It can strike without warning. There is no way to predict who will be affected next. It can happen regardless of how strong your safety program is. And when it does happen, it is almost always fatal.

Sudden Cardiac Arrest (SCA) strikes 250,000 people each year in the United States. In more than 95 percent of these cases, the victim cannot be resuscitated. Its prevalence in the workplace is significant, with OSHA reporting that 13 percent of workplace deaths are the result of SCA.

One of the primary reasons behind this dismal resuscitation rate is the delay in treating the victim with a special electrical shock called defibrillation. With the chance for a successful resuscitation dropping at the rate of nearly ten percent for every minute this shock is delayed, seemingly short delays of just four or five minutes drastically reduce the victim's chances of being resuscitated.

A growing number of companies have implemented special programs to combat this threat. Public Access Defibrillation (PAD) programs provide simple training courses and easy-to-use equipment that can often correct the abnormal heart rhythm that causes Sudden Cardiac Arrest.

"We are safety conscious and concerned about employees, customers and visitors," says Benny Gallimore, plant manager for Citizens Telephone Cooperative in Floyd, Va. Citizens Telephone recently established a workplace AED, but Gallimore sees their program having a potential impact on more than just employees. With a steady stream of customer traffic and other visitors through their office, Gallimore says their program is "as much for the general public as it is for our own people."

Starting a program

Starting a PAD program involves more than just buying a defibrillator. There are several factors critical to the success of a workplace PAD program:

AEDs - An Automated External Defibrillator (AED) can analyze a victim's heart rhythm and deliver a potentially life-saving shock to the heart once activated by a rescuer. Unlike defibrillators found in hospitals, an AED performs the jobs of analyzing the rhythm and calculating the shock's power setting automatically.

Voice prompts from the AED guide the rescuer through the procedure. Controls are simple and usually involve just one or two buttons. The devices are small, lightweight and easily portable. Costs range from $2,000 to $3,500.

Training - Most organizations that offer CPR training, such as the American Heart Association, also offer AED training. Training courses typically involve three to four hours of classroom time.

"We took first-aid, CPR and AED training," says Calvin Abshire, emergency response coordinator at McJunkin Corp.'s pipe, valve and fitting distribution facility in Nitro, W.Va. With a 24-hour operation to cover, Abshire says it was important to have designated members of the Emergency Response Team available on all shifts.

Citizens Telephone has the goal of training all of its more than 50 employees on the use of the AED. In addition to the role these trained responders play within the company, Gallimore sees an important community service by having more people in the community at-large trained in CPR and AED procedures.

Abshire also sees this as a way of improving health and safety concerns well beyond the facility's gates. "We are very big on safety, not only here, but also at home," he said.

Medical oversight - The purchase of an AED requires a physician's prescription. Beyond providing that prescription, medical oversight by a physician helps ensure the medical quality of the program, including reviewing training requirements and operational policies as well as critiquing any actual responses with the AED.

For companies that have occupational health physicians available, medical oversight can be supplied with very little additional time or task requirements. For companies that do not have physician availability, physicians can often be recruited in the community. CPR and AED training agencies can be a good source for finding physicians willing to accept this role. Most AED manufacturers also offer physician oversight as an option when purchasing the unit.

The American College of Occupational and Environmental Medicine has supported efforts aimed at developing workplace AED programs, including the development of a position statement outlining the expected role of occupational health physicians in these programs.

Quality assurance - In addition to physician oversight, a quality assurance program should be developed. Procedures must be established covering topics ranging from how to activate an emergency call for the AED to how maintenance checks and continuing training are performed.

AEDs require very little maintenance, with most needing only a periodic visual check of their status light and confirmation that the electrode pads are not expired. But these checks must still be performed to ensure the unit is ready when needed.

Local EMS - A PAD program is not a replacement for calling for emergency assistance from the local Emergency Medical Services provider. PAD programs are a vital link in a series of events called the "chain of survival," which all work together to offer the victim the best chance at recovery. EMS is an integral part of the chain.

As a workplace AED program is being started, contacting the local EMS agency is an important step. EMS may be able to offer assistance with continuing training, help in locating a physician to provide program oversight, and give suggestions on how to improve response to SCA.

Liability concerns - All 50 states have addressed the issue of liability concerns for AED use through special legislation aimed at protecting AED rescuers from liability risks. In many states, these protections extend to the owner of the AED, the trainers and the physician providing medical oversight. At the federal level, the Cardiac Arrest Survival Act of 2000 provided an additional level of protection against liability.

"Liability concerns should not be a barrier to implementing an effective AED program," contends Alan Relyea of the Hartford Financial Services Group loss control department. "As the public's recognition of the value of accessible AEDs increases, so will the expectation of their availability. If an attorney can establish a reasonable expectation that your business should have provided an AED and you failed to do so, you could face costly legal action," says Relyea.

While AEDs are not yet required in most workplaces, OSHA has released a Technical Information Bulletin (TIB 01/12/17, released December 2001) recommending that employers "should consider the use of AEDs at their worksites to reduce the time to defibrillation with the goal of improving survival."

Employee awareness - All employees, not just those trained in AED use, should be informed about the program, especially the AED's location.

Creating a workplace AED program can send an important message to employees, reinforcing the value the organization places on its workers. Just as the organization's physical assets are protected by a sprinkler system in the event of fire, an AED and its supporting PAD program stands at the ready to protect the lives of employees, customers and visitors in the event of Sudden Cardiac Arrest.

SIDEBAR: Using an AED

When the victim is found unresponsive with no breathing or signs of circulation, make a call for emergency medical assistance and start CPR. Once the AED arrives at the victim's side, take these actions:

Step 1 - Turn the unit on. Most AEDs have audio or visual prompts that will guide the rescuer through the actions needed to use the AED.

Step 2 - Attach the electrode pads. The pads come with diagrams showing where they should be placed. If not already done, connect the electrode pads to the AED.

Step 3 - Deliver the shock. Once connected to the victim, the AED will analyze the heart rhythm. If needed, the AED will automatically develop an electrical charge that the rescuer must discharge into the victim according to the prompts from the AED.

Links

• Charleston Area Medical Center Health Education and Research Institute