AED use by non-Thai doctors not illegal in Thailand.

[NomadJoe]

As an EMT and CPR/First Aid/AED (Automated External Defibrillator) and BLS instructor, when I first came to Thailand it troubled me to hear that you must be a Thai doctor to legally use an AED in Thailand. It is something I found very odd since the whole point of an AED was that it was to be used by laypersons in the field prior to the arrival of individuals with more advanced training. So over the years I have been watching this issue closely. I have yet to see anyone show any document suggesting AED's were illegal if used as intended, by laypersons.

There has been some discussions on Thaivisa forums about this previously, none of which provided any substantive evidence but relied purely on conjecture :

http://www.thaivisa.com/forum/topic/288671-aed-automated-external-defibrillator/

http://www.thaivisa.com/forum/topic/657469-elderly-american-dies-from-a-heart-attack-at-a-barber-salon/

http://www.thaivisa.com/forum/topic/241146-illegal-to-use-heart-defibrillator-in-thailand/

I was recently introduced to an AED sales rep who specialised in selling "non-hospital" AED's, according to her card. I asked her if you need to be a Thai doctor, and what training you need to legally use an AED in Thailand. She laughed at that, and said that it is a 4 hour course, same as in western countries.

She put me on to some interesting news items which show pretty strongly that the "Thai doctor only" rule was in fact a myth, probably created due to the common believe that Thailand lacks thorough "good Samaritan" laws.

Here is an article where they were recently installed in a shopping mall: http://www.thephuketnews.com/central-festival-phuket-gets-life-saving-defibrillators-42660.php

Here are some photos from the Thai Resuscitation Council website where medical staff are teaching lifeguards and other lay rescuers how to use them. (I am told by someone who was there that these people aren't actually all lifeguards, they just handed out the shirts to everyone):

Here is an AED instruction video in Thai by Bangkok Hospital:

I'm curious is anyone else has any definitive information on this subject.

[evadgib]

Many years ago a friend on Koh Tao with a similar background and with access to a defibrillator spent several hours cuffed & in the cells for "not being a Thai Doctor" after repeatedly resuscitating or attempting to resuscitate the odd snorkeler or diver. A few weeks after he discontinued the service the police descended upon his office and placed a body on his desk & asked told him to revive it because they didn't know how!

IIRC the patient died because of the delay.

Defibrillators are an excellent idea but there are places when I can see them being ransomed or used to jump-start a car.

Edited December 17, 2013 by evadgib

[BusyB]

I can only say that my Rescue Diver course taught in Kata on Phuket included thorough instruction on how to use these things, and there was never even a notion raised about legal traps or loopholes. It was expected I would use it in the event of it being necessary.

Even if it was illegal, how many people who know how to use one (and they come with VERY explicit, idiot proof instructions) would actually stand by and watch someone die, with a machine next to them? Not many I suspect.

[merijn]

Regarding the AED's installed at Central department in Phuket.

They are hanging on the walls but the cabinets are locked and can only be opened with a key.

Yes you have a AED but can't reach it, Thai logic in think or they are afraid that they get stolen or dirty.

And i have to admit even with a idiot proof guideline most Thai's would not know how to use it.

[flyingdoc]

Sounds like a tragic state of affairs!

[BarnicaleBob]

My business car had an AED as part of it's on board equipment for the last 8 years of my employment. During that time I used it twice with success both times and yes all I had was a four hour training course in it's use. I think it would be a great idea if AEDs were placed in more locations in Thailand.

[simon43]

I had an AED installed in my hotel public area about 8 years ago. Luckily, never had to use it. I cannot understand the reticence to install such AEDs in public places - the equipment is totally idiot-proof to use....

[NomadJoe]

Regarding the AED's installed at Central department in Phuket.

They are hanging on the walls but the cabinets are locked and can only be opened with a key.

Yes you have a AED but can't reach it, Thai logic in think or they are afraid that they get stolen or dirty.

Are they not behind breakable glass?

And i have to admit even with a idiot proof guideline most Thai's would not know how to use it.

They are not really intended to be used by people with no training in them, but rather by people who have gone through an 8 hour CPR/First aid course which includes instruction on AED's. "Layperson" in the above context just means someone who is not in the medical profession.

Edited December 18, 2013 by NomadJoe

[NomadJoe]

Many years ago a friend on Koh Tao with a similar background and with access to a defibrillator spent several hours cuffed & in the cells for "not being a Thai Doctor" after repeatedly resuscitating or attempting to resuscitate the odd snorkeler or diver. A few weeks after he discontinued the service the police descended upon his office and placed a body on his desk & asked told him to revive it because they didn't know how!

IIRC the patient died because of the delay.

Defibrillators are an excellent idea but there are places when I can see them being ransomed or used to jump-start a car.

Interesting story. How many years ago was this?

To use an AED is simple, but they are quite sophisticated machines. It's the sophisticated software that makes them simple. For example, they won't jump start a car, nor is it possible to shock a patient which has a normal heart rhythm. The software will not allow the user to deliver a shock unless the AED detects one of two arrhythmias, (irregular heart beats) in the patient. Either vetricular tachycardia (fast beating of the ventericals, or lower chambers of the heart) or ventricular fibrillation, (quivering ventricles)

Related: My new favorite road sign posted in several places around Phuket:

Edited December 18, 2013 by NomadJoe

[lostmebike]

Can I ask you Mr Joe, who told you that you have to be a doctor to use AED?

[merijn]

Regarding the AED's installed at Central department in Phuket.

They are hanging on the walls but the cabinets are locked and can only be opened with a key.

Yes you have a AED but can't reach it, Thai logic in think or they are afraid that they get stolen or dirty.

Are they not behind breakable glass?

And i have to admit even with a idiot proof guideline most Thai's would not know how to use it.

They are not really intended to be used by people with no training in them, but rather by people who have gone through an 8 hour CPR/First aid course which includes instruction on AED's. "Layperson" in the above context just means someone who is not in the medical profession.

Nope they are In steel cabinets with a locked door.

So far i'm learned the modern AED are idiot proof and most people should not have any problems using them.

I used them a few times during my first aid training's and they are very simple to use.

[NomadJoe]

Can I ask you Mr Joe, who told you that you have to be a doctor to use AED?

It's been something I have heard repeatedly over the years, but never from any person of authority nor have a seen any documentation supporting the idea that they are illegal to use. You can see in one of the older threads I posted above that Simon43 claimed to have been told by a Thai doctor that you must be a Thai doctor to use one.

[NomadJoe]

I can only say that my Rescue Diver course taught in Kata on Phuket included thorough instruction on how to use these things, and there was never even a notion raised about legal traps or loopholes. It was expected I would use it in the event of it being necessary.

Even if it was illegal, how many people who know how to use one (and they come with VERY explicit, idiot proof instructions) would actually stand by and watch someone die, with a machine next to them? Not many I suspect.

I wonder if I taught your course.

Lots of these courses are offered by and taught through PADI and SSI dive shops in Thailand through Emergency First Response, React Right, and Divers Alert Network courses, among others. This is why I am seeking definitive answers. I need to be able to answer this when my students ask.

[Kudel]

Aed divices in Europe are type one the idiot proof kind and are placed in most public buildings and company's.

A couple of months ago i got an earfull from people on here concerning an incident whith a farang operated diving school on phuket where de boat took off and left the divers to fend for themselves .

Its not only about first aid training and learning how to use the device ,for instance lets say i am on a beautiful diving trip in the andamen sea something bad happens with one of the divers ,what are the emergency procedures these dive operaters have in place?is there an emergency helicopter available to airlift the victims quickly ,Has there ever been an exercise done with dive operators and rescue service meetings toolbox talks etc..... I am pretty sure no will be the answer to most questions concerning the dive industry in Thailand.Cowboy stuff at best.

[simon43]

You can see in one of the older threads I posted above that Simon43 claimed to have been told by a Thai doctor that you must be a Thai doctor to use one

Yes I said that, but it's so long ago that I can't recall when/where I was told this. It was possibly by a doctor at Siriroj Hospital. I'm certainly happy if it proves to be a false statement that laypersons are not allowed to use AEDs.

Simon

[Sheryl]

Of course it is not "illegal", to be illegal it would have to be in the Criminal Code and needless to say there is no reference to AEDs in the criminal code.

I find that the term "illegal" gets misused quite a bit here. Usually a Thai person(s) says something along the lines of "not allowed" and that gets misinterpreted by farangs as meaning as illegal. Whereas it just means that in the mind of the Thai speaker(s) this was something not acceptable/not usual to be done, or they were not sure it was acceptable (in which case in Thailand, best not done) and no implication of a criminal statute.

In this particular case I don't think "not allowed" is correct either but can understand where that misunderstanding would come from since the whole idea of paramedics as we know them isn't really found here. Hence most Thais would simply assume that this is something only a doctor would have the training to do properly. (Actually many Thai docs would not have a clue how to use it).

[Kudel]

Of course it is not "illegal", to be illegal it would have to be in the Criminal Code and needless to say there is no reference to AEDs in the criminal code.

I find that the term "illegal" gets misused quite a bit here. Usually a Thai person(s) says something along the lines of "not allowed" and that gets misinterpreted by farangs as meaning as illegal. Whereas it just means that in the mind of the Thai speaker(s) this was something not acceptable/not usual to be done, or they were not sure it was acceptable (in which case in Thailand, best not done) and no implication of a criminal statute.

In this particular case I don't think "not allowed" is correct either but can understand where that misunderstanding would come from since the whole idea of paramedics as we know them isn't really found here. Hence most Thais would simply assume that this is something only a doctor would have the training to do properly. (Actually many Thai docs would not have a clue how to use it).

so can you please as a mod provide us with al the legal stuff about giving first aid in Thailand ,apparently a lot of so called legal companys are sponsors of this website so they must be able to answer said topic.And dont think be sure. Edited December 19, 2013 by Kudel

[txp158]

Sadly at this time, in order to operate AED, you are indeed required to be

1 a doctor

2 any personels who are given a permission by a doctor to operate the machine such as paramedic nurse or EMT-I (ermency medical tenician intermidiate).

Any forms of asking for permission will be ok. It could be done online per usage, or offline as in written protocol or procedure for a particular rescue organization. Anyone can not just use the machine and it's illegal to do so. The legality concerning the use of AED at this time is not about whether or not you'll go to jail. It's that if you are not a medical personel and end up operating AED on someone and that person dies. His/her family can sue you based on the law that only doctor is required to operate the machine. And you might end up paying lots of money despite of having good intention. As long as AED machine is designated as a medical device, only a medical personel can use it.

I'm sure a poor written law like this one will be changed in the future when doctors are more open minded. I'm a radiologist working in Thailand btw.

Edited December 19, 2013 by txp158

[FireMedic]

Sadly at this time, in order to operate AED, you are indeed required to be

1 a doctor

2 any personels who are given a permission by a doctor to operate the machine such as paramedic nurse or EMT-I (ermency medical tenician intermidiate).

Any forms of asking for permission will be ok. It could be done online per usage, or offline as in written protocol or procedure for a particular rescue organization. Anyone can not just use the machine and it's illegal to do so. The legality concerning the use of AED at this time is not about whether or not you'll go to jail. It's that if you are not a medical personel and end up operating AED on someone and that person dies. His/her family can sue you based on the law that only doctor is required to operate the machine. And you might end up paying lots of money despite of having good intention. As long as AED machine is designated as a medical device, only a medical personel can use it.

I'm sure a poor written law like this one will be changed in the future when doctors are more open minded. I'm a radiologist working in Thailand btw.

I will have to chime in now. TXP158 I would strongly suggest you contact Dr. Sopon at the Thai Resuscitation Council. He is the Chief Cardiologist at the Police General Hospital and happens to the be the cardiologist for the Royal Family including H.M. The King. He will inform you correctly that there is no "law that only doctors" can use AEDs. They are not "illegal" by any means. We have been working for months training BLS CPR classes with AED included in the training. We have instructed elementary to university students as well as large tourism based businesses. And if an AED is available and you know how to use one, by all means use it! You will not go to jail. In order for an AED to activate the person will not have a pulse and not be breathing and be in a shockable rhythm. As far as Thai people are concerned, that person is dead already, and you will not be held responsible for their death. As usual, and as we all very well know, Thai people can sue you for anything for any reason, including made up or unjustified reasons. In Thailand, there has been NO successful lawsuits brought upon any Thai or foreigner for using an AED. We have placed an AED in Chiang Mai Airport with others to follow shortly. You will see them in schools, sporting arenas, and public places soon enough.

I have spoken to Dr. Atacharyia who it the medical director for Thailand EMS. He has explained to me in detail his plans for AED use in the public sector. He is currently still getting his EMTs and Paramedics up to speed at his schools to have Semi AEDs for ambulances. His only request is that if someone is in cardiac arrest and 1669 is called for an ambulance, the dispatcher is told that CPR is being done and an AED is being used. This is not online medical control, but only to keep track how often they are used and used under the correct circumstances.

AEDs are currently approved for sale for out of hospital use in Thailand. If anyone would like to buy one or have the training feel free to pm and I will direct you to the correct person. I don't have the time to argue back and forth with keyboard cowboys who want to cause problems. If you want an AED for you or your business and you know how to use it, you can have one.

[NomadJoe]

Many years ago a friend on Koh Tao with a similar background and with access to a defibrillator spent several hours cuffed & in the cells for "not being a Thai Doctor" after repeatedly resuscitating or attempting to resuscitate the odd snorkeler or diver. A few weeks after he discontinued the service the police descended upon his office and placed a body on his desk & asked told him to revive it because they didn't know how!

IIRC the patient died because of the delay.

Defibrillators are an excellent idea but there are places when I can see them being ransomed or used to jump-start a car.

Ok, I got more of this story now. evdgib's friend in question is a friend of a friend. Turns out the issue was nothing to do with laypersons using an AED, but rather some Thai's claiming a foreigner was doing "work" illegally, as he was responding to these emergencies as part of a service he provided. Local EMS guys did not like him as competition. So really nothing to do with this topic at all.

Leaving out important details like this is how rumors get started.

Edited December 22, 2013 by NomadJoe

[ChrisNW1]

Many years ago a friend on Koh Tao with a similar background and with access to a defibrillator spent several hours cuffed & in the cells for "not being a Thai Doctor" after repeatedly resuscitating or attempting to resuscitate the odd snorkeler or diver. A few weeks after he discontinued the service the police descended upon his office and placed a body on his desk & asked told him to revive it because they didn't know how!

IIRC the patient died because of the delay.

Defibrillators are an excellent idea but there are places when I can see them being ransomed or used to jump-start a car.

Pardon? Jump-start a car? Can you please send me a video of this (ohh, no you won't be able to because YOU CANNOT DO IT)

This is typical of the ignorance surrounding AED's and CPR.

[ChrisNW1]

Regarding the AED's installed at Central department in Phuket.

They are hanging on the walls but the cabinets are locked and can only be opened with a key.

Yes you have a AED but can't reach it, Thai logic in think or they are afraid that they get stolen or dirty.

Are they not behind breakable glass?

And i have to admit even with a idiot proof guideline most Thai's would not know how to use it.

They are not really intended to be used by people with no training in them, but rather by people who have gone through an 8 hour CPR/First aid course which includes instruction on AED's. "Layperson" in the above context just means someone who is not in the medical profession.

Can we clear something up here please:

An AED is designed to be used by a by-stander who may or maynot have any first aid and/or CPR training.

The AED will guide the user through what to do using audible instructions.

The problem is that fery few Thai people are trained in how to perform CPR.

Chris H

Commercial First Aid Trainer/Assessor (for the largest training organisation in the UK)

[ChrisNW1]

Sadly at this time, in order to operate AED, you are indeed required to be

1 a doctor

2 any personels who are given a permission by a doctor to operate the machine such as paramedic nurse or EMT-I (ermency medical tenician intermidiate).

Any forms of asking for permission will be ok. It could be done online per usage, or offline as in written protocol or procedure for a particular rescue organization. Anyone can not just use the machine and it's illegal to do so. The legality concerning the use of AED at this time is not about whether or not you'll go to jail. It's that if you are not a medical personel and end up operating AED on someone and that person dies. His/her family can sue you based on the law that only doctor is required to operate the machine. And you might end up paying lots of money despite of having good intention. As long as AED machine is designated as a medical device, only a medical personel can use it.

I'm sure a poor written law like this one will be changed in the future when doctors are more open minded. I'm a radiologist working in Thailand btw.

Sorry but you are factually incorrect - there is NO law to this effect

[ChrisNW1]

This topic is a frustrating one as there is such a high degree of ignorance re the use of AED's and even more worryingly, there is an almost zero take up of first aid training meaning that the average person has NO idea how to do CPR.

Time for urgent change neeeded.

[Thongkorn]

They are dangerous things in the hands of some one who is not trained , they stop the heart, not start it. The Modern ones actually tell you how to use them, they are idiot prof. The tell you what and how to do, and if you are doing it correctly. You put pads on the Injured party and a computer that's incorporated in the device talks to you, If you can get them in Thai language i don't know. but i would have thought so.

Edited May 25, 2014 by Thongkorn

[evadgib]

Many years ago a friend on Koh Tao with a similar background and with access to a defibrillator spent several hours cuffed & in the cells for "not being a Thai Doctor" after repeatedly resuscitating or attempting to resuscitate the odd snorkeler or diver. A few weeks after he discontinued the service the police descended upon his office and placed a body on his desk & asked told him to revive it because they didn't know how!

IIRC the patient died because of the delay.

Defibrillators are an excellent idea but there are places when I can see them being ransomed or used to jump-start a car.

Pardon? Jump-start a car? Can you please send me a video of this (ohh, no you won't be able to because YOU CANNOT DO IT)

This is typical of the ignorance surrounding AED's and CPR.

"Whooossshhhh!"

(I guess it went straight over your head, albeit 6 months ago!)

[NomadJoe]

They are dangerous things in the hands of some one who is not trained , they stop the heart, not start it. The Modern ones actually tell you how to use them, they are idiot prof. The tell you what and how to do, and if you are doing it correctly. You put pads on the Injured party and a computer that's incorporated in the device talks to you, If you can get them in Thai language i don't know. but i would have thought so.

Saying they stop the heart is not really correct. It is more accurate to say they correct an arrhythmia (irregular heartbeat) specifically ventricle fibrillation and tachycardia, the two most common types of heart attacks.

The ones sold in Thailand give directions in Thai.

[NomadJoe]

Regarding the AED's installed at Central department in Phuket.

They are hanging on the walls but the cabinets are locked and can only be opened with a key.

Yes you have a AED but can't reach it, Thai logic in think or they are afraid that they get stolen or dirty.

Are they not behind breakable glass?

And i have to admit even with a idiot proof guideline most Thai's would not know how to use it.

They are not really intended to be used by people with no training in them, but rather by people who have gone through an 8 hour CPR/First aid course which includes instruction on AED's. "Layperson" in the above context just means someone who is not in the medical profession.

Can we clear something up here please:

An AED is designed to be used by a by-stander who may or may not have any first aid and/or CPR training.

Chris H

Commercial First Aid Trainer/Assessor (for the largest training organisation in the UK)

Your statement is inconsistent with my experiences, coming from the US perspective. There does appear to be a regional difference in protocols, as the UK resuscitation council has recently changed this.

Personally, I am hesitant to suggest to a person who has never touched an AED waste time fumbling around with it potentially delaying providing more effective care. I would need to see more data before making a conclusion. There are thus far only a couple of small scale examples of untrained by-standards using AEDs successfully. The data is promising though, and it is the reason for the UK change in protocols. As stated, they are fairly simple to use.

-

US:

If AEDs are so easy to use, why do people need formal training in how to use them?

An AED operator must know how to recognize the signs of a sudden cardiac arrest, when to activate the EMSsystem, and how to do CPR. It's also important for operators to receive formal training on the AED model they will use so that they become familiar with the device and are able to successfully operate it in an emergency. Training also teaches the operator how to avoid potentially hazardous situations.

http://www.heart.org/HEARTORG/CPRAndECC/CorporateTraining/AEDResources/AED-Programs-Q-A_UCM_323111_Article.jsp#If AEDs are so easy

-

American Heart Association-Stroke Association answered

Non-medical personnel such as police, fire service personnel, flight attendants, security guards, and other lay rescuers who have been properly trained can use AEDs.

http://www.sharecare.com/health/first-aid-emergencies-and-conditions/who-can-use-an-automated-external-defibrillator

-

5. Who can use an AED?

Most AEDs are designed for use by non-medical personnel such as police, flight

attendants, security guards, and other lay rescuers who have been properly

trained.

http://www.acphd.org/media/132141/aed_faqs.aboutaed.pdf

-

Who can use an AED?

Anyone who has minimal CPR and AED training can use an AED to help save a life.

http://www.physio-control.com/Who_can_use_an_AED.aspx

UK:

http://www.resus.org.uk/pages/aed.pdf

Guideline changes

There are no major changes to the sequence of actions for AED users in Guidelines

2010. The ILCOR Consensus on Science and Treatment Recommendations26 makes

the following recommendations which are relevant to the RC(UK) AED guidelines:

1. An AED can be used safely and effectively without previous training.

Therefore, the use of an AED should not be restricted to trained rescuers

-

"It is the view of the Resuscitation Council (UK) that the use of AEDs should NOT be restricted to trained personnel. Furthermore, the Resuscitation Council (UK) considers that it is inappropriate to display notices to the effect that only trained personnel should use the devices, or to restrict their use in other ways. Such restrictions are against the interests of victims of cardiac arrest, and discourage the greater use of AEDs by members of the public who may be able to preserve life and assist victims of cardiac arrest. This confirms similar advice from the British Heart Foundation."

https://www.resus.org.uk/pages/AEDtrnst.htm

-

Q: Do I have to be trained to use an AED?

A: The 2010 Resuscitation Council (UK) guidelines still advise training for AED

operators but state that in an emergency you do not have to be trained to use

an AED; in short it is better to use it than not, even if a trained operator is not

available.

https://www.stjohnsupplies.co.uk/downloads/faqs_defibrillators.pdf

Edited May 26, 2014 by NomadJoe

[NomadJoe]

This document puts this issue to rest.

[PhuketdashScuba]

See also this answer, http://www.thaivisa.com/forum/topic/741599-use-of-aed-law/, from Somsak.