Proliferation of AED technology is altering the long-accepted notion of proper medical care.

While there is no question that sports and recreation facility operators have a duty to provide proper medical attention to facility users, the question of what constitutes "proper" is not always easy to determine. For example, due to the violent nature of football, it is reasonable to have an ambulance and a doctor at a high school game. It would be unreasonable, however, to require a school to have that same ambulance and doctor available at a high school baseball game. Although athletes in both activities can suffer serious injuries, what is considered proper medical care depends on the activities, the age and experience of the participants involved, and the cost of providing the additional medical care. Two factors that can complicate the issue of how much medical care facility operators owe individuals using the facilities are: 1) the presence of older individuals, and 2) recent advances in medical and safety equipment. For instance, when offering activities to an older population, do facility operators have a legal duty to have an automated external defibrillator (AED) and staff capable of using the equipment available at all times? One case that looked at these issues was Rose Colon v. Chelsea Piers Management Inc. [3 Misc. 3d 1221A; 2006 N.Y. Misc. LEXIS 2831]. During an adult evening league basketball game at the Chelsea Piers facility in Manhattan, Victor Hernandez suffered cardiac arrest and collapsed. The facility did not maintain any type of resuscitation equipment or have any medically trained staff working during basketball games. While waiting for paramedics to arrive, various staff members attempted to revive him, but Hernandez was eventually transported to a hospital, where attempts to resuscitate him failed. As a result of Hernandez's death, Rose Colon (his estate's executrix) filed a negligence lawsuit against the Chelsea Piers facility and the league organizers, Basketball City New York LLC. In its defense, the facility and the league argued that they were not liable for Hernandez's death because he assumed all the risks inherent in playing basketball, including suffering cardiac arrest. Under the theory of assumption of risk, if Hernandez voluntarily consented, either expressly or impliedly, to expose himself to a known risk, he and his estate would lose the right to sue for any damages that he might incur from exposure to that risk. In order for Hernandez to have assumed all risk, the court would have to find that: 1) he had knowledge of the risk that he could suffer a cardiac arrest; 2) he appreciated that risk; and 3) he voluntarily exposed himself to the risk. Colon, however, argued that the assumption-of-risk defense did not apply under the relevant circumstances. Specifically, Colon argued that the facility and league were under a duty to maintain on the premises both emergency resuscitation equipment and a staff adequately trained in emergency medical care. Since there was neither such equipment nor medical staff at the facility, Hernandez could not assume the risk of dying from cardiac arrest. In granting the facility and the league's motion for summary judgment, the trial court held that in order to recover damages for negligence Colon must first establish that the facility and the league owed Hernandez a duty to keep and maintain on the premises emergency resuscitation equipment and a staff member adequately trained in emergency medical care. Once such a duty was established, Colon would then have to show that the breach of that duty caused Hernandez's injury. However, the court found there was no evidence that such a duty actually existed. In particular, the court held that while recreational and athletic facilities do in fact owe a general duty to participants, there is no authority for the proposition that the facility and league were required to maintain resuscitation equipment or a medically trained staff during adult league basketball games. Following Hernandez's death in December 2002, the state of New York passed specific legislation requiring every health club in the state with membership of at least 500 persons to have on the premises during all business hours: 1) at least one AED; and 2) at least one individual certified as having completed a course in AED operation and holding a valid CPR certification provided by a nationally recognized organization or association. Therefore, if such a case arose today in New York, the circumstances might be very different. To demonstrate the impact that new legislation can have on health and fitness clubs, a Florida court in March 2006 ruled that LA Fitness in Fort Lauderdale had to pay $619,650 to the family of a man who died of sudden cardiac arrest while working out at the gym. LA Fitness had no AED or staff capable of performing CPR in the facility. The case, which may be the first in the country finding a health club liable for failing to have a defibrillator on site, sends a clear message to the health club industry that club owners need to do a better job of protecting their members in the event of a medical emergency. As Colon demonstrates, due to advances in medical and communication technology, what was reasonable yesterday may not be reasonable today. Therefore, sports and recreation managers need to carefully plan in advance for all possible emergency situations. By so doing, sports and recreation managers should be able to not only assess any and all risks associated with activities offered at the facility, but also evaluate the severity of the injuries that can be expected and the types of emergency care that may be needed. Finally, when making an emergency plan, it is important that sports and recreation managers pay particular attention to such factors as the age and expertise of the people participating in or supervising the activity.