Memorandum on Automated External Defibrillators in Federal Buildings

Memorandum for the Secretary of Health and Human Services, the Administrator for General Services

Subject: Automated External Defibrillators in Federal Buildings

This country has taken many steps to try to reduce the number of persons who die each year from heart disease. Advances in the field of medicine and private-sector public education campaigns have helped to prevent and treat heart disease, but there is much more work we can do. Recent studies estimate that more than 250,000 persons die each year from sudden cardiac arrest—about 700 a day.

The most common lethal arrhythmia responsible for sudden cardiac arrest and collapse is ventricular fibrillation, which if treated quickly, can be reversed. By some estimates, one-quarter to one-third of people in sudden cardiac arrest might be saved with optimal emergency care. One of the most effective ways to reduce the number of people who die from sudden cardiac arrest is the prompt intervention of defibrillation. Estimates show that for every minute that passes without defibrillation, a victim's chances of survival decrease by seven to ten percent. After as little as 10 minutes, very few resuscitation attempts are successful. Automated external defibrillators (AEDs), which deliver a shock through the chest wall to the heart and enable the heart to regain its own normal rhythm, may be a helpful adjunct to cardiopulmonary resuscitation (CPR) and local Emergency Medical Services (EMS) in saving lives.

Recently, private companies, local governments, and airports have begun instituting programs to put AEDs into place and have provided training programs on how to use the devices for their employees. In June of 1999, the City of Chicago put AEDs within a minute's walk in airport terminals with accompanying emergency medical support. In the first month after they were made available, the devices saved four lives. Similar results may be found in Las Vegas, where many buildings now provide AEDs.

The Federal Government employs approximately 1.8 million people. Many millions more visit Federal buildings each year. While a number of agencies such as the Department of Transportation and the Environmental Protection Agency have begun putting AEDs in some of their buildings, I believe that we must make a more systematic effort to provide for the safety of Federal employees and the persons who visit Federal buildings each year.

To that end, I direct you to report back to me within 120 days with guidelines on a program for AED placement in Federal buildings. These guidelines should optimize the use of AEDs, putting them in buildings and other Federal areas. These guidelines should include, among other issues, training programs in the use of cardiopulmonary resuscitation (CPR) and AEDs; appropriate physician oversight; integration with the local EMS system; the use and maintenance of AEDs; placement of AEDs in each facility according to each facility's needs; response system activation and coordination; and legal issues. In creating these guidelines, you should cooperate and consult with interested parties, including other Federal agencies—particularly, the Office of Personnel Management, the Department of Transportation, and the Department of Justice—and State and local agencies focusing on research and public health, consumers, health organizations, and academia. The plan should make special efforts to build on efforts of the private sector, including nonprofits such as the American Heart Association and the American Red Cross, through the use of publicprivate partnerships or other appropriate mechanisms.

These steps, taken together, will help to protect the lives of Federal employees and the millions of other persons who visit Federal buildings each year.

WILLIAM J. CLINTON