EMS Insider, Legal Consult

Duty to Use AED

Previous articles have addressed the issue of whether a health club is required to provide an AED, and whether a “big box” store (such as Target or Walmart) is required to so.1 Although courts in general have been unwilling to find a legal duty for a business to have an AED on hand, the Florida Supreme Court recently ruled that a school owes a duty not only to have an AED available at athletic events, but also to supervise its students and to take reasonable measures to aid an injured student to prevent aggravation of injury. This tragic case resulted in severe brain injury to a student athlete.


In general, a party does not have a duty to take an affirmative action to protect or aid another. However, if a “special relationship” exists, such a duty may be created and the law will require the party to act as a reasonable person toward the injured party.


In this case, a 15 year old male collapsed during a high school soccer game at a high school other than his own. Although his coach immediately came to his side, he quickly went into cardiopulmonary arrest. EMS was summoned and the coach and a parent who was in the stands who was a nurse began CPR. The coach testified that he yelled for an AED, which he was trained to use. The host school’s AED was located in a facility at the other end of the soccer field, but somehow was never brought onto the field to the coach who requested it.


EMs responded approximately 10 minutes later and used their AED without success. Paramedics arrived and began ACLS resuscitation measures. They worked on the boy for 26 minutes, ultimately obtaining return of spontaneous circulation (ROSC). The patient survived, but with a serious anoxic brain injury that put him in a near persistent vegetative state. He will require full-time care for the rest of his life.


The boy’s parents filed suit against the school board and presented physician expert testimony demonstrating that although the boy suffered from a previously unknown heart condition, had an AED been used earlier, the anoxic brain injury would not have occurred. The trial court initially granted summary judgment in favor of the school board, and the Second District Court of Appeal affirmed. The courts found that Florida requires all public schools participating in the Florida High School Athletic Association to acquire an AED and train personnel in its use. The statute further requires the school to register the AED’s location with the local EMS.


The Florida Supreme Court reversed and remanded the case for trial. The “special relationship” between a school and its students exists because during the day and during school-sponsored activities, the school has a duty to supervise students even if the activity occurs in a location other than the school itself, such as an athletic event at another school. The standard of “reasonable care under the circumstances” applied.


The court discussed what the “reasonable care under the circumstances” standard means in this context, finding that it is a standard that may fluctuate with time, the student’s age, the activity, the extent of the injury, the available responders and other facts that may influence what is required.


The court made five specific findings about the legal duty of a school: (1) a school must adequately instruct student athletes; (2) a school must provide appropriate equipment; (3) schools must reasonably match participants; (4) a school must adequately supervise an athletic event; and (5) a school must take appropriate measures when a student is injured to avoid aggravation of an injury.


The court further addressed whether the school enjoyed immunity under the Cardiac Arrest Survival Act. The act, similar to those enacted in many states to provide immunity for rescuers who attempt resuscitation of cardiac arrest victims, provides immunity for harm resulting from the use or attempted use of an AED. The court said that simply purchasing an AED or having one available is not enough to trigger the immunity. Instead, immunity is provided only from harm that can result when an AED is actually used, or its use attempted. In this case, the court found that an AED was not used until the arrival of EMS.


Limones v. School Dist. of Lee County, 2015 WL 1472236 (Fla. April 2, 2015) (not designated for publication).


1. Maggiore W. AEDs in big box stores. EMS Insider. 2014;41(10):7–8.