Louisiana

A. The Legislature of Louisiana finds that each year more than three hundred fifty thousand Americans die from out-of-hospital sudden cardiac arrest. More than ninety-five percent of these Americans die, in many cases because a lifesaving defibrillator did not arrive at the scene of the emergency in time.

B. The American Heart Association estimates that more than twenty thousand deaths may be prevented each year if defibrillators were more widely available to designated responders.

C. Many communities throughout the state and nation have invested in 911 emergency response systems, emergency personnel, and ambulance vehicles. However, many of these communities do not have enough defibrillators in their community.

D. It is therefore the intent of the legislature to encourage greater acquisition, deployment, and use of automated external defibrillators in communities throughout the state.

As used in this Part “automated external defibrillator” and “AED” mean a medical device heart monitor and defibrillator that:

(1) Has received approval of its pre-market notification filed pursuant to 21 U.S.C. § 360(k) from the United States Food and Drug Administration.

(2) Is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia and is capable of determining whether defibrillation should be performed.

(3) Upon determining that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to an individual's heart.

(4) Is capable of delivering the electrical impulse to an individual's heart.

A. In order to ensure public health and safety, any person or entity that possesses an AED shall ensure that:

(1) The AED is maintained and tested according to the manufacturer's guidelines.

(2) A licensed physician or advanced practice registered nurse who is authorized to prescribe is involved in the possessor's program to ensure compliance with the requirements for training, emergency medical service (EMS) notification, and maintenance.

(3)(a) Expected AED users regularly, on the premises of a particular entity, such as a work site or users who carry an AED in a private security patrol vehicle, receive appropriate training in cardiopulmonary resuscitation (CPR) and in the use of an AED from any nationally recognized course in CPR and AED use.

(b) For purposes of this Paragraph, “expected AED users” shall be any person designated by the possessor to render emergency care.

(4) The emergency medical services system is activated as soon as possible when an individual renders emergency care to an individual in cardiac arrest by using an AED.

(5) Any clinical use of the AED is reported to the licensed physician or advanced practice registered nurse involved in the possessor's program.

B. Any person or entity that possesses an AED shall notify a local provider of emergency medical services, such as a 911 service, local ambulance service, or fire department of the acquisition, location, and type of AED.

C. Any manufacturer, wholesale supplier, or retailer of an AED shall notify purchasers of AED's intended for use in the state of the requirements of this Section.

D. (1) The owner of or the entity responsible for a physical fitness facility shall keep an AED on its premises.

(2) As used in this Subsection:

(a) “Physical fitness facility” means a facility for profit or nonprofit with a membership of over fifty persons that offers physical fitness services. This term includes but is not limited to clubs, studios, health spas, weight control centers, clinics, figure salons, tanning centers, athletic or sport clubs, and YWCA and YMCA organizations.

(b) “Physical fitness services” means services for the development of physical fitness through exercise or weight control. It shall not include a business limited solely to the practice of physical therapy, as defined in R.S. 37:2401, by a therapist licensed by the Louisiana State Board of Medical Examiners, nor shall it apply to medically related services performed by a physician licensed by the Louisiana State Board of Medical Examiners in a private office, clinic, or hospital.

E. (1) Any institution of higher education that competes in intercollegiate athletics shall have an AED on its premises in its athletic department.

(2)(a) Each high school shall have an AED on its premises, if funding is available, subject to appropriation. Each high school shall have the authority to accept donations of AEDs or funds to acquire AEDs.

(b) Notwithstanding the provisions of Subparagraph (a) of this Paragraph, each high school in any parish with a population of more than two hundred thousand and less than two hundred twenty-five thousand according to the latest federal decennial census shall have an AED on its premises.

F. The Department of Health and Hospitals shall promulgate all necessary rules and regulations to implement the provisions of Subsections D and E of this Section. Such rules and regulations shall, at a minimum, provide for compliance, enforcement, and penalties.

In addition to the civil immunity provided to persons rendering emergency assistance as provided by law, including R.S. 9:2793, R.S. 37:1731, 1732, and 1735, and R.S. 40:1231.2, any prescribing advanced practice registered nurse or physician who authorizes the purchase of the AED, any physician or advanced practice registered nurse involved in the possessor's program, any individual or entity which provides training in cardiopulmonary resuscitation and in the use of an AED, any purchaser of an AED, any person or entity who owns or who is responsible for the site or the private security patrol vehicle where an AED is located, and any expected user regularly on the premises or in the vehicle shall not be liable for any civil damages arising from any act or omission of acts related to the operation of or failure to operate an AED that do not amount to willful or wanton misconduct or gross negligence.

A. No person who in good faith gratuitously renders emergency care, first aid or rescue at the scene of an emergency, or moves a person receiving such care, first aid or rescue to a hospital or other place of medical care shall be liable for any civil damages as a result of any act or omission in rendering the care or services or as a result of any act or failure to act to provide or arrange for further medical treatment or care for the person involved in the said emergency; provided, however, such care or services or transportation shall not be considered gratuitous, and this Section shall not apply when rendered incidental to a business relationship, including but not limited to that of employer-employee, existing between the person rendering such care or service or transportation and the person receiving the same, or when incidental to a business relationship existing between the employer or principal of the person rendering such care, service or transportation and the employer or principal of the person receiving such care, service or transportation. This Section shall not exempt from liability those individuals who intentionally or by grossly negligent acts or omissions cause damages to another individual.

B. The immunity herein granted shall be personal to the individual rendering such care or service or furnishing such transportation and shall not inure to the benefit of any employer or other person legally responsible for the acts or omissions of such individual, nor shall it inure to the benefit of any insurer.

C. For purposes of this Section, rendering emergency care, first aid, or rescue shall include the use of an automated external defibrillator as defined by R.S. 40:1236.12.

A. Purpose. These rules establish standards for the maintenance of automated external defibrillators for the owner of or the entity responsible for a physical fitness facility, any institution of higher education that competes in intercollegiate athletics, and any high school that possesses an automated external defibrillator.

B. Definitions. The Louisiana Department of Health, Office of Public Health (LDH-OPH), Bureau of Emergency Medical Services (BEMS), in the exercise of its regulatory authority, defines the following words and terms applicable to this Chapter.

Athletic Department—the division or department of an institution of higher education, including colleges, universities, or community colleges, which schedules and competes in intercollegiate athletics.

Automated External Defibrillator (AED) —a medical device heart monitor and defibrillator that:

a. has received approval of its pre-market notification filed pursuant to 21 U.S.C. 360(k) from the United States Food and Drug Administration;

b. is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia and is capable of determining whether defibrillation should be performed;

c. upon determining that defibrillation should be performed, the AED automatically charges and requests delivery of an electrical impulse to an individual's heart;

d. is capable of delivering the electrical impulse to an individual's heart; and

e. pediatric AED capabilities are required.

Bureau—the LDH-OPH, BEMS.

Cardiopulmonary Resuscitation (CPR)—the process of providing oxygen while circulating blood to a patient in cardiopulmonary arrest usually, but not exclusively, in a combination of mouth-to-mouth breaths with external chest compressions.

Certification—adult and pediatric expected CPR providers and expected AED users who have been certified after successful completion of an adult and pediatric CPR and AED course recognized by a nationally recognized organization or association such as the American Heart Association (AHA), the American Red Cross (ARC), the National Safety Council and the Emergency Medical Physicians of America, or the equivalent cardiopulmonary resuscitation certification that has been approved by the Louisiana Department of Health.

Emergency Care—the occurrence of a sudden, serious and unexpected sickness or injury that would lead a reasonable person, possessing an average knowledge of medicine and health, to believe that the sick or injured person requires urgent or unscheduled medical care.

Expected AED Users—any person designated by the possessor to render emergency care.

Physical Fitness Facility—a facility for profit or nonprofit with a membership of over 50 persons that offers physical fitness services. This includes but is not limited to clubs, studios, health spas, weight control centers, clinics, figure salons, tanning centers, athletic or sport clubs, and YWCA and YMCA organizations.

Physical Fitness Services—services for the development of physical fitness through exercise or weight control.

Physical Fitness Center—any person or organization which, for profit or nonprofit, offers physical fitness services, whether at multiple outlets or single outlet. Any subsidiary of a center offering such services shall be deemed part of said center.

Possessor—any person, service, business, industry, physical fitness facility, institution of higher learning participating in intercollegiate sport, or security vehicle possessing an AED.

Premises—physical fitness facility or possessor, a distinct and definite locality, and may mean a room, shop, building, field or other definite area.

Sudden Cardiac Arrest—a medical emergency where a person is unconscious, not breathing and has no pulse.

A. Possessor's Program

1. The possessor's responsibility and requirements are as follows.

a. The AED must be maintained and tested according to the manufacturer's guidelines; in accordance with state and federal rules and polices, including review of product warranty expirations for AED machine, pads and batteries.

b. A licensed physician or advanced practice registered nurse in the state of Louisiana who is authorized to prescribe in the state of Louisiana must be involved in the possessor's program to ensure compliance with the requirements for training, emergency medical services (EMS) notification, and maintenance.

c. Expected AED users regularly, on the premises of a particular entity, such as a work site or users, who carry an AED in a private security patrol vehicle, must receive appropriate training in CPR and in the use of an AED by the American Heart Association, American Red Cross, or the equivalent cardiopulmonary resuscitation certification that has been approved by LDH.

d. The local provider of emergency medical services (EMS) (such as a 911 service, local ambulance service, or fire department) must be activated by the possessor as soon as possible when an individual renders emergency care to an individual in cardiac arrest by using CPR or an AED. It is the responsibility of the individual rendering the emergency care to activate the local EMS provider.

e. Any clinical use of the AED is reported to the licensed physician or advanced practice registered nurse involved in the possessor's program.

2. Every possessor shall notify a local provider of emergency medical services, such as a 911 service, local ambulance service, or fire department of the acquisition, location and type of AED.

3. Any manufacturer, wholesale supplier, or retailer of an AED must notify purchasers of AED's intended for use in the state of Louisiana of the requirements of R.S. 40:1137.3.

4. The owner of or the entity responsible for either a physical fitness facility or a physical fitness center, must keep an AED on its premises.

5. Any institution of higher education that competes in intercollegiate athletics must have an AED on its premises in its athletic department, with posters approved by AHA/ARC on how to safely perform CPR and use the AED. The AED must be placed in open view within 2 feet of a telephone to readily enable a call to 911 from within the athletic department. It must also be placed in an area with easy access to coaches and athletic personnel where athletes are training and/or competing.

6. Each high school must have an AED on its premises, if funding is available, subject to appropriation. Per R.S. 40:1137.3(E)(2), each high school is authorized to accept donations of AEDs or funds to acquire AEDs.

A. Plan and Usage Review

7. A written CPR/AED protocol or plan must exist for use in a sudden cardiac arrest (SCA) occurring at a physical fitness facility or a physical fitness center.

8. Every event in which an AED is used in a physical fitness facility or physical fitness center must be reviewed by the medical oversight of the possessor, in accordance with the CPR/AED protocol/plan and further determine if the CPR/AED protocol or plan should be modified. The review of use by medical oversight shall be privileged and confidential.

B. Failure to Possess Required AED

9. The BEMS shall inspect the premises in response to a complaint which specifies the name, address and telephone number of the alleged violator filed with the BEMS alleging a violation of R.S. 40:1137.3(D) or (E). The BEMS may inspect facilities or premises at other times to ensure compliance with this Rule.

a. If a physical fitness facility, physical fitness center, collegiate athletic department or appropriately funded high school violates this rule by failing to have on the premises an accessible and operational AED or to adopt or implement a plan for responding to medical emergencies as required by this Chapter, then the following actions, inclusive of the issuance of assessing monetary penalties on a per violation basis, is hereby authorized.

i. Voluntary Compliance Effort.

(a). The BEMS or its designee shall issue to a physical fitness facility, athletic department or appropriately funded high school a written administrative warning without monetary penalty upon determining that an initial violation of either of the requirements in this Subparagraph exists. The written notification of violation shall state that the physical fitness facility, athletic department or high school will be provided with a 30-day grace period from the date of the violation determination to voluntarily comply.

ii. Mandatory Compliance Penalties.

(a). at least $100 but less than $150 per violation upon determination that one or more violations continues to exist after the 30-day voluntary compliance grace period has expired;

(b). at least $150 but less than $200 per violation upon determination that one or more violations continues to exist for the third or subsequent times; and (c). upon determination that a fourth violation exists, the BEMS or its designee may report said violations to the Louisiana attorney general's office or other governing authorities requesting issuance of further warning and/or the institution of judicial enforcement procedures.

A. One-half unit of health education course offerings is required.

10. Health education will include instruction on dating violence awareness and prevention in accordance R.S. 17:81.

11. Cardiopulmonary resuscitation (CPR) will be taught.

a. Instruction must be provided for CPR and the use of an automated external defibrillator.

b. The instructional program must be nationally recognized and based on the most current national evidence-based emergency cardiovascular care guidelines.

c. Students are required to perform hands-on practice.

d. The instructor is not required to be CPR-certified.

e. Students trained in CPR are not required to obtain CPR certification.

f. The physical presence of an automated external defibrillator is not required.

B. JROTC I and II may be used to meet the health education requirement if the following requirements are met.

12. A minimum of 2000 minutes of instructional time must be devoted to health education in JROTC I and II. Students must take both JROTC I and II to meet the health education requirement.

13. All standards and GLEs for health must be covered in JROTC I and II.

14. JROTC I and II must include the instruction listed in Subsection A of this Section.