On 6 April, the Church of England tweeted “Did you know that hundreds of our churches have free Wi-Fi, defibrillators, post offices or a cafe? Find your nearest to visit this week by visiting http://AChurchNearYou.com“. The apparent nonsense of this “catch-all tweet” was captured by Archdruid Eileen (a.k.a. the Revd Gary Alderson) in the Beaker Folk of Husborne Crawley post Go to Church, Have a Cardiac Arrest. Nevertheless, the installation of defibrillators on church premises has been identified as an important issue for the Church, and in practice, this raises questions regarding their approval within the faculty jurisdiction, and issues of training and maintenance.

Background

The Church of England in Parliament reported

“on 24th June 2014, Lord Storey led a short debate in the House of Lords, to ask Her Majesty’s Government what action they will take to ensure that all schools, sports clubs and public service buildings have defibrillators as part of their first-aid kit provision. The Bishop of St Albans, the Rt Revd Alan Smith spoke during the debate, and expressed his desire to see a greater number of defibrillators in public spaces including churches and church halls. The Bishop commended the work of charities such as the British Heart Foundation and the Community Heartbeat trust as well as the efforts of the community first responders”.

The full debate is reported here.

Faculty authorization

Despite the availability of automated external defibrillators (AED) in “hundreds of churches”, petitions for their installation seldom, if ever, are reported in consistory court judgments. However, as will be gathered from the following brief review of the available information, this is not entirely surprising. The factors to be considered vis-à-vis faculty authorization are: whether the AED is to be sited inside the church or on a wall within its curtilage; the grade of the church; and any ancillary work that might be necessary.

It might be argued that If located in a “vestry or similar room”, their installation could be regarded within the category of “introduction… of…minor fixtures”? [List A1(9)], and would not require a faculty; however this might be stretching the meaning of a “minor fixture” too far, and furthermore, such a location might not be best for optimizing their potential use.

The Diocese of Lichfield gives the following advice in its document “Do your proposals require faculty permission?“, as a consequence of its  Additional Matters Order,  made pursuant to Section 18C (1) of the Care of Churches and Ecclesiastical Jurisdiction Measure 1991 and Rule 3.4 of the Faculty Jurisdiction Rules 2015.

B5. Churchyard
(6) The attachment of a defibrillator to an unlisted church building: The Archdeacon has been consulted on the proposal and has given notice in writing that it may be undertaken without a faculty. The works necessary for such attachment and/or the operation of the defibrillator do not require excavations within the churchyard.
(7) The attachment of a defibrillator to the boundary wall or fence of the churchyard of listed church building: The Archdeacon has been consulted on the proposal and has given notice in writing that it may be undertaken without a faculty. The works necessary for such attachment and/or the operation of the defibrillator do not require excavations within the churchyard.”

[With thanks to Luke Tatam for the clarification]

In the Dioceses of Leeds, guidance on the application for a faculty includes the following advice:

Dispensations
Applications for defibrillators and external noticeboards/signage usually requires a faculty. However, the Chancellor will consider these for a Dispensation from Faculty. This means that the parish apply directly to the registry for permission and do not need to seek DAC advice or display public notices. Please contact the DAC for more information on how to apply for a Dispensation from Faculty.

Other legal issues

Within the UK there are no statutory duties relating to the field of resuscitation, either generally or through the use of an AED, but potential liability can arise at common law in trespass and duty of care. The Resuscitation Council (UK) has produced a document The legal status of those who attempt CPR to resuscitate someone in a state of cardiopulmonary arrest; the current version (2015) is an update of the original guide, first published in 2000, and subsequently revised to take account of the  Mental Capacity Act 2005 (EW) more recent court judgements. Some important points raised in the 17-page document include [emphasis added]:

“In the United Kingdom, there is generally no legal obligation on an individual to assist someone in need of resuscitation provided he was not the cause of the person requiring treatment.

“A person, whether a healthcare professional or a member of the lay public who witnesses a situation ‘on the street’ where resuscitation might be required is under no obligation to assist, provided the situation was not caused by him. However, if that person does choose voluntarily to intervene to render assistance he will assume a duty of care towards the individual concerned.

“Whether intervening under a positive duty of care or under an assumed duty of care, a person who attempts resuscitation will only be legally liable if the intervention leaves a person in a worse position than he would have been in had no action been taken. It is difficult, in the circumstances under consideration, to see how a rescuer’s intervention could leave someone worse off since, in the case of cardiopulmonary arrest, a victim would, without immediate resuscitation, certainly die.

“…if an AED is being used, it will only permit the administration of a defibrillatory shock when its sophisticated electronic algorithms determine that ventricular fibrillation is present and, since patients in this state are clinically dead, it is unlikely that any intervention with this device could make the situation worse. If resuscitation is being carried out without an AED, however, it is slightly easier to envisage how the intervention of a rescuer might potentially leave someone worse off.

“It is possible that, if a rescuer performs a procedure negligently, others may, additionally or alternatively, be pursued for damages in respect of the injuries sustained. In this context, there is a potential liability for those who train rescuers in resuscitation techniques, those who provide or maintain resuscitation equipment, and those who administer the system under which rescuers operate“.

Comment

Although the application of the FJR in relation to AEDs will vary between dioceses and the details of their installation, it is likely that some form of formal approval will be required; in some circumstances, however, this may not require a faculty. Once installed, administration of the facility, its maintenance and training will be a priority.

Within the A Church near You part of the CofE website, the “Enter a tag” box has an option for “defibrillator”, but as with other tags in this otherwise excellent search tool, this is reliant upon the appropriate tags being set at local level.