Each year, more than 250,000 Americans die from sudden cardiac arrest. According to medical experts, the key to survival is timely initiation of a "chain of survival", including CPR (cardiopulmonary resuscitation). Because of recent technological advances a portable lifesaving device, called an "automated external defibrillator" or "AED" has recently become an important medical tool. Trained non-medical personnel can use these simplified electronic machines to treat a person in cardiac arrest. The AED device "guides the user through the process by audible or visual prompts without requiring any discretion or judgment."1 The American Heart Association notes that at least 20,000 lives could be saved annually by prompt use of AEDs. Ultimately, with broad deployment of AEDs among trained responders, as many as 50,000 deaths due to sudden cardiac arrest could be prevented each year.
2013 Federal Update: FDA Seeks to Toughen Defibrillator Regulations, the New York Times, March 22, 2013 BY Sabrina Tavernese. "The devices, which can be found in malls, airports, casinos, churches in addition to medical settings, re-establish cardiac rhythms in patients whose hearts have abruptly stopped or lost their regular beats. Such cardiac arrests kill as many as 400,000 people a year in the United States, according to the American Heart Association, more deaths than caused by Alzheimer’s disease, diabetes and accidents combined. There have been 45,000 reports of the devices failing or malfunctioning since 2005, agency officials said. The vast majority of them were due to manufacturing problems, officials said, but some were because of improper maintenance, such as battery failure. Manufacturers have recalled the devices 88 times in that period."
Advocates of this approach envision placement of AEDs in public buildings, transportation centers and even large offices and apartment buildings. Meanwhile, the commercial market has expanded substantially, with machines that once sold for $3,000 and up now advertised at under $1,000 for small office, personal or home use.
State Legislators have become actively involved with this issue in the past six years. Most commonly, the recent state laws encourage broader availability, rather than creating new regulatory restrictions. Most of the bills enacted from 1997 to 2001 included one or more provisions to:
- Establish legislative intent that an "automatic external defibrillator may be used by any person for the purpose of saving the life of another person in cardiac arrest."
- Encourage or require training in the use of AED devices by potential users.
- Require AED devices to be maintained and tested to manufacturer's standards.
- Create a registry of the location of all such defibrillators, or notification of a local emergency medical authority.
- Allow a "Good Samaritan" exemption from liability for any individual who renders emergency treatment with a defibrillator.
- Authorize a state agency to establish more detailed requirements for training and registration.
Florida was the first state to enact such a broad public access law in April 1997 (Chapter 34 of 1997). As of 2001, all fifty states, listed below, had enacted defibrillator laws or adopted regulations.
In 2003, Utah updated its AED law by establishing a statewide registry; while Virginia updated AED laws by deleting the requirement for registration. Alabama, Alaska, Colorado, Connecticut, Indiana, Kansas, Nebraska, Nevada, Tennessee and Texas also changed or expanded their AED laws.
In 2004, AED laws were changed or expanded in Connecticut, Florida, Hawaii, Idaho, Illinois, Louisiana, Maine, Michigan, Missouri, New York, Ohio, Oklahoma and Rhode Island. The Illinois law (H. 4232) requires every physical fitness facility to have at least one AED on premises, by mid-July 2006, with exceptions.
In 2005-06, Maryland added a requirement that every high school and school-sponsored athletic events have an AED available. California required health clubs to have at least one AED. Florida authorized state and local police vehicles to carry an AED. Indiana and Virginia repealed filing and training requirements. New York required places of public assembly to maintain an AED. Oregon updated Good Samaritan protection for trained AED providers, employers, property-owners and sponsoring agencies. Arizona, Colorado, Florida, Illinios, Maryland, Massachusetts, Nebraska, New Jersey, Pennsylvania, and Wisconsin also enacted AED laws.
In 2007, Texas added a requirement for AEDs not approved for over-the-counter sales.
In 2008 laws were enacted in Georgia, Idaho, Illinois, Indiana, Iowa, Massachusetts, New Hampshire, New York, South Carolina, Tennessee, West Virginia, Wisconsin and the District of Columbia (as of July 8, 2008).
In 2009, Illinois added dentist offices; Kansas and North Carolina expanded access by allowing "any person to use an AED.
In 2010, Arizona, Idaho, Maryland, Missouri and Oregon enacted laws to assure that program facilitators, individuals, businesses and entities that place AEDs in their establishments are afforded appropriate immunity. Maryland and Missouri’s new laws also guarantee protections to lay rescuers who in “good faith” use an AED when working to save someone from sudden cardiac arrest. Iowa and Wisconsin require all high schools students to be offered life-saving CPR training. These trainings must offer psychomotor skill development, which help ensure critical hands-on course work will be offered. Arkansas secured $300,000 to fund a Medical Emergency Response Planning in Schools program to assure that the AEDs are placed appropriately and school staff is trained properly. (adopted from AHA materials).
A 2011-12 AED Legislative Snapshot
As of January 2012 there were a total of 56 state bills pending or recently passed which specifically relate to Defibrillators (AEDs) and Cardiac Arrest. They relate to a variety of subjects: training in the workplace, schools, and medical facilities, availability of Defibrillators (AEDs) in gyms, places of work, schools, government buildings, community centers, golf courses, public areas, and medical facilities, a declaration of Cardiac Awareness Month, emergency actions plans of school districts to include Defibrillators (AEDs) in their emergency plan equipment, immunity from civil liability for the use of Defibrillators (AEDs) in good faith during an emergency, and tax credits for the cost of purchasing Defibrillators (AEDs).
States with pending or newly passed legislation include Illinois, New Jersey, Pennsylvania and Virginia.
TABLE 1: AED Required Use and Placement
| AED Location
|| States Requiring or Supporting AED Placement
||California "urges" K-12 schools to implement AED programs (2005), Colorado (donations), Florida, Georgia (2008), Illinois, Iowa (2010), Maryland, Michigan, Nevada, New Jersey (2012), New York, Ohio, Pennsylvania, South Carolina (2008), Virginia and Wisconsin (2010) require some schools to have portable defibrillators; actual extent varies. Tennessee "encourages" placement in schools (2008.)
| Health Clubs
|| California, Illinois, Indiana (2007, 2008), Massachusetts (2007), Michigan, New Jersey, New York, Pennsylvania (2012), Rhode Island and the District of Columbia (2008) laws now require health clubs to have at least one AED. Definition example (Michigan): "Health club" means an establishment that provides, as its primary purpose, services or facilities that are purported to assist patrons in physical exercise, in weight control, or in figure development, including, but not limited to, a fitness center, studio, salon, or club. A health club does not include a hotel or motel that provides physical fitness equipment or activities, an organization solely offering training or facilities for an individual sport, or a weight reduction center.
| Day Care Centers
|| Wisconsin (2008 - requires day care center personnel to have AED proficiency)
| Dental offices
|| Illinois (2009), Wisconsin (2008- requires dentists to have AED proficiency.)
| Places of Public Assembly
|| New York (2006)
| Swimming Pools
|| New York (2008)
Congress Acts on AEDs
In 2002, Congress incorporated the Community Access to Emergency Devices Act (Community AED Act) into H.R. 3448 of 2002(sections 159, 312 and 313) of the Public Health Security and Bioterrorism Response Act. The President signed the bill on June 12, 2002 as Public Law 107-188. The provisions authorize $30 million in federal grants in year one of the five-year measure. The grants, to be made available to applying states and localities, would be used for the purchase and placement of automated external defibrillators (AEDs) in public places where cardiac arrests are likely to occur. Grant funds would also be used to train first responders to administer immediate life-saving care, including AED use and cardiopulmonary resuscitation (CPR). The bill also encourages private companies to purchase AEDs and to train employees in CPR and emergency defibrillation.
Related NCSL Article: High Cost of Safe Sports, SL Magazine, July 2009
This 50-state table is provided for reference only. It was current when produced, but is no longer maintained and may now be outdated. Revised 2010.
Visit this page for current NCSL health information.
Notes: The following references are to signed, enacted legislation in the 50 states. They reflect examples and actions at a particular time and are not intended as a comprehensive review of history and current statutes. Law citations in color are links directly to bill text or summaries on state legislative web sites.
AED stateAction: Commercial Publication
A company named AED Brands Inc. has compiled an AED State Laws and Legislaton report, posted on a public website. It includes this instruction and list:
NOTE: NCSL provides links to other websites from time to time for information purposes only. Providing these links does not necessarily indicate NCSL's support or endorsement of the site.
- A = allow lay persons to use AEDs; terms and conditions
- L = provide limited immunity for trained lay persons under state Good Samaritan law.
- M = mandated or required installation
- $ = funding and distribution
- T = mandatory training of employees or students
The box allows you to conduct a full text search or use the dropdown menu option to select a state.
Congress Acts on AEDs: In May 2002 President Bush signed into law the Community Access to Emergency Devices Act (Community AED Act) within H.R. 3448 (sections 159, 312 and 313) of the Public Health Security and Bioterrorism Response Act. The President signed the bill on June 12, 2002 as Public Law 107-188. The provisions authorize $30 million in federal grants in year one of the five-year measure. The grants, to be made available to applying states and localities, would be used for the purchase and placement of automated external defibrillators (AEDs) in public places where cardiac arrests are likely to occur. Grant funds would also be used to train first responders to administer immediate life-saving care, including AED use and cardiopulmonary resuscitation (CPR). The bill also encourages private companies to purchase AEDs and to train employees in CPR and emergency defibrillation.
On Nov. 13, 2000 President Clinton signed the federal "Cardiac Arrest Survival Act", in H.R.2498, now Public Law 106-505, regarding the placement of AEDs in federal buildings and providing civil immunity for authorized users. If a Good Samaritan, building owner, or renter acts in good faith to purchase or use an AED to save a life, this law will provide protection from unfair lawsuits. It appropriates $25,000,000 for fiscal years 2001 through 2003 for local grants to purchase AEDs. The federal bill does not preempt state laws on immunity. Many of the 49 states with existing laws cover additional issues not addressed in this bill. U.S. Rep. Cliff Stearns (R-FL) and 132 cosponsors sponsored H.R. 2498.
The Aviation Medical Assistance Act, Public Law 105-170, was the first federal law addressing the positive use of AEDs, signed April 24, 1998 by President Clinton. It declares that air carriers and individuals "shall not be liable for damages" in attempting to obtain or provide assistance on airplanes. It directs the FAA Administrator to "evaluate regulations" and decide on future required use of AEDs on passenger aircraft and in airports.
Disclaimer: The descriptions of state laws provided in this memorandum are abbreviated for ease of use. Use the links or citations to full text of the laws for a more complete understanding of individual state's laws and procedures. NCSL is not responsible for interpretation or local application of these laws and regulations.
Definitions - cardiac arrest or heart attack?
Sudden cardiac arrest occurs when the heart fibrillates - a chaotic, abnormal electrical activity of the heart -- which causes the heart to quiver in an uncontrollable fashion. The person loses consciousness very quickly and unless the condition is reversed, death follows in a matter of minutes. Heart attack, on the other hand, occurs when the blood supply to part of the heart muscle itself is severely reduced or stopped because of an obstruction in an artery. A heart attack can trigger sudden cardiac arrest, but they are not the same things.
Mixing up the terms "heart attack" and "cardiac arrest" is quite common. In the media, reporters often misreport people dying from a "massive heart attack." Chances are, the reporter is actually referring to sudden cardiac arrest. Making the distinction is important because, while both heart attack and cardiac arrest are medical emergencies, a person suffering cardiac arrest literally has minutes to live and responding with an AED within those minutes will mean the difference between life and death for the victim.
Source: American Heart Association, 1999
1 - CT: Quote from summary of CT S 318 of 1998.
2 - WA: "Final Bill Report, SHB 2998: Synopsis as Enacted" Washington State Legislature.
3 - DE: The Delaware Health & Social Services, Division of Public Health, Office of Emergency Medical Services promulgated: "The Delaware Early Defibrillation Program Administrative Policy", Protocol revised 5/6/98. §9 Provider Training Program "shall be under the direction and supervision of the American Heart Association".
For a more detailed discussion of the medical and social implications of this issue see "Is It Time for Over-the-Counter Defibrillators?" by Mickey Eisenberg, M.D., and "The Shocking Truth about AEDs" by Jeremy Brown, M.D., both published in JAMA, September 20, 2000.
- American Heart Association/American Stroke Association Contact: Jill Birnbaum, email@example.com, AHA National Advocacy Department, Minneapolis 952-278-7902.