Each year, as many as 450,000 people die from various types of cardiac arrest in the United States, many from Sudden Cardiac Arrest, otherwise known as SCA. Out-of-hospital SCA survival rates average 7 percent, but survival rates can substantially increase if victims are treated with an electric shock from an automated external defibrillator (AED), in conjunction with CPR immediately following the event. Normal heart function can be returned by issuing an electric shock with a defibrillator, but this must be performed within the first few minutes after the attack.
Let’s examine seven key questions regarding SCA, AEDs and how to create a “heartsafe” environment at your workplace
1) What causes SCA and who is at risk?A victim of SCA abruptly stops breathing and becomes unconscious. The heart stops beating normally and quivers, preventing the heart from pumping blood to vital organs. This condition is called Ventricular Fibrillation and is the most common cause of SCA. Some victims have a history of coronary heart disease, but SCA can also be caused by a blow to the chest, electrocution, drowning, choking and trauma; so anyone is at risk.
SCA can occur without warning, anywhere, anytime. The workplace is no exception. According to OSHA, of the 6,628 workplace fatalities reported from 2001-2002, 1,216 were from heart attacks, 354 from electric shock and 267 from asphyxia. OSHA estimates that up to 60 percent of these deaths may have been prevented if AEDs were used immediately.
2) Why purchase an AED?
Timing is crucial â€” with each passing minute, chances of survival decrease 7 percent to 10 percent. It often takes EMS professionals eight to 12 minutes to arrive, but brain damage can start to occur after only six to eight minutes. Having an AED onsite can drastically increase the rate of survival â€” some estimates suggest that an onsite AED can increase survival rates by up to almost 50 percent.
3) How do you implement an AED program?Several steps are necessary in implementing an effective AED program. First, identify an appropriate onsite person to oversee the program. Likely individuals include: an occupational health nurse, risk management officer, safety director or any other company employee responsible for the health and welfare of its personnel.
AEDs require a physician’s prescription, and many states require physician oversight of AED programs. If a company does not have an onsite physician, a local doctor who can advise the program needs to be identified. AED manufacturers and non-profit groups can assist organizations in finding an appropriate physician. Some AED manufacturers also offer comprehensive programs that include medical oversight as well as program tracking tools to monitor devices, expiration dates for batteries and electrodes, and trained personnel.
To determine the number of AEDs necessary for the workplace, a good guideline is to place AEDs within a one-minute walk from any location in the facility. Decide placement locations â€” such as onsite medical clinics, in plants or manufacturing areas, in reception or common areas, near a fire extinguisher or other safety equipment â€” with the assistance of a safety response team member or with a security officer. Consider the time it will take to reach a victim and whether there might be any obstacles that will cause delays, such as security checkpoints.
AEDs should be placed on the wall in a cabinet or mounting bracket that is easily identifiable and easily accessible. Most wall cabinets emit an alarm when the AED is removed to alert others that there is an emergency situation and to call 9-1-1.
Employee training is a crucial element to developing an AED program (see “Training” sidebar). A good guideline is to have five to ten employees trained for each defibrillator onsite.
It is important to notify local EMS of the program. In fact, some localities even require that AED programs are registered with EMS.
Develop an emergency response plan, or incorporate the AED into the company’s existing plan. Once the plan has been implemented or updated, it should be heavily marketed and practiced internally so that all employees are familiar with the new protocol.
4) What do you look for when purchasing an AED?Three critical elements when selecting an AED are reliability, ease of use and advanced technology.
Since AEDs may go months or years without being used, consider a device that has regular self-tests to confirm that the battery charge, internal electronics and pre-connected pads are fully functional.
Stress levels are sky-high in a life-threatening situation, so devices should be easy to use to minimize confusion. Features to look for in an automatic AED include: no buttons to push; pre-connected interchangeable pads that save time; and a text screen that provides clear (audible and visual) prompts that lead the lay-rescuer through each step of the rescue process. Choose an AED with advanced technology that delivers an efficient and effective defibrillation shock based on an escalating energy protocol.
5) What is the liability?In 2000, Congress passed the Cardiac Survival Act, which protects AED users and acquirers from liability. Additionally, many states have passed their own Good Samaritan legislation. Many states and localities are now passing legislation requiring AEDs at schools and other public areas. Having an AED program can actually reduce liability, as there have been a number of lawsuits in the past decade against organizations for not providing AEDs in their facilities.
6) What about OSHA standards/compliance?Currently, OSHA does not have a regulation specific to AED use, though it does fall under general first-aid regulations, such as those regarding employee bloodborne pathogens training.
7) Can you outsource AED management?Some AED manufacturers have consultants who will assist in the development of a company’s entire AED program. They can assist in:
- Selecting the appropriate AED for the facility;
- Finding a physician to sponsor the program or offer medical direction;
- Determining the number of AEDs necessary and how many employees should be trained;
- Training employees in AED use and CPR;
- Tracking tools to ensure that employees are re-certified when their training certification is expired, and that also remind program managers when pads and batteries need to be replaced;
- Managing system maintenance and documentation;
- Assisting with internal marketing of the AED program;
- Providing post-event support.
A â€œheartsafeâ€ environment
Implementing an AED program in the workplace creates a “heartsafe” environment and helps to ensure that if the unthinkable happens to an employee, a program is in place to provide a rapid and effective rescue attempt.
Sidebar: Training is part of the programEmployee training is crucial to developing an AED program. Employees must be trained in both CPR and AED operation. The American Heart Association, American Red Cross, and the American Safety and Health Institute offer certification in AED and CPR, as well as in general first-aid and bloodborne pathogen training.
Ideally, five to ten employees should be trained for each defibrillator onsite. If there are multiple shifts at your facility, plan to have employees trained on each shift. Employees should refresh their skills every six to 12 months to be well-prepared in an emergency. Many AED manufacturers that offer training programs also offer online refresher training programs so that trained responders can refresh their skills periodically.