Proposition 53K0416

Proposition de résolution visant à généraliser l'accès public aux défibrillateurs externes automatiques.

General information ¶

Authors

MR Daniel Bacquelaine, Philippe Collard, Denis Ducarme, Damien Thiéry, Valérie Warzée-Caverenne

Submission date

Oct. 19, 2010

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

first aid medicine emergency medical treatment medical device resolution of parliament public health

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP Open Vld MR

Voted to reject

VB

Abstained from voting

∉ N-VA LDD

Party dissidents ¶

• Hagen Goyvaerts (VB) abstained from voting.
• Peter Luykx (CD&V) abstained from voting.

Contact form ¶

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Discussion ¶

June 27, 2013 | Plenary session (Chamber of representatives)

Full source

Mrs De Meulemeester, rapporteur, refers to the written report.

Mr. Speaker, I look forward to the adoption of this resolution and I also thank all my colleagues, French and Dutch, for the very constructive discussion conducted during these debates.

Of course, this resolution has no force of law. In the near future it will need to be implemented. The aim is to ask the federal government to make arrangements, but of course to do so in consultation with the Regions and Communities. Indeed, I call for uniformity in the implementation of this type of apparatus across our entire territory as well as in terms of subsidies.

I have also insisted and I continue to insist on the importance of a contact between the higher levels of power but also with the levels of local authorities, because it is the municipalities that will be able to precisely indicate where these devices will be placed, where they are needed and the quantity that will be requested.

Sure, these devices are expensive, but what is the cost of a device when it saves a life? It is above all about this that we will have to talk about and think about because, under no circumstances, the problem of cost should take over what they are intended for: saving lives.

We will remain vigilant with regard to the discussions that will take place in the coming months so that municipalities are contacted as soon as possible for the implementation of all these devices with the help of the federal.

This resolution is partly a missed opportunity for our group. Rapid intervention in heart failure is crucial for the survival of the patient. That defibrillators play a role in this, nobody denies. However, scientific research shows that a solid knowledge of first aid is just as important, if not more important.

In addition, research from the FOD Public Health shows that most people do not dare to use a defibrillator, if they already know when to use it. Investing in awareness is therefore at least as important as investing in the devices themselves. That this aspect is missing in the text is a missed opportunity.

Also, the fact that the federal government, unlike the Flemish government, will not be asked to place defibrillators and that for this only a strategic plan is drawn up, is a missed opportunity.

If the submitters of the resolution proposal really want to invest in a better spread of the aircraft, it seems to us necessary that they ask the federal government to take its responsibility.

In short, the resolution proposal for our group is too unilateral. It will not ⁇ the intended. That is why we will abstain.

Mr. Speaker, Mr. Minister, Mr. Colleagues, in Belgium, the number of people who suffer from cardiac arrest outside the hospital is estimated at 10,000 each year. We all know that the chances of survival are even greater when one is able to quickly restore the normal rate of fibrillation.

In case of cardiac arrest, if there is no immediate and adequate intervention, a progression to a fatal outcome is often inevitable. The concept of the survival chain is and remains the model to be followed. It consists of identifying the different actions that increase the chances of survival of patients with cardiac arrest. The survival chain consists of four links: recognition - early warning - early, early basic cardiopulmonary resuscitation by early witnesses, early defibrillation, specialized resuscitation. These four complementary links must be subject to special and constant attention.

Following our analysis, we believe that the early defibrillation axis can and should continue to develop in our country. This is the subject of this proposal for a resolution that my colleagues from the MR group and I have submitted for discussion in a committee, a proposal that was adopted by a large majority.

Remember first that external automated defibrillation is safe and improves the prognosis of cardiac arrest. It should be done as early as possible. It is estimated that in the absence of defibrillation, the chances of survival, after a cardiac arrest due to ventricular fibrillation, decrease by 7 to 10% per minute.

To date and although there is an increasingly marked public interest in these devices, 2,300 automatic external defibrillators category 1 are registered with SPF Public Health for the whole of our country. We do not have a clear indication on their accessibility to the public. There may indeed be many private initiatives, including companies and/or certain sports centers, but these devices are not accessible to everyone.

One objective of this resolution proposal is to establish a publicly accessible cadastre of external automatic defibrillators and to publish it on the SPF Public Health website. Then, starting from this cadastre, it would be important – this is the second goal of the resolution proposal – to identify with the collaboration of the provincial commissions for urgent medical assistance, the strategic places where the installation of a defibrillator would be recommended.

It is thought of areas removed from a hospital or not allowing the rapid intervention of the SMUR. We all know that in some rural areas, access to medical care is not always guaranteed.

Furthermore, given our institutional landscape, it is clear that this type of initiative must be taken in collaboration with the Communities and Regions as well as with all relevant actors – thus also municipalities and provinces.

We think of the places within their competence – schools as well as sports and cultural centers – but also the information and training of the public in first care. Indeed, I recall that the use of an automatic defibrillator is inseparable from the emergency medical assistance offered by the service 100 and basic rules in terms of first aid.

We already have a very precise legal framework, since the special law of June 12, 2006 allowed the use of external automatic defibrillators by non-physicians. In addition, the Royal Decree of 21 April 2007 set the safety standards applicable to automatic defibrillators used during resuscitation. Finally, a circular of SPF Public Health regulates the implementation in the emergency medical care chain of external automatic defibrillators in public places.

We believe that there are priority actions to be taken to complement this framework. I mentioned the establishment of a cadastral of publicly accessible external automatic defibrillators and the identification of strategic places where it would be recommended to install them.

Mr. Speaker, Mrs. Minister, colleagues, I would also like to take this opportunity to sincerely thank the colleagues who submitted the draft resolution for the effort made to put it on the agenda and thereby to draw attention to the importance of a generalized public access to automatic defibrillators.

No one can deny that these devices in some circumstances can perform a very good function and can be life-saving. They therefore absolutely deserve the necessary attention and publication, not only from the general public and the voters, but above all also from the local authorities, from the organizers of mass events and sports events, from the operators of airports, amusement parks, schools, sports halls, old-age homes and so on.

It would indeed be advisable for the government to draw up and publish a register of the automatic external defibrillators accessible to the public.

When I’m talking about government, I’m talking about local governments and the Communities and Regions, not about the federal government or the FOD Public Health, as proposed in the proposal. After all, the provision of defibrillators is a preventive measure, a measure to prevent a person from dying from a heart attack. This is pure community competence. It can be regretted, but this is now legally stipulated in Article 5, § 1 of the Special Law of 8 August 1980 on the Reform of the Institutions.

Colleague Thiéry regrets this, because he would have wished that all Belgians were equal when they were affected by heart failure. It sounds very nice, but it is not so. This is ⁇ stated in our Constitution, which has been the first official Dutch-language version since 1967. It states that all Belgians are equal before the law.

Article 1 of Title I of the Constitution states, however, that BeIgie is a federal state composed of communities and regions. As a result, not all Belgians are equal before the law.

I can give a few examples of this and I don’t even have to go looking for it. I think of the federal parliament. At the elections of 13 June 2010, my Flemish colleagues needed 44 927 votes for a seat, while the French-speaking colleagues needed 36 413 votes. That is about ten thousand fewer. If the Dutch speakers and the French speakers were treated equally, we were here today with 92 Flemish and 58 French speakers instead of 88 Flemish and 62 French speakers now.

For example, one could easily form a government without a majority on the Flemish side. This has then been usefully used to discriminate the Flamings even more, among other things in the reform of the judicial district Brussel-Halle-Vilvoorde approved during this legislature, in which it has been introduced that only a French speaker in Brussels can ascend to the highest office of Prosecutor des Kings. A Fire is excluded from this post. All Belgians are not equal before the law.

We live in a federal state and that is a minimum requirement to allow each community in relation to personal matters to make its own decisions, carry out its own policies and also be held accountable for the policies being carried out, including for preventive health policy and the placement of automatic external defibrillators, and everything associated with it. I think of maintenance, repair, information and training.

Mr. Speaker, could we ask Ms. De Bont to focus on the resolution as such: it is in the interests of the people. I find that, as in many cases, the community comes back to the surface when someone wants to do so.

You find that c'est proprement inadapté, c'est inadequat, ce n'est pas le moment. Here, we talk about the automatic defibrillators for which I simply demanded that all the population be placed on a foot of equality to resort to this type of device destined to save the dirt. The point.

Mr. Thiéry, you inspired me to what I said. I have given just a few examples to prove that not all Belgians are equal before the law.

I have now come to the topic, namely the defibrillators. The competence in this regard lies, in my view, at the level of the Communities. I just said that the installation of defibrillators is not enough. They must also be used. If not, it looks like the mass purchase of environmental boxes. A lot of money has been invested in it, but nothing has been done for it. Defibrillators should be used. Providing the necessary training and information is a Community competence.

The Communities must make a choice in this regard, because the resources are limited. They must be able to make that choice. Is therefore the provision of universal access to EHBO courses not a full-fledged alternative? It would also be possible to offer a decent EHBO training, including heart massage, to all pupils during school training. These are choices that must be made, but they are within the competence of the Communities.

Where should the defibrillators be placed primarily? That is another choice that must be made. I understand that colleague Warzée thinks of some regions of the country, rural and semi-rural areas and/or areas with little medical facilities, but according to a recent American study published in Clinical Cardiology, automatic external defibrillators are only cost-effective in places with a high concentration of potential victims and potential rescuers.

In addition, they require a significant investment. A few defibrillators will not be enough. Indeed, in times of scarcity and savings at all levels, at all policy levels, often difficult choices have to be made. Only at the local level and at the Community level can a sound, rational and efficient policy relating to defibrillators and other life-saving practices be pursued.

That is what I wanted to do, Mr. Thiery. As I said, I appreciate the effort that has been made to highlight the life-saving aspect of defibrillators, but the Flemish Interest Group cannot support the proposed resolution. The Flemish Interest cannot tolerate that the federal government goes beyond its competence, throws general resources over the bar and continues to play the mother-in-law of the community governments.

Unfortunately, this issue is still topical. A couple of days ago, a twenty-two-year-old athlete died on a football field. According to the doctor who intervened, the presence of a defibrillator could have saved the life of this young man. The activities of the sports club are underway.

It can be hoped that, through awareness and accountability of competent authorities, the number of defibrillators accessible in public places will continue to grow. On the whole Belgian territory, there were 65 aircraft of this type in 2007 and 726 last year; today there are more than 2,000. The more these devices will be, and the more people will be aware of their employment and first aid gestures, the greater the chances of saving lives will be. This is the aim of this resolution, which my group will support.

Mr. Speaker, I would like to thank all the colleagues who led the debate on automatic defibrillators. Indeed, I am convinced that we must continue to increase the number of defibrillators, because they save lives.

As for training, courses related to the automated external defibrillator are already given by provincial schools under the auspices of SPF Health.

The registry, on the other hand, already exists and is held by the SPF Health.

As for the identification of the locations, this work could indeed be entrusted to the Commission for Emergency Medical Assistance (COAMU).

Finally, for the elements included in the resolution in points 4, 5 and 6, I will ask my administration to work on the follow-up of this excellent resolution.