Can you provide the "Chain of Survival"?
October 3, 2008
John Lane was talking to his coworkers when suddenly he slumped down in his chair.
His colleagues at Climate Master in Oklahoma City, Okla., immediately knew something was wrong. Lane was unresponsive â€” unconscious, not moving and not breathing.
They called the company’s first response team, and within seconds, someone arrived and started CPR on him. Another workplace first responder got the company’s onsite AED (automatic external defibrillator).
Just one shock later, and Lane started breathing and had a weak pulse. By the time paramedics arrived, Lane was in a semi-conscious state. He was whisked away by ambulance to the hospital where doctors found some blockage in all four major arteries.
Lane underwent seven hours of surgery and had four graphs put in to redirect the flow of blood around the blockages. Just four weeks after his incident, he was back at work.
“It was a pretty humbling experience,” he says. “Had it not been for our first responders, I would not have survived. I feel very fortunate that people were here. I’m glad someone had the foresight to have a team in place here.”
Lane is lucky. In the U.S., a mere six percent of people who have a sudden cardiac arrest outside of the hospital survive. And less than one-third of those victims receive bystander CPR.
Lane is also lucky to work for a company that made the commitment to not only have AEDs available onsite, but also invested in a comprehensive program that included having a volunteer team trained and ready in the event of an emergency.
Trends in training
While many companies have AEDs, Climate Master is part of a growing trend of companies that have their own onsite response teams trained in CPR and AED use. More and more companies are investing in these types of holistic AED programs, says Sandy Devine, product manager for AEDs and Training for Zee Medical Inc.
“Employers are saying, ‘I’m not just buying a box, I’m making an investment to a program,’” she says. “Businesses are more aware that they need to take an extra step in CPR/AED training so they can perform the entire Chain of Survival.”
According to the American Heart Association, that “chain of survival” includes the following four steps that can greatly improve the chance of survival from sudden cardiac arrest:
- Early Access: Notifying EMS as soon as possible
- Early CPR: Starting CPR immediately after cardiac arrest
- Early Defibrillation: Defibrillation as soon as equipment arrives (if needed)
- Early Advanced Care: Trained healthcare providers (EMS) arrive quickly
“It sure is becoming an interest to employees that their employers care enough about them to have trained response teams and save a life in the event of a sudden cardiac arrest,” she says.
Technology has enabled AED programs to be even more intuitive, so employers don’t have to worry about the administrative details. Now tracking tools can tell when certifications need to be renewed, if laws or CPR guidelines have changed or even when the batteries or pads on the AEDs need to be replaced.
“It’s so much easier on the risk manager or safety director,” Devine says.
Guidelines & recommendations
According to its standards, OSHA does not require employers to have AEDs onsite:
Section 5(a)(1) of the OSH Act, often referred to as the General Duty Clause, requires employers to “furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees”. Section 5(a)(2) requires employers to “comply with occupational safety and health standards promulgated under this Act”.
However, in 2003 the organization published the “Saving Sudden Cardiac Arrest Victims in the Workplace” brochure, which highlights the use of AEDs in the workplace and has included AED training in its best practices guidelines.
The American Heart Association strongly encourages large businesses and public facilities to establish AED programs. The association has developed a list of key elements to a successful AED program:
- Having a medical professional oversee the program
- Notifying the local EMS agency about the plan and coordinating their response
- Selecting, placing and maintaining AEDs
- Training responders in CPR and AED use and conducting regular drills
Cost and fear of legal liability are the reason many employers are hesitant to implement an AED program at their worksites. The cost of an AED can range from $1,200-3,000 per device, without any training.
The Food and Drug Administration requires a physician’s prescription to buy most AEDs, and each state has its own training requirements.
Many insurance companies now offer a discount for liability insurance that have lay rescuer AED/CPR programs.
As for legal ramifications of using workplace AEDs, all 50 states and the District of Columbia now include using an AED as part of their Good Samaritan acts. These acts vary by state, but generally limit the liability of rescuers using AEDs and others involved with an AED program. In addition, the Cardiac Arrest Survival Act (CASA) provides limited immunity to persons using the AED and the purchaser of the AED unit. Cost aside, implementing a CPR/AED program sends a clear message to employees: We care about you and your safety.
“Ask employers who had a save at their workplace,” says Mary Fran Hazinski, R.N., an American Heart Association spokesperson. “I’m sure they would say the lives of their saved employees were well worth the money invested in an AED program.”
SIDEBAR:Sudden cardiac arrest is not the same as a heart attack. Sudden cardiac arrest happens when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. A heart attack occurs when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest.
SIDEBAR: Statistics on Sudden Cardiac Arrest:7 to 10 â€” Average number of minutes it takes for EMS to arrive at the scene in many cities
4 to 6 â€” Average number of minutes it takes for brain death to occur without CPR or shock from an AED
30:2 â€” Rate of chest compressions to breaths when performing CPR
80 percent â€” Average number of cardiac arrests that occur outside the hospital