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LAW REVIEW continued from page 33

Three members of the facility provided testimony regarding their observations of the scene. George Basantes, a
gym patron, testified that he saw Tringali
fall from the stair climber and land on his
back. He described Tringali as " gasping " for air. He said that the deceased
turned blue within five minutes of collapsing. According to Basantes, no one
administered CPR or attempted to get
Tringali's vital signs. Instead, bystanders just encouraged him to breathe. Basantes testified on cross-examination
that the L.A. Fitness employees merely
sat and stared at the deceased. He estimated that 10 to 12 minutes passed between the time Tringali collapsed and
the paramedics arrived.
Connie Wagaman, an emergency
medical technician (EMT) for the City of
Oakland Park Fire Rescue, testified that
she responded to L.A. Fitness with two
other EMTs. Wagaman testified that Fire
Rescue received a call from Fitness at 9:18
p.m., and that they arrived at Fitness at
9:21 p.m. Wagaman observed Tringali
lying on his back with his head in someone's lap. Tringali was not breathing and
did not have a pulse. Emergency Medical Services (EMS) attached a valve mask
with oxygen, performed CPR, and used
a defibrillator to treat Tringali. Wagaman
testified that EMS used CPR protocol to
treat Tringali. Wagaman stated that EMS
shocked the defendant at 9:21 p.m. and
then again at 9:24 p.m. but were unable
to re-establish a pulse.

Plaintiff's Experts
Dr. Steven Van Camp, a cardiologist with
a special interest in the hazards of exercise, was the plaintiff's medical expert.
Dr. Van Camp testified that the deceased's cause of death was hypertrophic cardiomyopathy. In Dr. Van Camp's
opinion, Tringali's condition was treatable with defibrillation; however, if defibrillation was not possible, CPR could
have been " used to increase the likelihood the [later] defibrillation would be
successful and to preserve brain function. " Dr. Van Camp explained that " CPR
does not correct ventricular fibrillation
by itself, but what it does, it prolongs the

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FEBRUARY 2011

time for which effective defibrillation can
be . . . administered. " Dr. Van Camp testified that although EMS responded very
quickly, the shocks administered were
not effective because CPR had not been
timely and effectively administered.
In Dr. Van Camp's opinion, if CPR had
been administered before paramedics
arrived, even in the absence of defibrillation by L.A. Fitness employees, there
is a 75 percent or greater chance that
Tringali would have been successfully
resuscitated. Moreover, Tringali likely
would have survived for 20 or 25 more
years.
Anthony Abbott, Ph.D., testified that
Strayer was negligent by failing to follow CPR protocol and perform CPR on
Tringali. Abbott, an exercise physiologist and president of Fitness Institute
International, testified about the health
club industry's standards of care in
April 2003 and their recommendations
for cardiac safety at such facilities. Abbott testified that L.A. Fitness violated the
industry's standards of care by failing to
have a written emergency plan and to
employ personnel qualified to handle
emergencies.
Abbott testified further that the standards promulgated by the industry's
authorities, including the International
Health and Racquet Sports Club Association (IHRSCA) and the American College of Sports Medicine, are directed at
responding to cardiopulomonary emergencies because " when people exercise
there's a radically increased chance of
having a cardiovascular incident because of the increased stress that comes
with exercise. " Abbott testified that Fitness' plan was inadequate; an emergency plan " is designed to assign various
roles to individuals and how they carry
those roles out. "
In addition to a written emergency
plan, in 2003, IHRSCA required facilities
to have qualified persons on duty. In Abbott's opinion, L.A. Fitness did not have
a CPR-qualified person on duty when
Tringali was injured. Abbott testified
that Strayer was certified, but not qualified in CPR and did not follow appropriate CPR protocol. Abbott explained the

w w w . NR P A . ORG

CPR procedure as follows:
First, the responder must determine if
the individual is responsive. If the individual does not respond, regardless of
the reason, the responder must activate the emergency medical service
system or call 911. Then, if the individual is not breathing, the responder
must administer CPR. Abbott noted
that even though an individual has a
heartbeat, his heart will stop if he is
not breathing. After the responder determines that CPR is necessary, he
must perform a chin lift to open the
airway. The responder then puts his
ear over the individual's mouth and
nose to feel for air, and looks at the individual's chest for movement.

Abbott noted that Strayer did not perform a chin lift, nor did he assume an
appropriate position to note any chest
movement. The responder must then
ventilate the individual. After ventilating, the responder should determine
whether the individual's heart is beating
by looking for movement of the body and
checking for a pulse at the carotid artery
in the neck. Abbott noted that Strayer
checked Tringali's pulse at his wrist, instead of his neck. If there is no pulse, the
responder must then perform chest compressions. As the other medical experts
testified, Abbott explained that CPR is
important because it prolongs the time
during which effective defibrillation can
be performed.
Abbot testified that, in addition to failing to have a written emergency plan or
qualified responders, L.A. Fitness fell
below the industry's standards of care
by failing to have an Automated External Defibrillator (AED) on its premises in
April 2003. Abbott admitted that AEDs
were not required by law in 2003 and
that L.A. Fitness employees were not required by law to perform CPR or to have
a written emergency plan.
Abbot further testified that L.A. Fitness fell below the pertinent standards
by failing to screen individuals prior to
their commencing exercise and by failing to employ a medical liaison. Abbott
admitted on cross-examination that he
could not quantify the number of similar

February 2011 - Parks & Recreation

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