[Congressional Record Volume 146, Number 57 (Wednesday, May 10, 2000)]
[Senate]
[Pages S3832-S3834]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Feingold, Mrs. Murray, Mr. 
        Abraham, Mr. Wellstone, Mr. Hutchinson, Mr. Dorgan, Mr. Grams, 
        Mr. Bingaman, Mr. L. Chafee, Mr. Enzi, and Ms. Snowe):
  S. 2528. A bill to provide funds for the purchase of automatic 
external defibrillators and the training of individuals in advanced 
cardiac life support; to the Committee on Health, Education, Labor, and 
Pensions.


                 rural access to emergency devices act

  Ms. COLLINS. Mr. President, today I am pleased to join my friend from 
Wisconsin, Senator Feingold, in introducing the Rural Access to 
Emergency Devices Act of 2000, which is intended to improve access to 
automated external defibrillators in small communities to boost the 
survival rates of individuals who suffer cardiac arrest.
  We are very pleased to be joined in introducing this legislation by 
the following cosponsors: Senators Murray, Abraham, Wellstone, 
Hutchinson, Dorgan, Grams, Bingaman, Chafee and Enzi.
  Heart disease is the leading cause of death both in the State of 
Maine and nationwide. According to the American Heart Association, an 
estimated 250,000 Americans die each year from cardiac arrest. Many of 
these deaths could be prevented if AEDs were more accessible. AEDs are 
computerized devices that can shock a heart back into the normal rhythm 
and restore life to a cardiac arrest victim. They must, however, be 
used promptly. For every minute that passes before a victim's normal 
heart rhythm is restored, his or her chance of survival falls by as 
much as 10 percent.
  We have a number of new and improved technologies in our arsenal of 
weapons to fight heart disease, including a new generation of small, 
easy-to-use AEDs that can strengthen the chances of survival. These new 
devices make it possible not only for emergency medical personnel, but 
also trained lay rescuers, to deliver defibrillation safely and 
effectively. The new AEDs are safe, effective, lightweight, low 
maintenance, and relatively inexpensive. Moreover, they are 
specifically designed so they can be used by nonmedical personnel, such 
as police, firefighters, security guards, and other lay rescuers, 
providing they have been trained properly.
  According to the American Heart Association, making AEDs standard 
equipment in police cars, firetrucks--as I know the Presiding Officer 
has done in his hometown--ambulances, and other emergency vehicles, and 
getting these devices into more public places could save more than 
50,000 lives a year.
  Last December, the Bangor Mall installed an AED that is one of the 
first of these devices in Maine to be placed in a public setting 
outside the direct control of emergency medical personnel and hospital 
staff. Both the AED and an oxygen tank are kept inside a customer 
service booth, which is in an area of the mall where there is a high 
concentration of traffic and where heart emergencies might occur. Mall 
personnel have also received special training and, during mall hours, 
there is always at least one person who has been certified in both CPR 
and defibrillator use.
  For at least one Bangor woman, this has been a lifesaver. On January 
12th, just weeks after the AED was installed, two shoppers at the Mall 
collapsed in a single day. One was given oxygen and quickly revived. 
But the other shopper was unconscious and had stopped breathing. The 
trained mall staff--Maintenance Supervisor Larry Lee, Security Chief 
Dusty Rhodes, and General Manager Roy Daigle--were only able to detect 
a faint pulse. They quickly commenced CPR and attached the AED.
  It is important to note that defibrillation is intended to 
supplement, not replace standard CPR. These devices, which are almost 
completely automated, run frequent self-diagnostics and will not allow 
the administration of shock unless the victim's recorded heart pattern 
requires it. When the AED is attached, it automatically analyzes the 
victim's vital signs. One of two commands will then be voiced and 
displayed by the unit: ``Shock advised--charging''; or ``Shock not 
advised--continue CPR.''
  In the Bangor Mall case, the shock was not advised, so CPR was 
continued until the emergency medical personnel arrived. The EMT's told 
Mr. Daigle, the General Manager of the mall, that the woman--who had 
had a heart attack and subsequently required triple by-pass surgery--
simply would not have survived if they had not been so prepared. As Mr. 
Daigle observed, ``Twelve to fifteen minutes is just too long to wait 
for the emergency services to arrive.''
  Cities across America have begun to recognize the value of fast 
access to AEDs and are making them available to emergency responders. 
In many small and rural communities, however, limited budgets and the 
fact that so many rely on volunteer organizations for emergency 
services can make acquisition and appropriate training in the use of 
these life-saving devices problematic.
  The legislation that Senator Feingold and I are introducing today is 
intended to increase access to AEDs and trained local responders for 
smaller towns and rural areas in Maine and elsewhere where those first 
on the scene may not be paramedics or others who would normally have 
AEDs. Our bill provides $25 million over three years, to be given as 
grants to community partnerships consisting of local emergency 
responders, police and fire departments, hospitals, and other community 
organizations. This money could then be used to help purchase AEDs and 
train potential responders in their use, as well as in basic CPR and 
first aid.
  I commend the leadership of the Senator from Wisconsin for coming 
forth with this idea. I am very pleased to join him in introducing this 
important legislation.
  The Rural Access to Emergency Devices Act has been endorsed by both 
the American Heart Association and the American Red Cross as a means of 
expanding access to these lifesaving devices across rural America. I 
urge all of our colleagues to join us as cosponsors of the bill.
  I ask unanimous consent that letters of support from both the 
American Heart Association and their Maine affiliate be printed in the 
Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                   American Heart Association,

                                         Augusta, ME, May 3, 2000.
     Hon. Susan M. Collins,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Collins: The State Advocacy Committee of the 
     American Heart Association in Maine commends you for your 
     leadership in sponsoring the ``Rural Access to Emergency 
     Devices (AED) Act.'' As volunteer advocates for the American 
     Heart Association, we are pleased that you have recognized 
     that the placement of AEDs with trained, local, first 
     responders, such as fire and rescue departments, paramedics, 
     police departments and community hospitals in rural areas 
     will make a difference in a person's chances of surviving a 
     sudden cardiac arrest. We are also proud that this bill is 
     being sponsored by a Maine Senator.
       Heart disease is the leading cause of death in the state of 
     Maine, as well as the nation. Early defibrillation is the 
     only known therapy for most cardiac arrests. Each minute of

[[Page S3833]]

     delay in returning the heart to its normal pattern of beating 
     decreases the chance of survival by 7% to 10%. As you well 
     know, Maine's population is dispersed over a large 
     geographical, mostly rural, area. The Emergency Medical 
     Services in our state are excellent, but travel times within 
     rural communities can occasionally be too long to benefit the 
     patient in cardiac arrest. The availability of AEDs and 
     trained local responders should improve the chain of survival 
     for these victims of sudden cardiac arrest. The American 
     Heart Association estimates that the sudden cardiac arrest 
     survival rate can improve from only 5% to 20% when AEDs and 
     trained rescuers are readily available within communities.
       Thank you, Senator Collins, on behalf of the residents of 
     Maine and our fellow citizens in other rural states.
           Sincerely yours,
                                           Gayle Russell, RN, BSN,
     Chair, Maine State Advocacy Committee.
                                  ____



                                   American Heart Association,

                                   Washington, DC, April 27, 2000.
     Hon. Susan Collins,
     Hon. Russell Feingold,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins and Feingold: The American Heart 
     Association applauds your commitment to saving lives and 
     thanks you for your introduction of the ``Rural Access to 
     Emergency Devices (AED) Act.'' The legislation will help 
     improve cardiac arrest survival rates across rural America.
       As you know, heart disease is the leading cause of death in 
     this country. Cardiac arrest, whereby the electrical rhythms 
     of the heart malfunction, causes the sudden death of more 
     than 250,000 people every year. We are fighting this killer 
     with improved technology, including automated external 
     defibrillators (AEDs). These small, easy-to-use devices can 
     shock a heart back into normal rhythm and restore life to a 
     cardiac arrest victim. But, they must be used promptly. We 
     have to act quickly because for every minute that passes 
     before a victim's normal heart rhythm is restored, his or her 
     chance of survival falls by as much as 10 percent.
       Cities across America have begun to recognize the value of 
     fast access to these devices and are making them available to 
     emergency responders. The Rural AED Act recognizes that we 
     cannot and should not leave rural communities behind in this 
     fight to improve survival. Because the first emergency 
     responders on the scene of a cardiac arrest may not always be 
     the medical responders, the Rural AED Act makes resources 
     available to rural communities to purchase AEDs for police 
     and fire as well as emergency responder vehicles. In 
     addition, it provides resources to train these responders in 
     the use of the devices. The bill provides $25 million for 
     this effort to expand access to devices that can save lives 
     across rural America.
       The American Heart Association thanks you for your 
     leadership in the fight against heart disease and looks 
     forward to working with you to ensure the passage of this 
     important legislation.
           Sincerely,
                                       Lynn A. Smaha, M.D., Ph.D.,
                                                        President.

  The PRESIDING OFFICER. The Senator from Wisconsin.
  Mr. FEINGOLD. Thank you, Mr. President.
  Let me first thank the managers for allowing us the opportunity to 
introduce our bill at this time. I especially thank my friend, the 
Senator from Maine, for taking the lead on this issue with me. She is a 
very effective Senator on many issues, and is specially effective, I 
think, when it comes to the concerns of rural people in Maine and 
throughout the country about an issue which is incredibly important--
first aid.
  I also thank the Presiding Officer, the junior Senator from Rhode 
Island, for joining us and cosponsoring the bill.
  I rise today with Senator Collins to introduce the Rural Access to 
Emergency Devices Act. This legislation provides a first step to 
helping save the lives of the more than 250,000 people who die each 
year from sudden cardiac arrest.
  Every two minutes, someone in America falls into sudden cardiac 
arrest--a medical emergency in which the heart's rhythm becomes so 
erratic it can not pump blood to the brain and other vital organs.
  According to the American Heart Association, over 250,000 Americans 
die each year from sudden cardiac arrest. That is 700 deaths each day--
a startlingly large number. Overall heart disease kills more Americans 
than AIDS, cancer, and diabetes combined.
  In my home state of Wisconsin, as in many other states, heart disease 
is the number one killer. Ninety-five sudden deaths from cardiac arrest 
occur each day in Wisconsin.
  These numbers are disturbing by any measure, but they are especially 
troubling because they don't need to be this high. By taking some 
relatively simple steps, we can give victims of cardiac arrest a better 
chance of survival, particularly in rural areas. Cardiac arrest victims 
are in a race against time, and today I'm introducing a bill to 
increase access to defibrillators, that are essential to reviving 
cardiac arrest victims.
  Cardiac arrest strikes its unwilling victims with no warnings or 
indications. In most cases it's all but impossible to predict who will 
have a sudden cardiac arrest, or where and when it will happen.
  Cardiac arrest can strike anyone. When cardiac arrest occurs, the 
victim loses consciousness, has no pulse and stops breathing normally. 
Death often occurs within minutes.
  Cardiac arrest does not discriminate against age, gender, or race. A 
recent issue of Women's Day magazine detailed a number of cases in 
which a variety of people suffered from cardiac arrest.
  The article tells about a 24-year-old woman, a writer for a Seattle 
comedy show, who suffered from cardiac arrest after watching her 
favorite television show. Another victim was a 48-year-old women who 
was out for a birthday dinner with her husband and friend. Yet another 
individual, only 31 years of age, suffered cardiac arrest at his 
computer programing job in Minnesota.

  What these victims have in common is that all three survived. Each 
was saved because a properly trained person was there with an automated 
external defibrillator (AED). These life saving machines are compact, 
portable, battery-operated versions of the machines that were 
traditionally only in the hands of emergency medical personnel.
  Wisconsin's Emergency Medical Services are some of the finest in the 
country. They are effectively trained to identify victims and determine 
when a shock is needed. There are countless stories of quick EMS 
responses that have saved so many lives.
  Unfortunately, for those in many rural areas, Emergency Medical 
Services have simply too far to go to reach people in need and time 
runs out for victims of cardiac arrest. It's simply not possible to 
have EMS units next to every farm and small town across the nation.
  Fortunately, recent technological advances have made the newest 
generation of AEDs inexpensive--approximately $3,000--and simple to 
operate. Because of these advancements in AED technology, it is now 
practical to train and equip fire department personnel, police 
officers, and other community organizations--and that's exactly what 
this legislation would do.
  But let me be clear, I think they are only one part of the so-called 
chain of survival.
  This chart indicates the four crucial aspects of the chain of 
survival, which is a proven method to save lives.
  The first link in the chain is simple: it is vitally important that 
cardiac arrest victims have early access to care. When someone suffers 
from cardiac arrest, it's crucial that bystanders dial 911 to dispatch 
the appropriate emergency personnel to the scene.
  The next link is early CPR--if performed properly, it will at least 
buy a few minutes to perform defibrillation. Let me be clear though, 
effective CPR does not replace defibrillation in saving lives.
  The critical link in the chain of survival for victims of cardiac 
arrest is early defibrillation. Mr. President, each minute of the delay 
in returning the heart to its normal pattern of beating decreases the 
chance of survival by 10 percent.
  The final link in the chain is early access to advanced care--it is 
literally of vital significance. Even after successful defibrillation, 
many patients require more advanced treatment on the way to the 
hospital.
  By passing this legislation, and increasing access to defibrillators, 
we have the chance to strengthen the more important link in the chain 
of survival.
  Communities across America are in dire need of better access to 
defibrillators. Making AEDs widely available so that trained laypeople 
can use them to administer shocks to cardiac arrest victims will go a 
long way toward saving lives.
  In fact, the American Heart Association estimates that over 50,000 
lives could be saved each year if AEDs were more readily accessible.

[[Page S3834]]

  This next chart illustrates a startling statistic I mentioned a 
moment ago--for every minute that passes a cardiac arrest victim is 
defibrillated, the chance of survival falls by as much as 10 percent. 
After only eight minutes, the victims survival rate drops 60 percent.
  Our legislation, the Access to Emergency Devices Act of 2000 takes a 
common sense approach to strengthen this chain of survival. This 
legislation provides $25 million to expand access to devices that can 
save lives across rural America.
  It also provides for training grants to give people the training they 
need to learn how to operate defibrillators.
  And I have learned that training is very important, but also that 
nearly anyone can be taught to make proper use of a defibrillator.
  Cities across America have begun to recognize the value of fast 
access to defibrillators and are making them available to emergency 
responders. This legislation recognizes that rural communities should 
have the same chance to improve cardiac arrest survival rates.
  Because the first emergency responders on the scene of a cardiac 
arrest may not always be the medical responders, our legislation makes 
resources available to rural communities to purchase AEDs for police 
and fire as well as emergency response vehicles--and our bill also 
provides funds for the training that will sustain the lifesaving effect 
of these grants.
  Cardiac arrest can be a killer. But if we give people in rural 
communities a chance, they may be able to stop a cardiac arrest before 
it takes another life. Our bill is a simple and effective way to 
increase the availability of defibrillators, and give rural victims of 
cardiac arrest a better chance of survival, and I look forward to 
working with my colleagues to pass this legislation.
  I yield the floor.
                                 ______