ANNAPOLIS – Nicole Bohrer just purchased a life-saving device that she hopes she will never have to use in the nursing home she runs in Frederick. Two weeks earlier, Wanda Lapp registered one to use in her assisted living facility in Garrett County.
They are two of only three residential health facilities in the state that are registered owners of Automated External Defibrillators, or AEDs, which are portable lunchbox-sized machines that shock a patient’s heart back to a normal rhythm during a heart attack. This week, Maryland health officials decided not to require all 240 nursing homes and 1,500 assisted living facilities licensed by the state to keep an AED on site. Others, though, say these places are where the devices are needed most.
“It seems peculiar that schools and shopping malls would have these before nursing homes, where under one roof we have more members of the frail population that could benefit from them,” said Bohrer, who manages Frederick’s Citizens Care and Rehabilitation Center, a nursing home with 170 beds. “It just makes sense to have one.”
In 1999, Maryland created a voluntary program through which any facility — from government buildings to private businesses — could own and operate an AED as long as it is registered and certified with the Maryland Institute for Emergency Medical Services. Currently 526 facilities at 1,084 locations are registered with the state, according to Lisa Myers, who directs the program. Only three of those sites are residential health care facilities.
During the past legislative session, a bill to require all assisted living facilities with more than nine beds and nursing homes to keep an AED on site passed unanimously in the House of Delegates, but failed in the Senate, which asked for further review by the state health department. Wendy Kronmiller, acting director of the state Office of Health Care Quality, gave the department’s answer at a hearing on Tuesday before the Senate Finance Committee, rejecting the proposal on the grounds that AEDs are not effective for all patient populations and too expensive for some facilities to afford.
“We’re not saying that they’re not good things to have, but right now we’re not in a place to require them,” Kronmiller said. Instead, she suggested implementing regulation that would require all facilities to disclose whether or not an AED is on site to use as a marketing tool to attract patients.
Sheila Mackertich of the Health Facilities Association of Maryland, which represents 135 nursing homes and 20 assisted living programs, said many facilities are planning to purchase AEDs regardless of the state policy. “As long as consumers are aware of what their options are — that’s what’s important to us,” she said.
AEDs can stop a heart attack that is due to cardiac arrhythmia — or irregular heartbeat — which accounts for about half of all attacks, according to Ron Berger, a professor at The Johns Hopkins University School of Medicine. Successful resuscitation of a heart attack victim quickly declines after the first few minutes, so an AED is useful when paramedics can’t get there in time.
Delegate Robert A. Costa, R-Anne Arundel, who sponsored the legislation, said he plans to introduce it again in the upcoming session. “Any tool or resource that the state can do to save lives has got to be implemented,” he said, adding that several AED manufacturers agreed to provide group discounts on the devices to help offset the cost.
But Kronmiller questioned the real effectiveness of AEDs, pointing to a study released by the Maryland Institute of Medical Systems Services that tracked the location of heart attacks in the state over a two-year period. According to the report, the majority of attacks occur at home, and an AED in a skilled nursing facility would likely be used only once every six months.
Looking at the same report, Michaeline Fedder of the American Heart Association pointed out that an AED at a race course would be used once every two years, while one at a school would be used every 333 years.
“In these places it’s more likely to happen on a regular basis,” Fedder said. “This is a relatively easy way to save a life.”
AEDs, which cost between $800 and $4,000 each, are appearing at more and more public places where large groups of people gather, like airports, stadiums and office buildings. Commercial airplanes are required by federal law to carry a device on board. Statewide, 51 schools and universities and 28 religious organizations have registered at least one AED. Montgomery County now requires all commercial gyms and fitness centers to have one.
Under the current voluntary program, nursing homes are not required to register their AEDs with state and follow state guidelines, which has the practical effect of dissuading some nursing home operators from purchasing them.
Matt Neiswanger, who manages a total of 307 beds at Annapolis Nursing Home and Rehabilitation Center and St. Thomas More Nursing and Rehabilitation in Hyattsville, said “any equipment that you bring into a nursing home without regulation is setting yourself up” for liability lawsuits. He added that many nursing homes, including his, have staff trained to handle cardiac arrest situations. “We’re pretty much set,” he said.
Lapp, who manages the 24-bed Cherry Hill Assisted Living in Garrett County, opted to buy the device more out of concern for her large number of visitors than her residents, 98 percent of whom do not wish to be resuscitated. Hopkins’ Berger said a nursing home seems to be a “reasonable place” for an AED, but it should be looked at on a case-by-case basis. “If you have a large collection of people who would like to be resuscitated, then that’s a setting where one would be warranted.”