[PASSED!] Education & Availability of Basic Medical Devices

[Walfo]

Although I get the merits of this suggestion, waiving all liability contradicts the other pieces of this resolution. To incentivize citizens to learn how to use medical devices properly, they must have a reason to do so. Waiving all liability means that they could wing it, even in good faith, and not be responsible for the damage it deals due to their incompetence of not participating in the available curriculum.

The Tigrisian Delegation has several issues with this. First of all, humans tend to see risks more than the benefits. Hence, introducing liability could lead to even trained people not initiating rescue measures at all. We propose two different solutions:
The first would be to mandate training to anybody and also waiving all liability.
The other one would be to waive only the liability for trained personnel.

I think I have added a clause (8) that adds this content appropriately in a manner similar to what you recommended. Take a look and let me know what you think! Also, to other nations, let me know if you find that this clause may be thorny in any way.

[Kenmoria]

Ambassador Fortier stands to speak. “The newly added eighth clause is extremely problematic, and I encourage its removal. There is no reason to oust the jurisdiction of domestic courts over injuries that were incurred by negligent, reckless, or simply incorrect implementation of cardiopulmonary resuscitation, irrespective of what qualifications the resuscitator might have.”

[Walfo]

Ambassador Fortier stands to speak. “The newly added eighth clause is extremely problematic, and I encourage its removal. There is no reason to oust the jurisdiction of domestic courts over injuries that were incurred by negligent, reckless, or simply incorrect implementation of cardiopulmonary resuscitation, irrespective of what qualifications the resuscitator might have.”

Edits made, it was worth an inclusion for a second but I tend to agree with your analysis.

[United Calanworie]

To solve this, I have added a clause requiring child locks on the devices. Child locks should not interfere with the accessibility for the adult public.

We, the Tigrisian delegation, see this clause as very problematic. A child lock that actually works might cut off people with certain physical disabilities from accessing the container. Even if these locks are only adding a few seconds to the time it needs to deliver the medication to the patient, it may be these seconds that make the difference between life and death. Therefore, this line should be dropped. We are more in favour to change "to any person" to "by the public".

Also, we would like to add that it would be a good idea to add anti-anaphylaxis meds to the basic medical device, as this medical shock might lead to dead, if not treated within minutes.

OOC: There are rules in place in real live that allow such meds to be shipped without child locks as each second counts: https://healthychildcare.unc.edu/resour ... gency-use/

Lastly, the resolution should state that a person who provides first aid in good faith should risk no liabilty in the case that their actions result in further injuries or death of the victim. The best basic medical devices are worth nothing if no one dares to use them because they fear the liabilty that comes with using them.

There should not be epinephrine auto-injectors in those kits. Epinephrine is a dangerous medication to misuse (accidentally or otherwise), and the risks associated with giving it out willy-nilly in such a fashion outweigh the benefits. Most individuals do not understand how to properly recognize anaphylactic shock, nor understand the indications for epinephrine administration.

We, the Tigrisian delegation, see this clause as very problematic. A child lock that actually works might cut off people with certain physical disabilities from accessing the container. Even if these locks are only adding a few seconds to the time it needs to deliver the medication to the patient, it may be these seconds that make the difference between life and death. Therefore, this line should be dropped. We are more in favour to change "to any person" to "by the public".

Also, we would like to add that it would be a good idea to add anti-anaphylaxis meds to the basic medical device, as this medical shock might lead to dead, if not treated within minutes.

OOC: There are rules in place in real live that allow such meds to be shipped without child locks as each second counts: https://healthychildcare.unc.edu/resour ... gency-use/

Lastly, the resolution should state that a person who provides first aid in good faith should risk no liabilty in the case that their actions result in further injuries or death of the victim. The best basic medical devices are worth nothing if no one dares to use them because they fear the liabilty that comes with using them.

I don't think the answer is so clear in the risk-benefits analysis you're providing of the child locks. Yes, it could add a few seconds to the intentional use of the device by an adult, and on very rare occassion that adult could have a disability that further hinders their use of that lock, and those seconds are a risk, though not an extraordinary one in the case of V tach, V fib, and other uses of the AED device, but this has to be weighed against the dangers of children having access to a device, which, improperly handled, can cause electrical burns, start clothing fires, or even create a cardiac event with no adult present.

I would tend to disagree that there need to be safety locks mandated under all conditions. Certainly in areas where there are substantially more young children than adults, e.g. a preschool, but an AED in the workplace does not need one.

[Walfo]

I would tend to disagree that there need to be safety locks mandated under all conditions. Certainly in areas where there are substantially more young children than adults, e.g. a preschool, but an AED in the workplace does not need one.

My wording, found in 3d, ensures that AEDs do not activate for unnecessary circumstances. Equipping all AEDs with this creates a safety system that does not hinder access and is a more comprehensive solution.

[Tigrisia]

There should not be epinephrine auto-injectors in those kits. Epinephrine is a dangerous medication to misuse (accidentally or otherwise), and the risks associated with giving it out willy-nilly in such a fashion outweigh the benefits. Most individuals do not understand how to properly recognize anaphylactic shock, nor understand the indications for epinephrine administration.

OOC:

That is why the resolution mandates comprehensive training schemes in the first place. That reduces the risk drastically. Two sources worth reading: https://academic.oup.com/jscr/article/2 ... ogin=false, https://www.annallergy.org/article/S1081-1206(10)60332-8/fulltext

Please take note of the School Access to Emergency Epinephrine Act, which does exactly that. See here: https://aafa.org/advocacy/key-issues/ac ... n-schools/

[Walfo]

Just checking in, what does everyone think about the current draft? After all the work done, and time this has been on the forum, I'd like to get this submitted in the next 2 weeks (unless any large holes are found).

[United Calanworie]

I would tend to disagree that there need to be safety locks mandated under all conditions. Certainly in areas where there are substantially more young children than adults, e.g. a preschool, but an AED in the workplace does not need one.

My wording, found in 3d, ensures that AEDs do not activate for unnecessary circumstances. Equipping all AEDs with this creates a safety system that does not hinder access and is a more comprehensive solution.

Yes, an AED will not (theoretically) discharge unless a recognizable rhythm of ventricular fibrillation or pulseless ventricular tachycardia is analyzable. There's still potential safety hazards contained in an AED kit itself, such as a razor. Inquisitive young children may injure themselves with such supplies, or may attempt to consume pieces/parts contained therein. I'm not arguing for safety locks in all circumstances because in 95% of them, the natural way that an AED works is enough safety. Notably though, children have a habit of causing problems in a manner that software safety interlocks do not tend to be able to prevent. Just food for thought -- this is potentially not addressable through regulation however. Perhaps a general encouragement of "safe storage" could be included?

There should not be epinephrine auto-injectors in those kits. Epinephrine is a dangerous medication to misuse (accidentally or otherwise), and the risks associated with giving it out willy-nilly in such a fashion outweigh the benefits. Most individuals do not understand how to properly recognize anaphylactic shock, nor understand the indications for epinephrine administration.

OOC:

That is why the resolution mandates comprehensive training schemes in the first place. That reduces the risk drastically. Two sources worth reading: https://academic.oup.com/jscr/article/2 ... ogin=false, https://www.annallergy.org/article/S1081-1206(10)60332-8/fulltext

Please take note of the School Access to Emergency Epinephrine Act, which does exactly that. See here: https://aafa.org/advocacy/key-issues/ac ... n-schools/

Yes -- your first source is a case of conservative management of accidental epinephrine injection in an otherwise healthy 19 y/o male presenting to the ED with impalement of an autoinjector in his right thumb. That's somewhat different than my concern for the patient. Your second source is also surrounding accidental needle sticks in re. autoinjectors. Still different than my initial concern. Your note of SAEEA would be relevant if it didn't include the specific implication of "trained personnel" administering epinephrine. My argument is that any random individual who has taken a course on first aid/basic life support at *some point* in their life (as the resolution mandates, in school) is not necessarily going to recall the necessary information to adequately assess and determine the necessity to administer epinephrine in any given context. Let me set an example for you:

An individual in a restaurant begins to complain of some shortness of breath approximately 45 minutes after the consumption of some excellent shrimp scampi. The individual is a 59 year old male, with an estimated weight of 95kg. He does not believe that he is allergic to shellfish.

Is he having an allergic reaction? Does he need epinephrine administered? Well, he could be having one, but he also might not be. He could potentially be having a pulmonary embolism or a myocardial infarction, after all. He's at risk for both due to his age, and there's half a dozen factors that you haven't yet obtained here that could feasibly lead to any of the three pathways being the truth in this situation. But let's play this out some more. You assess him and half-recall from your first aid class that shortness of breath is a symptom of allergic reactions, and further recall that shellfish allergies can develop at any age. You spring into action, grab the epinephrine autoinjector from the restaurant's kit, and stab it into his upper right thigh. It clicks, and you hold it for the whole ten seconds, delivering the entire 0.3mg dosage into his vastus lateralis. Somebody has dialed 911, and EMS arrives shortly thereafter. They set up and conduct a primary and secondary assessment, and discover findings on a 12-lead EKG significant for MI. You've now increased this man's heart rate and blood pressure on average by 12/2.8, and 16.3 BPM respectively. in a situation where both need to be lowered not raised. Oops. There's even literature to the effect of epinephrine-induced ST-elevated myocardial infarction, if you want to get really wacky with the side effects.

Maybe we can dispense with the idea of including medication with large side effects such as these in public-access kits.

[Tigrisia]

My argument is that any random individual who has taken a course on first aid/basic life support at *some point* in their life (as the resolution mandates, in school) is not necessarily going to recall the necessary information to adequately assess and determine the necessity to administer epinephrine in any given context. Let me set an example for you:

I see the risk. Yes, people will get hurt, some people may also die. However, please note that people will also die when we put the EpiPens not into the kit. And I believe that more people will die if we don't do that.

Source for my arguments: https://doi.org/10.1111/j.1398-9995.2008.01733.x

The World Allergy Organization says that most of the people dying from anaphylaxis die due to not having fast access to an EpiPen or similar medicine. They say that the benefits outweigh the risks.

Any medical intervention is a balance of risks. No medical intervention comes without them.

Concerning your argument that people don't remember how to do first aid is valid, though. But that can be solved by mandating regular "booster courses" (in Germany, for example, in each company there has to be a certain amount of personnel responsible for First Aid that regularily takes first aid courses).

[United Calanworie]

My argument is that any random individual who has taken a course on first aid/basic life support at *some point* in their life (as the resolution mandates, in school) is not necessarily going to recall the necessary information to adequately assess and determine the necessity to administer epinephrine in any given context. Let me set an example for you:

I see the risk. Yes, people will get hurt, some people may also die. However, please note that people will also die when we put the EpiPens not into the kit. And I believe that more people will die if we don't do that.

Your argument hinges on people who have fatal allergies not being aware of it and not doing anything such as carrying an epipen themselves. Odd. I don't think it's a compelling argument.

Source for my arguments: https://doi.org/10.1111/j.1398-9995.2008.01733.x

I'm not paying $15 for 48-hour online access, and my former college library login does not work on this article, so I'm going to have to work off of the abstract here. Hopefully that's okay. I don't think you spent the $15 either.

The World Allergy Organization says that most of the people dying from anaphylaxis die due to not having fast access to an EpiPen or similar medicine. They say that the benefits outweigh the risks.

That's *not* what they said. Here, I'll even post the abstract here, you know, the one that you're sourcing.

Anaphylaxis is an acute and potentially lethal multi-system allergic reaction. Most consensus guidelines for the past 30 years have held that epinephrine is the drug of choice and the first drug that should be administered in acute anaphylaxis. Some state that properly administered epinephrine has no absolute contraindication in this clinical setting. A committee of anaphylaxis experts assembled by the World Allergy Organization has examined the evidence from the medical literature concerning the appropriate use of epinephrine for anaphylaxis. The Committee strongly believes that epinephrine is currently underutilized and often dosed suboptimally to treat anaphylaxis, is under-prescribed for potential future self-administration, that most of the reasons proposed to withhold its clinical use are flawed, and that the therapeutic benefits of epinephrine exceed the risk when given in appropriate i.m. doses.

They say that epinephrine is underutilized and dosed suboptimally to treat anaphylaxis, which is different than saying there's a lack of fast access. They don't say the benefits outweigh the risks, they say that the benefits outweigh the risks when given in appropriate IM doses. A little different than generically arguing that the benefits always outweigh the risks.

Any medical intervention is a balance of risks. No medical intervention comes without them.

Correct.

Concerning your argument that people don't remember how to do first aid is valid, though. But that can be solved by mandating regular "booster courses" (in Germany, for example, in each company there has to be a certain amount of personnel responsible for First Aid that regularily takes first aid courses).

This seems like a significant logistical burden to accommodate a small change in the resolution.

[Walfo]

Just food for thought -- this is potentially not addressable through regulation however. Perhaps a general encouragement of "safe storage" could be included?

I think that this encouragement is already included, take a look at 3e/3f. I think those two pieces are good enough.

Maybe we can dispense with the idea of including medication with large side effects such as these in public-access kits.

I am refraining from mentioning any specific medications as different nations may have different needs and different solutions. As such, a member nation may need drugs that have side effects because it is all they can manage or consume. As long as the device or drug preserves life, prevents the worsening of a medical emergency, and aids the recovery of a victim (wording from 1) it should be permitted.

This seems like a significant logistical burden to accommodate a small change in the resolution.

I concur.

[Necroghastia]

I'm not paying $15 for 48-hour online access, and my former college library login does not work on this article, so I'm going to have to work off of the abstract here. Hopefully that's okay. I don't think you spent the $15 either.

There's a thing called [DATA EXPUNGED]. There, you can get the paper without paying.

Your argument hinges on people who have fatal allergies not being aware of it and not doing anything such as carrying an epipen themselves. Odd. I don't think it's a compelling argument.

Well, no. See section "Underutilization of epinephrine by patients, parents, and caregivers". It gives multiple reasons to why even people that know of their fatal allergies often have no EpiPen with them, most notably the high cost as well as lack of knowledge on EpiPens in general.

That's *not* what they said. Here, I'll even post the abstract here, you know, the one that you're sourcing.

Well, that's why reading the abstract is not enough. They do in later sections. Section "Underutilization of epinephrine by patients, parents, and caregivers": "Fatalities during witnessed anaphylaxis, most of which occur outside of a medical facility, usually result from delayed administration of epinephrine".
Section "Conclusion": "Based on available evidence, the benefit of using appropriate doses of i.m. epinephrine in anaphylaxis far exceeds the risk."

A little different than generically arguing that the benefits [i]always{/i] outweigh the risks.

I never said always. And I didn't mean that. I should have used better words, though.

Any medical intervention is a balance of risks. No medical intervention comes without them.

Correct.

This seems like a significant logistical burden to accommodate a small change in the resolution.

Well, also for the other First Aid techniques, you need education and regular "boosters". Otherwise, this resolution won't have the effect we would like it to have.

[Kenmoria]

(OOC: I don’t think that it is necessary to include anti-anaphylactic medications in this proposal. It looks fine as it is. Otherwise, there would be an ever-growing list of possible inclusions to these kits, which would both quickly fill the character-limit and quickly limit the applicability of this proposal to all member-nations.)

[Necroghastia]

Tigrisia, let's not openly shout-out pirate sources, eh? That can get legally problematic.

[Walfo]

I am planning on submitting this in the next few days, and I’d like to thank everyone who has provided feedback and assistance throughout this process. Let me know if there are any more issues with this draft, but I think this draft is pretty cohesive now.

-Waffles

[The Ice States]

Comments for the author, reposted from Discord,

1. Why specifically opiates in 1a? What if they aren't a problem in some member nation? (For example, in the Ice States barely anyone knows what they are).
2. "Preserve life" of whom and in what situations? Who is a "victim"? (Referring to the definition of a first aid kit)
3. You shouldn't capitalise each term you define every time you use it in the resolution
4. In Section 4 what happens in the case of homeschooling? The way to avoid this issue is to make it apply to all students in a member nation that at some point they be taught the relevant materials; rather than specifying schools
5. You don't need to define the acronym "WAGF" when you don't use it anywhere in the resolution
6. Don't specify "less economically developed" in Section 5; it opens up questions of "less developed than what" and "what is developed". Same goes for "underdeveloped" in Section 7
7. Section 6a -- harm to whom? And what are these "requested areas", which aren't referenced in Section 5?

I think it's quite good and I would vote for as written, but I'd encourage you to address all of the above points.

[Walfo]

1. Why specifically opiates in 1a? What if they aren't a problem in some member nation? (For example, in the Ice States barely anyone knows what they are).

I thought to bring up opiates because IRL they are a huge problem. Additionally considering that Recreational Drug Use is an NS statistic, opioids overall are very relevant for NS as a whole. It's good to bring up, and the 6th clause will ensure that unnecessary spending is not done in situations where the devices would be pointless.

2. "Preserve life" of whom and in what situations? Who is a "victim"? (Referring to the definition of a first aid kit)

Added further clarification on the "preserve life" clauses and added a definition for "victim".

4. In Section 4 what happens in the case of homeschooling? The way to avoid this issue is to make it apply to all students in a member nation that at some point they be taught the relevant materials; rather than specifying schools

Just got rid of the content inside the parenthesis.

7. Section 6a -- harm to whom? And what are these "requested areas", which aren't referenced in Section 5?

Added the needed language, and changed "requested areas" to "requested public spaces".

I also resolved your other comments! Thanks for the feedback!

[The Ice States]

I thought to bring up opiates because IRL they are a huge problem. Additionally considering that Recreational Drug Use is an NS statistic, opioids overall are very relevant for NS as a whole. It's good to bring up, and the 6th clause will ensure that unnecessary spending is not done in situations where the devices would be pointless.

I think a better solution would be to apply it to general drug overdose kits, not just for opiates; while they may very well be an issue in real life, that does not mean they are in the NS world.

Added the needed language, and changed "requested areas" to "requested public spaces".

The point is more so that you don't specify that the funding has to be requested for devices in a specific area; if you want them to be then you should say so.

[The Overmind]

I thought to bring up opiates because IRL they are a huge problem. Additionally considering that Recreational Drug Use is an NS statistic, opioids overall are very relevant for NS as a whole. It's good to bring up, and the 6th clause will ensure that unnecessary spending is not done in situations where the devices would be pointless.

I think a better solution would be to apply it to general drug overdose kits, not just for opiates; while they may very well be an issue in real life, that does not mean they are in the NS world.

I can't speak to drug overdose kits in general, but one of the best things about the treatment for opiate overdose is that it presents absolutely no danger to the life of a person who is not in the midst of an opiate overdose. It is therefore safe to administer it even if you're not trained and even if you're not sure the person is actually having an opiate overdose. Can the same be said for other medications used to treat other types of overdoses?

[Walfo]

The point is more so that you don't specify that the funding has to be requested for devices in a specific area; if you want them to be then you should say so.

Got it! Does the new wording for clause 5:

Instructs the World Assembly General Fund to assist member states who cannot afford the purchasing, installment within public spaces, and maintenance of basic medical devices through subsidization;

add that wording?

Additionally, the WAGF's role is to assist nations that need funding, not those who can afford it themselves. As such funding does not need to be requested for devices in a specific area in every case.

[Walfo]

TO NOTE!

A new clause has been added as 5i to prevent corruptive practices, and with that, I think the draft is complete! I will be submitting this tomorrow! Thank you to EVERYONE who helped during this long process (85 days! Worth it ), and hopefully, I will be able to regard this as my first WA resolution!

[Tigrisia]

"One last note" says a very busy and exhausted Junior Consular Secretary. "It may be a good idea to get rid of the subparagraphs in 5 and 6 and integrate them into their respective articles, because if there is a subparagraph 1, there's normally also a subparagraph 2."

[Walfo]

At 9:10 EST on February 22nd, this proposal was submitted to the WA.
https://www.nationstates.net/page=UN_vi ... 1708611009

At 9:32 EST on February 22nd, the letter was sent to all WA delegates:

Dear Esteemed Delegate,

We would like to ask you to approve this proposal: Education and Availability of Basic Medical Devices, which is our proposal that seeks to set standards for the availability of basic medical devices and provide education to the public on the methods necessary to operate basic medical devices and perform basic life support maneuvers.

Every day, countless lives are lost due to heart attacks, choking, or overdose—incidents that can be preventable if the public can and knows how to intervene. With easily accessible devices in public spaces, victims can receive treatment when mere seconds can lower the odds of survival, maximizing survivability. Through educational practices, these regulations will not only bolster the intelligence of our citizens but will also allow them to assist their loved ones in emergencies that do not need to be deadly.

To assist nations with constructing the needed framework for this legislation, if they cannot afford them, the WA General Fund will subsidize projects within member nations to build their medical infrastructure and increase the availability of medical devices. To prevent wasteful spending, these cases will go through an approval process headed by the World Health Authority.

For a safer future and stronger medical infrastructure approve this resolution, and vote FOR the proposal once it comes up for vote. I am open to any questions about the proposal.

Thank you for your help!

-The Delegation of Walfo

[United Calanworie]

Can the same be said for other medications used to treat other types of overdoses?

I mentioned something along those lines here already:

[...]laypersons should not attempt to reverse a tricyclic overdose, for example, as they should not be administering activated charcoal and IV sodium bicarbonate.

[Walfo]

I am pleased to announce that this proposal has reached a quorum! If all preceding resolutions pass, it will be passed as GA #222. I would like to thank all of the delegates who approved the proposal, and once again anyone who provided feedback and helped create such a strong and comprehensive resolution. I look forward to seeing this on the floor, and hopefully, I will be able to regard this as my first passed WA resolution!

Best,
-Waffles