to the Subcommittee on Health and
Environment. No action.
6/23/98 Reintroduced (as HR4121) and Referred to the
House Committee on Commerce
Senate Version: 6/19/98 Referred to the Committee on
Labor and Human Resources
HR1670 Airline
5/20/97
Kennelly (D-CT)
Establishes a routine set of procedures to be followed
Passenger Safety
10 co-sponsors
during in-flight emergencies. Requires airlines to keep
Act of 1997
10 Dem
automated external defibrillators or an equivalent cardiac
device on board for use during emergencies.
5/20/97 Referred to the House Committee on Transportation
and Infrastructure.
6/2/97 Referred to the Subcommittee on Aviation.
Hearings Held by Subcommittee on Aviation Prior to
Referral (May 21, 97).
HR 2843 Aviation
11/6/97
Duncan (R-TN)
Directs the FAA to reevaluate the medical equipment
Medical Assistance
5 co-sponsors
required on aircraft operated by air carriers. Requires the
Act of 1998
2 Dem
FAA administrator to decide whether or not to require
3 Rep
automatic external defibrillators on passenger aircraft and
Public Law 105-
in airports. Provides good samaritan protection from
170
liability lawsuits for the air carrier and any passengers who
assist in good faith during a cardiac arrest.
3/24/98 Passed House by voice vote
4/3/98 Passed Senate by unanimous consent
4/24/98 Signed by the President
heastattaches
The New York Times
WEDNESDAY, APRIL 16, 1997
Cardiologists Say Portable Defibrillators Can Save Time and Lives
cal squads as the chief means of
By JANE FRITSCH
RACING THE AMBULANCE
reviving heart patients. In the last
When Tony Cox's heart stopped
A special report.
year, the American Heart Associa-
tion has begun to push for much
beating, he was working out on a
wider availability of defibrillators.
treadmill at the Reebok Club on the
an electric shock to restart the heart.
The devices should be placed just
Upper West Side.
But it took 16 excruciating minutes
about everywhere, the association
Theoretically, his odds of survival
for the ambulance to arrive that day,
contends - in factories, health clubs,
were as high as 60 percent or 70
far more than the 5- or 6-minute
apartment buildings, and even in pri-
percent. A doctor was exercising
window of hope.
vate homes, and available for use by
nearby and a club employee was a
In New York City, in fact, the
a variety of nonmedical people, like
trainee paramedic; they began
likelihood of being revived after car-
security guards and doormen. Within
working on him immediately. Others
diac arrest is only about one percent.
a decade, the association hopes, the
called 911. And the club was only 10
The congealed traffic in New York -
devices should become as common
blocks from St. Luke's-Roosevelt
and in most American cities - and
as fire extinguishers.
Hospital, whose ambulances respond
the vast distances ambulances must
While the heart association's pro-
to 911 calls.
travel in rural areas mean that
posal may seem simple, state laws
But Winston Hill (Tony) Cox, a 55-
emergency workers simply cannot
and Federal regulations are in the
year-old father of four and the for-
reach most cardiac arrest victims in
way.
mer chairman of Showtime, died
time.
The Food and Drug Administra-
that Saturday afternoon last Septem-
Cardiologists estimate that a half
tion! which regulates the machines,
ber.
or more of the 350,000 people who die
has not considered whether they are
He might have had a chance, doc-
of cardiac arrest in the United States
safe and effective for use by the
tors said, if emergency medical
each year could have been saved.
general public.
workers had arrived sooner with a
Cardiologists now argue that it is
State emergency medical direc-
defibrillator, a machine that delivers
time to give up on emergency medi-
tors have joined together to oppose
the widespread use of defibrillators,
THE NEW YORK TIMES
10 BEST LIVES OF OUR YEARS MEET "THE
saying that the matter needs more
Librado Romero/The New York Times
is available for home of office
First Lady of Camelot." Watch the BIOGRAPHY of
study.
delivery in most major U.S.
Jackie 0. Tonight only on A&E 8 PM ET/9 PM PT
ADVT.
Still, the heart specialists plan to
The Lifepak 500 is made by Phy-
cities. Call, toll-free: 1-800-
sio-Control, one of four companies
NYTIMES. Ask about Trans-
CAMPAIGN FOR TOBACCO-FREE KIDS HITS THE
media TimesCard.
ADVT.
354613
Tobacco Industry Hard. See Today's Op-Ed page-Advt.
Continued on Page A22, Column 1
offering a new defibrillator.
1/3
The
Continued E
Page Al
The Newest Models
fight aggressively for
plan,
kicking it off at a meeting this
Come on the Market
Washington.
Not too long ago, defibrillators
Use of defibrillators by the public
were so complicated that the opera-
generally not covered
had to be specially trained to
good samaritan laws which
the screens and interpret the
tect amateur rescuers from Hability,
wayes But the heart associa-
But
cardiologists
are
afraid
that
Hat
reality
is
that
none
of
D
says a new generation of auto-
some point, health clubs office build
that good at Elisaid Dr
matic, machines has
ings and other, public chuldings as
been developed that can be operated
well as airlines could be found negli-
Kuchl the chairman of the New
by almost anyone. The new light-
The Condition
gent If they did not have defibrilla
City medical advisory(
weight machines analyze heart
tors.
emergency services sind the to
thythms, decide whether a shock ts
American Airlines recently, be-
head tif the city's emergency
needed, and give simple voice in-
The Heart
came the first airline in this country
ices agency.
structions. The "machines will not
And Its Problems
to order defibrillators for Its planes,
"There's always a danger
shock a person who does not need It,
and other domestic airlines are con-
you going to shock a
the manufacturers say
sidering It because tt Is all but impos
into a living rhythm, but that
What thas made the machines
Like Mr. Cox, about half of all
those who die of heart disease die
sible to land a plane and get a defi
brain is going to be dead," be
practical the association says, are
brillator to a victim in time Metro
"But if we can get the
five lithtum batteries that
suddenly and unexpectedly, without
North has ordered defibrillators to
very few of us play God in
the need mainte
ever having shown any symptoms,
nance. The Food and Drug Vimints
the heart association says. Many are
be placed on Its eart of emergency
who lives and who dies. We
unaware that they have clogged ar-
medical supplies in Grand Central
back the one thing that we
tration approved several of the new
Station, and a few castnos in Las
back, which is the heart, and
lightweight models'last fall but only
teries or other types of heart disease.
Vegas have also bought defibrilla-
that the brain is intact."
for prescription use
11 In Mr. Cox's case, an autopsy
showed that three coronary arteries
tors.
And those who are brain
The average cost is about $3 000
but the sprice is expected to drop
were blocked, but there was no sign
Dr. La Pook can legally have his
not linger on life supports, be
of the muscle damage that would
own defibrillator because be is a
adding, "Two days later
ur
significantly H the market is opened
have been present If be had had a
physician. Under current Federal
the respirator
to all who want to buy them
The collection of data on deaths
regulations and most
been re,
states, including New only doc.
cardiac As haphazard,
been A candi-
tors or people authorized by
making the rates difficult to com
date for cardiac bypass Dr
may buy and operate illators)
pare. But experts gener agree
Nicholas J. Fortuin, a professor of
even the simplest models
that dismal survival rates apply to
Last fall, the National Association
all but few American cities and
medicine at: Johns Hopkins, said.
suburban and rural areash
That procedure restores blood flow
of State Emergency Services Direct
This is an area that has been
to the heart and can add decades to a
tors became so concerned with the
Indebound by frules and laws and
life. But Mr. Cox might have died
push for public access to defibrilla-
regulations sald Dr.
even with early defibrillation, Dr.
tors that It passed a resolution call-
Wetsfeldt, the chairman the De:
&
Fortuin said.
ing on the heart association to post-
partment of Medicine Columbia
Cardiac arrest does not necessar-
pone its defibrillator campaign until
Presbyterian Medical Center and the
Ify mean a heart attack occurred.
data show. that use by the public is
Arterial blockages alone can cause
effective and safe.
of the heart association's task
a on defibrillators
the heart's electrical impulses to be-
"They are potentially wonderful
come disorganized and incapable of
devices," said Dr. Robert R. Bass,
"If the defibrillators aren't there
coordinating the contractions that
the executive director of the Mary-
and the survival rate is less than
keep the heart beating normally.
land Institute for Emergency Medi-
percent, then you'd better find a way
The disorganized electrical activi-
cal Services. "But we don't see any
to get them there," Dr. Welsfeldt
ty, called ventricular fibrillation, can
evidence that the devices are going
said.
last for about five minutes. During
to be effective, in the hands, of the
that time, a shock from a defibrilla
public. Before we call for a national
tor can reorganize the electrical im
movement to place these devices evt
pulses that the heart resumes
erywhere, we need to know how safe
normal beating:
they are and what's the
But with each passing minute, the
Manufacturers of the devices
likelihood of successful defibrillation
they are completely safe, and the
drops significantly. Expertly done
heart association says they are all
cardiopulmonary resuscitation can
but foolproof. And, they add, if the
buy the victim a little more time, but
choice is between defibrillation by an
it is useless unless a defibrillator
amateur and no defibrillation at all
arrives quickly, before all electrical
the answer is clear.
activity in the heart has ceased.
But Food and Drug Administration
It is a common notion suggested
officials say some safety and ethical
by television shows and movies that
considerations have yet to be ad.
defibrillation is not done until à flat
dressed.
line appears on a heart monitor, but
"There's a question of whether you
that is not so. A flat line indicates
can do as much harm as you can do
that there is no electrical activity in
good," said Thomas J. Callahan, the
the heart at all, and therefore no
Food and Drug Administration offi-
electrical impulses to be reorganized
cial who oversees the evaluation of
by a shock from a defibrillator.
such devices. "In the hands of day
Dr. John La Pook, a Manhattan
person, are there going to be more
internist and friend of Mr. Cox, was
disasters than there are benefits
so disturbed by his friend's unex-
said he was that in
pected death that he has since pur-
all cases the ne machines could
chased a defibrillator and keeps It at
distinguish R hear
his apartment on Central Park West.
should be shocked from those that
Sometimes, be even takes his defi-
should not. To evaluate fine distinc-
brillator to his régular basketball
tions, he said, trained technicians are
game in Brooklyn, where be plays
necessary.
with an friends with ages ranging
Late-stage resuscitation by ama-
from the 30's into the 50's. At first
teurs, he said, might restore a heart-
they Laughed at him, Dr. La Pook
beat and do little more, leaving the
said, but they seem to have come to
victim with little brain function and
appreciate having the thing around.
permanently dependent on life sup-
port systems.
Advocates of greater distribution
of defibrillators say such results are
rare and no more likely happen.
when rescuers are amateur than
when they are highly trained.
2/3
York City was published in the Jour-
ters in Wappingers Falls, N.Y.; Phy-
nal of the American Medical Associ-
sio-Control Corporation of Redmond,
ation and was based on 1991 data.
Wash, and Survivalink Corporation,
Since then, the department has
of Minneapolis.
gradually equipped all fire engines in
Their machines, all similar, weigh
Brooklyn, Queens, the Bronx and
about five pounds and were designed
Staten Island with defibrillators, on
in consultation with the heart associ-
the theory that firetrucks are more
ation to be as simple as possible for
likely to reach victims in time than
amateurs to use. The recent advance
are ambulances. Similar plans are
that makes them practical, accord-
under way in Manhattan
ing to cardiologists, is the inclusion
The latest statistics show that the
of a lithium battery with a five year
average response time for fire en-
life. The batteries eliminate the need
gines on cardiac arrest calls is only
for constant maintenance for re-
five minutes, according to Deputy
charging, and computer chins per-
Commissioner Edward 3M. Dolan. It
form complete tests of the operating
Present Practice
takes another five minutes for an
systems each day
ambulance to arrive he said
When the machine is turned on It
A Few New Models
The firefighters are using virtually
gives a series of simple voice in-
the same models that the heart asso-
structions; so that panicky lisers do
But Most Are Old
clation is advocating for public use.
not need to 'stop to read complex
The Suffolk County Police Depart-
directions. The rescuer is told to at-
ment has ordered the models for its
tach two plastic leads to the victim's
For the near future, at least, New
police cars because the county is
chest and then stand back.
Yorkers must depend on the Fire
almost entirely served by volunteer
The machine -analyzes the heart
Department Gemergency services
ambulance squads, which have great
rhythm and determines whether the
for help with cardiac arrests. The
difficulty reaching victims in time.
victim's heart is in fibriliation. If so,
department has worked aggressive-
Four companies are now manufac-
It charges up, Instructs the rescuer to
ty for the last three years to improve
turing the machines, and are tn
stand clear, and then to push a red
response time, and there are Indica-
flerce competition for what they
button that delivers a shock. The
tions that the efforts are working
hope will be an texploding market
machine may call for a second or
But no statistics have been complied
over the next decade. They are
third shock If necessary, then a peri-
to show whether the survival rate
Heartstream, of Seattle: Laerdal
od of cardio-pulmonary resuscita-
has improved The study that showed
Medical Corporation, a Norweigian
tion, followed by another cycle of
a one percent survival rate in New
company with American headquar-
shocks.
3/3
Zules
Parel
appented
WHEY
patily
2 WKS
outcomes
Conf.
5.m
822
502 STATES
G35D
56%
This
Come
1
10
pay
-Fired
D
4/19
Cir
X
and
States
6888
Newly OK'd defibrillator-could save 100,000 lives
4/16"
By Doug Levy
arrest victim first, such as po-
for maintenance. Even auto-
could be saved if defibrillators
USA TODAY
lice or office security guards.
mated versions, in use by some
were more widely used
47316
Less than 25% of emergency
fire and police departments,
Heartstream plans to sell
A lightweight, less expensive
vehicles carry defibrillators,
cost $5,000 or more.
Fore Runner for $3,000 to
and easier-to-use device to
but using one within four min-
ForeRunner "has some very
$4,000. A recording provides
start the heart beating again
utes of a cardiac arrest in-
definite advantages," says Dr.
instructions, and there are only
Am High Artins bream
has been approved by the Food
creases survival rates to 30%,
Roger White of the Mayo Clin
two buttons to use. Powered by
and Drug Administration.
from less than 5%
ic, who urged defibrillators be
a Flong-life battery, the four-X14
Seattle-based Heartstream
Defibrillators, which shock a
put in police cars in the clinic's
pound device is about the size.)
announced the approval Thurs-
heart into normal rhythm,
hometown of Rochester, Minn
of a large paperback.
day, saying its ForeRunner
have long been carried by
It now has the USA's highest
ForeRunner was not ap
automatic defibrillator now
obtaine
paramedics.
cardiac arrest survival rate.
proved for use on airplanes be
can be available to the people
But their use has been limit-
The American Heart Associ-
cause its ability to function at
By Robert Sort
TODAY
most likely to reach a cardiac
ed by the cost, size and need
ation estimates 100,000 lives
high altitude is unstudied. New model: Smallest, che
OUR
SA TODAY SUBSCRIPTION AND CUSTOMER SERVICE
CALL 1-800-USA-0001
and
9/13/96
p.1
HHS Comments Related to the Draft Legislation on
The Cardiac Arrest Survival Act and Cardiac Survival Activities
the Department Could Support
HHS/The National Institutes of Health/National Heart, Lung
and Blood Institute (NHLBI), supports the "chain of
survival" concept and the position that all emergency
medical personnel should be trained to use a defibrillator
and that all medical vehicles should be equipped with a
manual or automated external defibrillator (AEDs).
With respect to the proposed legislation, it contains a
number of provisions that are of concern to the Department.
For example, it provides for the development and
dissemination of a "core content" for a model state training
program in lifesaving interventions, including
cardiopulmonary resuscitation. Organizations such as the
American Red Cross and the American Heart Association are
currently involved in developing and disseminating training
programs for cardiopulmonary resuscitation. We believe it
is not appropriate for the NHLBI to assume this function and
thus duplicate the ongoing efforts of private entities.
The legislation also proposes a demonstration project to
provide training in the core content to first responders and
bystanders. While we would support such a project, we are
concerned that implementation of a demonstration project of
this type through the Department would require additional
funding and staff resources.
HHS supports the development of a nation database related to
the incidence of cardiac arrest. This is an important area
that is not currently addressed. This also would involve
the investment of substantial resources, both human and
financial, that are not currently planned for within the
Department. The proposed legislation does not address
financial support in this regard.
We believe there is merit in developing model state
legislation to ensure access to emergency medical services
for basic life support. However, we have a concern about
the appropriateness of the NHLBI in developing such
legislation. The NHLBI has a research and education
mandate. Thus, we do not believe NHLBI should be involved
in the development of legislation at the state level
especially legislation that may establish requirements for
state licensure or credentials of health professionals.
JJVIC In JUIUS
ARQ 707 VVJ EE:ET 701 1R/R7
Page 2
We strongly believe that any advances in this area should
address research needs in cardiac arrest. For example,
although the NHAAP supports the concept of placing AEDS in
public places, it has emphasized the need for additional
research before this occurs.
There is also a need for additional research on
resuscitation. Electrical instability of the heart remains
a vexing problem and research into understanding mechanisms
and therapies to prevent it and or restore normal health
rhythm, particularly following cardiac arrest, is urgently
needed.
Additional studies of the feasibility and efficacy of public
programs to treat cardiac arrest are also highly desirable
and should precede implementation of any nation emergency
action programs.
The Department will work with our health professional
training programs in the Health Resources and Services
Administration and the Health Care Financing Administration
to explore the possibility of putting greater emphasis on
the chain of survival training activities and the use of
AEDs in their grant and contract training programs.
We also will explore with Public Health Service Agencies in
the Department, including the Food and Drug Administration,
the possibility of broadening the use of AEDs so that more
non-EMT and other health professionals, who are first
responders, are able to use AEDs.
con M
CHIEF OF STAFF
77555 069 202 PAY 14:15 TUE 04/29/97
Office of Public Advocacy
American Heart
1150 Connection Avenue Northwest Suite 810 Washington, DC 20036
Association
Tel 202 822 9380
Fax 202 822
Fighting Heart Disease
and Stroke
http://www.americanhcurt.orp
Emergency Cardiac Care
Case for Support
More than 350,000 Americans suffer a sudden cardiac arrest each year. Less than ten percent will be
discharged from a hospital alive. The key to survival is timely initiation of a series of events, coined the
of
"Chain of Survival." The chain includes early activation of the emergency medical system; basic
cardiopulmonary resuscitation (CPR); rapid defibrillation; and early advanced cardiac life support.
Weakness In any link lessens the chance of survival and condemns the efforts of an emergency medical
system to poor results. After as little as 10 minutes, very few resuscitation attempts are successful.
Unfortunately, pre-hospital medical care (Including training. equipment and standards of care) suffers
from state-by-state variation, which condemns the public to inconsistent care. It is clear that legislative
interventions can substantially affect the delivery of pre-hospital care, resulting in Increased survival
rates. In cities such as Seattle, WA and Rochester, MN, where early access to EMS, early CPR, and
early defibrillation have dramatically increased survival rates. However, according to data recently
published in the Journal of Emergency Medical Services (JEMS). non-EMT first responders are legally
permitted to use AEDs in only half the states and less than one half of EMTs. and less than one quarter
of non-EMT first responders, in the U.S. are trained and equipped to defibrillate. As for basic life support
training, more than half the states in a recent study had no secondary school curriculum requirements for
first aid and CPR.
automated defibrillators exteRNaL
AHA position
Cardiac
In a few weeks, Representative Cliff Stearns (R-FL-6) will be introducing the Cardiac Arrest Survival Act.
This legislation, drafted in large part by the American Heart Association, in partnership with the American
ARREST
Red Cross and nearly two dozen national organizations, establishes a federal program regarding training
SuRvivaL
in lifesaving interventions and the use of lifesaving equipment, including automated external
defibrillators (AEDs) to assist individuals experiencing cardiac arrest. Specifically, the legislation calls
Act
for:
the National Heart, Lung, and Blood Institute (NHLBI), in cooperation with the National Highway
Traffic Safety Administration (NHTSA), to develop and disseminate a model state training program
for first responders and bystanders in lifesaving interventions, including cardiopulmonary
resuscitation (CPR).
the development of model state legislation to ensure access to emergency medical services,
including donsideration of the necessary location and placement of lifesaving equipment, including
AEDs; the development of requirements for training in the core content and use of life-saving
equipment, including AEDs; and the provision of good samaritan immunity for bystanders first
responders instructors and owners and owners and managers of property where equipment is placed.
the development of a national database for reporting and collecting information relating to the
incidence of cardiac arrest and whether interventions, including bystander or first responder, improve
the rate of survival.
Action requested
Co-sponsor the Cardiac Arrest Survival Act, sponsored by Rep. Cliff Stearns (R-FL).
THE CASE FOR SUPPORT FOR THE
CARDIAC ARREST SURVIVAL ACT
Background
Removing barriers to care In addition,
legislative interventions can substantially
Some time ago, the federal government
affect the delivery of pre-hospital care,
established a program to develop nationally
resulting in increased survival rates. The
uniform standards for training curricula and
value of an unbroken Chain of Survival has
procedures for local emergency medical
been highlighted in cities such as Seattle, WA
services. This program is housed within the
and Rochester, Minnesota, where early
Department of Transportation, in the National
access to EMS, early CPR, early defibrillation
Highway Traffic Safety Administration
and early advanced cardiac life support have
(NHTSA). NHTSA has done an admirable job
dramatically increased survival rates.
in developing training materials that could be
Unfortunately, the broad range of state
voluntarily npjemented locally.
statutes has resulted in pre-hospital care
which suffers from state-by-state variation,
Ensuring heart disease and stroke focus -
condemning the public to inconsistent care. A
There is significant concern that, as our
1995 poll of state EMS directors, published in
knowledge about out-of-hospital cardiac arrest
the Journal of Emergency Medical Services
has expanded. NHTSA has not incorporated a
(JEMS), identified lack of enabling legislation
heart disease and stroke focus in the
(34%) as a prime obstacle to implementation
standardized or proposed curricula for
of early defibrillation programs. According to
bystanders and first responders. Bystander
new data published in JEMS (January 1997),
and first responder CPR are essential to
non-EMT first responders are legally
facilitating survival from out-of-hospital arrest,
permitted to use AEDs in only half the states,
and we believe that the time has come for
and less than one half of EMTs and less than
broadening of model EMS program to include
one quarter of non-EMT first responders in the
both clinical evaluation of the results of
U.S. are trained and equipped to defibrillate.
proposed interventions - to ensure timely and
As for basic life support, more than half of the
appropriate changes in the curriculum - and
states in a recent study reported having no
development of a uniform national standard
secondary school curriculum requirements for
on the appropriate use of life-saving
first aid and CPR. If a national standard were
equipment for first responders, bystanders
developed by the federal government, states
and other persons who may volunteer to
would likely be more receptive to changes.
resuscitate patients but are not trained
paramedics or EMTs.
Summary of provisions
The current program, housed at NHTSA, while
superb, has historically not engaged in these
The bill directs the National Heart, Lung, and
activities because its focus, properly so, has
Blood Institute (NHLBI), in cooperation with
been on vehicular and traffic safety. NHTSA
NHTSA, to develop and disseminate a model
lacks clinical and research infrastructure in
state training program for first responders and
heart disease readily available at, for instance,
bystanders in lifesaving interventions,
the National Institutes of Health. But, the
including CPR, and directs the development of
NHTSA program has been developed without
model state legislation to ensure access to
significant clinical or scientific input from those
emergency medical services, including:
components of the federal government
consideration of the necessary training in,
directly involved in understanding heart
placement of, and good samaritan protection
disease and the potential that appropriate
for the use of life-saving equipment for those
local management or, and training for, out-of-
choosing to intervene in out-of-hospital arrest.
hospital arrest can have on mortality and
Finally, NHLBI is called upon to develop a
disability from heart disease.
national database for reporting and collecting
data on the incidence of cardiac arrest and to
evaluate the effectiveness of bystander and
AHA (March 1997)
first responder lifesaving interventions.
ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT THE
CARDIAC ARREST SURVIVAL ACT
Question
Question
Is there support for the proposal?
Is the Chain of Survival effective?
Answer
Answer
Support for the Cardiac Arrest Survival Act in the
In Houston, 40% of patients with venticular
104th Congress was broad. A diverse cross-
fibrillation/ventricular tachycardia were
section of national health and safety groups
discharged form the hospital if they had received
endorsed the proposal, including the American
bystander CPR, versus 19% for patients not
Heart Association, American Red Cross,
given bystander CPR. Some communities have
American Association for Respiratory Care,
widely deployed AEDs (Richmond, Seattle, Bay
American Association of Critical Care Nurses,
Area). In such places survival rates run as high
American College of Cardiology, American
as 30 percent. In other large cities, such as
Nurses Association Citizen CPR Foundation,
Chicago and New York, rates run as low as 1-2
Emergency Nurses Association, North American
percent. Up to 100,000 lives could be saved
Society of Pacing and Electrophysiology;
annually through removal of barriers to the chain
National Safety Council; Save a Life Foundation:
of survival.
Society for Academic Emergency Medicine; and
The Institute of Critical Care Medicine.
Question
Haven't most states implemented the links in the
Question
Chain of Survival?
How important is rapid access to basic and
advanced cardiac life support?
Answer
According to a 1995 survey, 31% of the
Answer
population and 65% of the land area in the U.S.
A recent study found that if CPR is initiated in
is not covered by the 911 system; only 14 states
less than four minutes, and advanced cardiac life
offer CPR training as part of their secondary
support in less than eight minutes, then the
school curricula; and only 22 states allow first
survival rate of the cardiac arrest patient is 43%.
responders to use an automatic external
When CPR is initiated in less than four minutes
defibrillator. We have a long way to go!
but advanced cardiac life support is not initiated
for 16 minutes, the rate of survival for the patient
Question
drops precipitously to 10 percent
Isn't this just another burdensome federal
mandate to the states?
Question
What is the "Chain of Survival"?
Answer
The bill simply directs the National Heart, Lung,
Answer
and Blood Institute to develop and disseminate a
More people can survive sudden cardiac arrest
model state training program for first responders
when a particular sequence of events occurs as
and bystanders in lifesaving first aid, including
rapidly as possible: 1) recognition of early warning
CPR, and directs the development of model state
signs, 2) activation of the emergency medical
legislation to ensure access to emergency
system, 3) basic cardiopulmonary resuscitation
medical services, including consideration of
(CPR), 4) defibrillation, and 5)advanced cardiac life
mandatory location and placement of life-saving
support. The American Heart Association has
equipment and requirements for training in the
embraced the phrase "Chain of Survival" to
core content and use of life-saving equipment for
communicate this concept in a useful way. This
first responders.
legislation makes a concerted effort to remove the
barriers to the Chain of Survival in order to increase
the likelihood of people surviving sudden cardiac
arrest.
Question
Question
What is an example of life-saving equipment?
With Congress moving to cut federal
Answer
appropriations, won't additional funds be scarce
Automated external defibrillators. The vast
for implementing this legislation?
majority of sudden cardiac arrests are due to an
Answer
electrical malfunction of the heart called
Existing resources at DHHS can be used if the
ventricular fibrillation (VF). In VF, the heart's
leadership mission were assigned, because
electrical signals, which normally induce a
industry, academia, and the medical community
coordinated heartbeat. suddenly become chaotic,
would all be available to contribute to the
and the heart's function as a pump abruptly
development of the legislation's
ceases. Consciousness is quickly lost and
recommendations.
unless this condition is reversed, death follows
within a matter of minutes. The only effective
Question
treatment for this condition is defibrillation, the
Aren't all ambulances already equipped with
delivery of a powerful electrical shock to the
defibrillators?
heart. Defibrillation which can be compared to
rebooting a 'frozen' computer -- eliminated VF
Answer
and allows a coordinated rhythm to resume.
AEDs are designed for trained basic life support
(BLS) personnel. Currently, only 25 percent of
Question
BLS responders have defibrillators. First
Isn't this issue more properly addressed at the
responders include fire rescue, police, BLS, flight
state level. Aren't we ignoring what the public
attendants, or security personnel with a minimum
asked for during the 104th Congress when they
of four hours AED training.
voted for less federal bureaucracy?
Question
Answer
Even if first responders are authorized to use
Pre-hospital medical care (training, equipment,
AEDs, won't the costs be prohibitive?
standards of care) suffers from state-by-state
variation which condemns the public to
Answer
inconsistent care. A 1995 poll of state EMS
The expense and time involved in equipping
directors identified obstacles to implementation of
emergency vehicles with AEDs and training all
early defibrillation programs. Among the major
first responders how to use them is minimal in
obstacles identified was a lack of enabling
proportion to the number of lives that can be
legislation (34%). If a national standard were
saved. A Tucson, Arizona study showed the cost
developed by DHHS. states would likely be more
per year of life saved for care of sudden cardiac
receptive to changes.
arrest by paramedics to be $8,000. The actual
cost of some AEDs is now under $3,000 and
Development and dissemination of a core
training in its use takes less than four hours per
content for a recommended model state training
person.
program for first responders and bystanders in
lifesaving first aid, including cardiopulmonary
resuscitation (CPR), throughout the U.S., in a
standardized fashion using current science,
would be an efficient use of government
resources.
(AHA - 12/96)
South Shore 1-800-794-9911
Cape Cod and the Islands - 1-800-870-2626
223 Water Street
1213 Street
166 Main from
146 Main Street
Physouth, NA 02360 Quincy, MA 02169 Brocking MA 02601
Hymais, MA 02601
- -
COMMITTEE ON COMMERCE
Congress of the United States
16% Kam STREET
MA town
FLYMOUTH
SUBCOMM/TTEE ON HEALTH
25 Wayse STREET. BURE 401
AND THE ENVIRONMENT
house of Representatives
PLANOUTH, MA 04360
SUBCOMM/TEE ON
CAPS con AND ISLANDS 1-800-870-2625
AND FINANCE
HVANNIS
NEW ENGLAND CONGRESSIONAL CALICLE
144 Man STREET
March 14, 1996
MA even
CO-CHARMAN
COSPONSOR THE CARDIAC ARREST SURVIVAL ACT
Dear Colleague:
Each year, approximately 250,000-people die when they suffer cardiac arrest.
Less than seven percent of those who suffer cardiac arrest outside of a hospital
survive.
The evidence is clear, however, that when more people are trained in
cardiopulmonary resuscitation (CPR). more lives can be saved. For example, in
Seattle, where CPR training Is required for high school students, cab drivers and
Seattle sports arena vendors, and is offered free to anvone who wants it a
is five times more likely to survive a cardiac arrest than in most other parts of the
country. The average survival rate for cardiac arrest is 29 percent and rises to 40
percent for victims who receive the quickest emergency response.
Current programs to teach CPR have been successful in many areas, but have
been limited to a relatively small segment of the population. Legislation that 1 have
repently introduced - the Cardiac Arrest Survival Act would increase training of
citizens and first responders to victims who suddenly suffer cardiac arrest and in
other serious trauma Injury.
H.R. 3022 would potentially expand the number of health professionals and
members of the general public who are trained to perform life saving techniques,
such as CPR, rescue breathing, relieving airway obstruction and other first aid
techniques. It would require the Secretary of Health and Human Services to make
recommendations to the states on policies regarding the provision of first aid, CPR
training and access to emergency medical services through the 911 system. in
making these recommendations, the Secretary would consider the merits of
requiring lifesaving training for law enforcement officers, fire fighters, teachers,
athletic coaches, day care providers and other first responders.
The Secretary would be required to carry out demonstration projects in these and
THIS STATIONERY PRINTED ON PAPER MADE OF RECYCLED FIBERS
09/17/96
16:02
202 225 2212
CONG STUDDS - DC
1002
National Office of Public Aftairs
American Heart
1150 Connecticut Avenue. N.W.
Suite 810
Association
Washington, D.C. 20036
Fighting Heart Comm
Tel 202 822 9380
and Strole
Fax 202 822 9883
For Release: March 7, 1996
Contact: Trish Moreis
(202) 822-9380
American Heart Association Supports Cardiac Arrest Survival Act
Cardiac Defibrillation Should be More Accessible
WASHINGTON, DC - The American Heart Association announced its support for the Cardiac
Arrest Survival Act, HR 3022. being introduced today by Rep. Gerry Studds (D-MA). This legislation
would recommend making automated external defibrillators (AEDs) more accessible to professionals
E
who regularly respond to emergency situations, especially those involving cardiac arrest
According to the AHA, each year more than 250,000 people die when they suffer cardiac
arrest. Fewer than 7 percent of those suffering cardiac arrest outside a hospital survive.
The Cardiac Arrest Survival Act, supported by the AHA and a number of other organizations,
would require the Secretary of Health and Human Services to make recommendations to the states on
policies regarding the provisions of first aid, CPR training and access to emergency medical services
through the 911 system. The Secretary would also be required to carry out demonstration projects
dealing with the use of automated external defibrillators. These projects would result in
recommendations about whether states should require that defibrillators be located in public places.
such as office buildings, stadiums, and arenas.
Dr. Joseph Omato, chair of the American Heart Association's Emergency Cardiac Care
Committee explained. "Every day in the United States, 1,000 adults will become victims of sudden
cardiac arrest. States need to be encouraged to adopt policies and programs that will significantly
improve the survival rate of people suffering from cardiac arrest. This legislation recognizes that full
public access to automated external defibrillators (AEDs) is essential for increased survival of cardiac
arrest victims."
More people can survive sudden cardiac arrest when a particular sequence of events occurs as
rapidly as possible. The American Heart Association developed the phrase "cardiac chain of survival"
to communicate this concept in a useful way. Weakness in any link lessens the chance of survival and
condemns the efforts of an emergency medical system (EMS) to poor results. The cardiac chain of
survival is:
1) early access -The legislation would ensure that more people are trained to recognize the warning
signs of cardiac arrest, to be able to adequately perform CPR, to promptly call 911, and to ensure that
emergency personnel are dispatched to the scene.
- more-
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. email
Zoraida Pagett to Elizabeth Drye re: SSN and DOB (partial) (1 page)
05/27/1997
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Devorah Adler
OA/Box Number: 20465
FOLDER TITLE:
Portable Defibrillators
2012-0463-S
rc814
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA|
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
To:
[email protected]
Cc:
Bcc:
From:
Zoraida [email protected]@OS.DC
Subject:
Defibrellators
Date:
Tuesday, May 27, 1997 14:12:54 EDT
Attach:
Certify:
N
Forwarded by:
As per Mary Beth's request, I am forwarding the waive information of the
participants attending the WH meeting tomorrow, May 28, 1997 at 10:00.
Mary Beth Donahue
Denuty Chief of Staff (HHS)
P6/(b)(6)
[001]
Jerry Mande
(FDA)
public
P6/(b)(6)
Bruce Burlington
(FDA)
P6/(b)(6)
specially
trauned
Michael Friedman
(FDA)
P6/(b)(6)
Claude Lenfant
(NIH)
amblose
P6/(b)(6)
five
David Snyder
(HRSA)
P6/(b)(6)
Kathy Buto
(HCFA)
P6/(b)(6),
2.50 5 or O:Do
Thank you.
prost
2,000
2. what' 5 mill
3. Chr 2500
2
4 = 10,000