Proposition 51K1566

Projet de loi concernant l'utilisation des défibrillateurs automatiques "externes".

General information ¶

Authors

Open Vld Yolande Avontroodt, Maggie De Block

Submission date

Jan. 24, 2005

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

first aid medicine emergency medical treatment medical device public health

Voting ¶

Voted to adopt

CD&V Vooruit Ecolo LE PS | SP Open Vld N-VA MR FN VB

Contact form ¶

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Discussion ¶

Feb. 23, 2006 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, Mr. Minister, dear colleagues, the Public Health Committee on this 7 February 2006 examined a bill authorizing the use of automatic defibrillators by non-medicines.

Avontroodt, lead author, states that the proposal to be considered aims to allow the use of external automatic defibrillators by people who have not completed medical training. He said that for the time being it is reserved for doctors. It also draws attention to the fact that today there are devices that no longer require the interpretation of the patient’s situation before deciding whether to defibrillate or not. by

The author reminds that in Belgium, 10,000 people suffer from cardiac arrest each year, which is a significant incidence. The immediate calling of ambulances and the immediate start of basic resuscitation has the effect of increasing by 10% the chances of survival of the patient victim of ventricular fibrillation observed in 80% of cases. by

The treatment of this fibrillation consists of the administration of electric shocks using defibrillators. In a number of neighboring countries, external automatic defibrillators have already been placed in public places. The correct use of these defibrillators by people present on the site can save lives. Today, use by people who have not completed medical training is not legal.

The defibrillator has the advantage of reducing the time interval between cardiac arrest and the start of basic resuscitation, which obviously significantly increases the patient's chances of survival.

The author points out that at the moment, defibrillators are already found on board planes and in gyms. by

The authors also note that they want to ask the minister to extend as much as possible the placement of defibrillators in ambulances. Currently, almost 50% of hospitals are equipped with defibrillators. by

They also call for public awareness to encourage them to take first aid training in the event of an accident and to include the use of defibrillators in this training. In addition, this proposal is supported by professional and scientific associations. by

During the general discussion, Mr. Verhaegen supports the bill. It has no medical arguments that justify that only doctors can resort to the defibrillator. It emphasizes, however, that it is important that users of these devices receive appropriate training.

As for mr. Drèze, a representative of the CDH, is also in favor of the proposal.

President Yvan Mayeur, for the PS Group, in principle adheres to the proposal. However, it questions the ability of each to use this device and the responsibility of the user. by

Is it possible to misuse a defibrillator and what can be the consequences of misuse?

Ms. Avontroodt specifies that the non-medical use of this device could not be considered as the non-assistance to anyone in danger and stresses that it is the responsibility of the King to determine the conditions and, in particular, the mode of use and the criteria relating to the maintenance of the defibrillator.

When it comes to the programming of the device, it is necessary to comply with international directives. If the devices no longer comply with these directives, the manufacturer is responsible. The responsibility of the defibrillator is obviously the manufacturer and not the person who misuses the device.

Ms. Colette Burgeon, on the other hand, considers that it is appropriate to frame the sale of this type of device. For my part, Mr. Speaker, I also supported the bill on behalf of the MR group and recalled that defibrillators can be used safely. The device itself shows the steps to follow and indicates if and when a shock is administered. I also recalled that in the province of Liège, these devices were already installed in public places, especially since this equipment is easy to use.

The Minister, on the other hand, subscribes to the bill to be examined and highlights, in particular, an important point relating to responsibility. This is double: in addition to the responsibility of the manufacturer, the one who acquires a device must ensure that the maintenance and proper operation of the defibrillator is ensured.

Prior to the vote, the Speaker stressed that the first paragraph of Article 2 was misformulated and proposed that the committee mark its agreement on a technical modification. The articles are successively adopted unanimously and the entire draft, as corrected in terms of legal technique, is adopted unanimously.

Ms. Avontroodt is the only one registered in the general discussion. Ms. De Block has been commissioned abroad and therefore validly apologized.

Mr. Speaker, Mr. Minister, colleagues, creating a legal basis for the use of defibrillators – devices that restore the normal pump operation of a heart that goes into cardiac arrest because it vibrates or fibrillates – is, in my opinion, a very big step forward. I would like to thank my colleagues from various political groups and the Minister for supporting and making this possible.

By the way, there is already a legal basis in other countries such as the Netherlands and France, where even several cities and municipalities were made heartsafe.

The purpose of the bill is very simple. It is an extension of the basic resuscitation that can be performed by anyone today. It is intended to save the ten thousand victims of cardiac arrest that are there every year in our country. Of these, more than 80% are victims of fibrillation, of a heart that vibrates, which does not function normally and does not have a pump effect. By administering an electrical shock, the pump function of the heart can be restored.

The particular thing about this is that this act was justified up to several years - exclusively reserved for medical skilled, for doctors. Thanks to this bill, everyone will have the opportunity to be saved by the proximity of such equipment. This will be made available by the ambulance services and will be present in the ambulance cars.

At the beginning, when we submitted our bill, 50% of the ambulances were equipped with such a device. Mr. Minister, you said that this is 75% today. I hope you can say before the end of the year that all ambulances will be equipped with such a device. After all, then there will be a legal basis and ambulances, rescue workers and firefighters will no longer be in a situation as it is now where they act in an illegal way to save lives.

The purpose is very clear: laying a legal basis so that this is not seen as a medical act, but as an act of basic resuscitation. This equipment can and will of course only be handled when a heart is fibrillating.

This is the case in 80% of cases of cardiac arrest.

We didn’t go ice overnight. The proposal did not come simply. It was preceded by a very broad round of consultations, not least at European level. We have followed the recommendations of the European Society of Cardiology and the European Reanimation Council, which are also requesting parties to implement this in all countries of Europe.

The importance is very clear. Each minute wasted by applying a defibrillator to a victim of a heart fibrillation reduces the chances of life by 10%. When one knows that one has only a few minutes before one can enter a lethal phase, there is no need to argue that every minute can be life-saving.

There are four large axes. First, the legal basis strengthens that anyone can do it. Rightly, many colleagues have asked this question. Can it just? Is this dangerous? Is there a risk? Is there a question of responsibility?

This is the second point that we regulate with the legislation. We place the product responsibility on the manufacturer. This is clearly enshrined in Article 2 of the law and it is the Minister who will have to make an implementing decision in this regard. I think the device in the first place will need to be placed where a lot of people gather and where there are risks. Mr. Speaker, I do not think that the Chamber is a risky place, but nevertheless. I ⁇ ’t just throw away the idea.

The room has a big heart, Mrs.

That’s true, but because in the Room the emotions can sometimes accumulate, some people are still at risk of cardiac arrest, although I hope not.

We also have good members, who are doctors.

I think it would be an excellent example if the Room were also equipped with such a device.

Where I want to go is that our minister also puts responsibility on those who place the devices, by analogy to what happens when placing fire extinguishing devices. You cannot simply install a device. Of course, the conditions of control and maintenance must also be met.

This is the second leak.

In our text, of course, we also advocate for a greater base, a greater support for training. I also checked how many people in Flanders today already have a certificate of aid provider. I do not only think of the many volunteers from organizations such as the Red Cross, but also the legally provided emergency workers, the so-called industry assistants or those who are patent holders of urgent assistance at the workplace.

Mr. Minister, we are actually doing well in our country. In the private sector alone, there are no less than 50,000 people with training in the workplace. If we extrapolate that to Flanders, it means that in Flanders 1 in 100 people already has knowledge of urgent assistance and thus has mastered the basic resuscitation. This is hopeful. I can assure you that both students and teachers in certain sectors such as the high-risk sports — I mean deep-sea diving, but also athletics, football and swimming — have a large level of support to master this technique. After all, it is a technique with a low threshold because everyone can use the device. After all, because they are automatic devices, there are no risks associated with them and only life-saving actions can be taken. Their

I would therefore like to make a plea here, Mr. Minister, - and I will address a question in that sense to the Minister responsible for employment - to give, in addition to the obligation of 1 aid provider per 20 industrial workers, 1 per 50 non-industrial workers and 1 per large site where many workers are present, also the necessary attention to a regulation that works stimulating and raising awareness, so that even more people would follow such training. I think it would be very useful to provide in this training also in the final terms of education. We note that one wants to include automotive lessons in the final terms. I therefore think that emergency care courses can ⁇ be valuable for a young audience who can take that experience and expertise with them for the rest of their lives.

In conclusion, Mr. Speaker, I would like to thank the colleagues for their support for the bill. I think I can do this especially on behalf of the many potential victims who can now expect a life-saving action by a citizen, thank you for that.

Mr. Speaker, I hope that we will be the first, as soon as possible, to have such a device available in this Chamber.

The room has excellent doctors. I think not only of the doctors attached to parliament, but also of the members of our assembly.

Mr. Speaker, I would like to thank the House for continuing to care about heart problems and to do so effectively, nine days after Valentine’s Day!

The text that is proposed to you is based on an evolution in the knowledge of science and technology which has recently been confirmed by the two major international councils that look at cardiology problems: the "European Resuscitation Council" and the "American Heart Council". Both, as of December 2005, acknowledged the virtue of the use of defibrillators in the circumstances of which it has been sufficiently talked to this tribune.

I would just like to draw attention to the fact that five minutes of delay can cost 10 to 15% of additional mortality. It is therefore necessary to intervene within short timeframes.

I had initially attempted, by means of a ministerial decree, to make a modification of the scope of the royal decree 78. But the State Council considered that the legal basis was insufficient. I am therefore pleased — and I congratulate the authors — that the House has been able to address this problem.

I will not make any more literature on this subject. I would simply like to return to the main question that was raised in this debate: are the texts of implementing decisions being prepared? Where are we? When can their implementation take place?

I had a contact, now about twenty minutes ago, with the administration. The latter assured me that, on 21 March, these texts will be deposited with the Financial and Economic Affairs Inspectorate. In other words, if we respect the deadlines, we could have these texts at the end of this parliamentary session or at the latest at the beginning of the next session. We will thus be able to fulfill the heartwish of our colleague Mrs Avontroodt to have the faculty, before the end of this calendar year, to cover all those who use defibrillators without having to prove the possession of a doctor's title.