In many, if not most workplace settings, there are certain lifesaving devices we would never consider removing. Fire extinguishers, smoke detectors and first aid kits, for example, are some of the must-haves in any facility.
By the same token, AEDs are becoming more prevalent in workplace settings. When sudden cardiac arrest strikes, quick access to an AED unit and cardiopulmonary resuscitation (CPR) is critical for survival. According to OSHA, there are 220,000 victims of sudden cardiac arrest per year in the United States, and about 10,000 of these cardiac events occur at work.
Taking no action while waiting for emergency medical personnel to arrive results in a 7 percent rate of survival, according to Mary Newman, president of the Sudden Cardiac Arrest Foundation. However, studies examining survival rates following immediate defibrillation by use of an AED unit show up to 60 percent survival rate 1 year after sudden cardiac arrest.
“With these [AED] devices now becoming so readily available in more workplaces, we're seeing the number of lives saved have been increasing,” Newman says, adding that there is more work to be done to increase that number.
Despite the fact that AEDs are becoming more commonplace, misconceptions about them abound, particularly in the workplace. For instance, many individuals who have conducted training on AEDs find that employees are afraid of trying them out, as they believe they are too complicated to use. In addition, many employers are under the impression that just having an AED in the facility will be enough to take care of an emergency situation, not realizing that without proper training and awareness, this could create more of a liability than a solution.
What is an AED?
Since one of the challenges in raising AED awareness is getting employees to overcome misconceptions about AEDs, it is important to know what they are and what they do.
An AED often is no bigger or heavier than the average laptop computer, and delivers a small but powerful shock that may be able to reset the heart rhythm of somebody in cardiac arrest. Often confused with a heart attack, sudden cardiac arrest happens when the heart abruptly and unexpectedly ceases to function normally and is no longer able to pump oxygen-rich blood to the rest of the body.
Once the adhesive pads are placed on the victim, the AED can monitor the person's heart rhythm, determine if they are in need of a shock and instruct the user to administer a shock or CPR.
According to Craig Aman, vice president of sales for the Eugene, Ore.-based training company Medic First Aid International, all AEDs roughly work in the same manner, but there may be small differences between different brands. For instance, some devices offer just the basic functions, with a voice prompt telling the user when a victim needs a shock and when to deliver it. Others are more advanced, offering the user CPR coaching, and advising him where to put his hands and how many compressions he should give. The ultra-advanced AEDs give users real-time feedback about improving their CPR skills.
Because of these small differences, Aman advises that employers train the employees responsible for operating AEDs to use the specific brand in their facility before they attempt a lifesaving measure.
“I would recommend that the employer examine each of the models, first examine what experience level their responder will have, how frequently they will do training and then evaluate which device is best for them,” counsels Aman.
But no matter what type of AED an employer gets, one thing is for sure: They all are very easy to use.
Are You Smarter Than a 6th Grader?
Richard Lazar, president of AED Risks Insights, a nationally-recognized authority on AED law, public policy, program operations and risk management, cites a study conducted by the University of Washington Medical School in which 15 sixth-grade children were given brief instructions on how and where to properly place the pads of an AED on a mannequin's chest so that the electrical shock to defibrillate the heart would be given safely and correctly.
“It took these sixth-graders 90 seconds to complete the defibrillation compared to about 60 seconds on average for the EMTs/paramedics,” Lazar says.
Even so, employers need to create management policies for their AED program, says Lazar. He has seen employers face liability issues because they didn't have a proper management program in place. For instance, Lazar notes cases when the AED didn't work because its batteries were dead or the unit wasn't maintained. In other cases, he says the AED was locked up and no one knew who had the keys, making the unit inaccessible.
Lazar also found that some very large facilities, which should place three or four AEDs in various locations to protect employees, often buy just one. This too creates a risk, because the time it takes to get to the AED location and respond to a sudden cardiac arrest may be too long; having one nearby could make the difference in saving a person's life.
“If you implement a good AED program, you have done good things for your employees and have managed your risk,” Lazar says. “But if you implement a bad AED program, which frankly is often the case, you have placed your organization at a greater risk than if you didn't have them.”
For this reason, Lazar says he works closely with his clients in designing their AED programs so they can respond in an effective and risk-free manner. In addition to analyzing costs and estimates, Lazar helps clients analyze other elements of a program, including:
- Do they have enough devices, enough people involved?
- What sort of access and use policies do they have?
- What do the good Samaritan laws say in the states in which they operate?
- How will they store their AEDs?
Training: Easy as A-E-D
There is no science in administering an AED program, according to Sandy Lovett, product sales manager for the American Red Cross. She emphasizes that a lot of the misconceptions and resistance employees may have about AEDs quickly are allayed once they understand how to use one. In order for this to happen, however, training must be conducted.
“Training is necessary in order to understand the role of defibrillation in the broader context of the cardiac chain of survival,” Lovett says. “Training in CPR and AED skills will allow the rescuer to use all the steps in the cardiac chain of survival, which will significantly increase the victim's chance of survival.”
The American Red Cross offers half-day courses that include CPR and AED skills and comprehensive, day-long sessions that also include first aid. The courses are interactive and use hands-on practice scenarios and videos that reflect a variety of situations. Each participant receives a skills card for use during in-class practice sessions, which also can aid in retaining skills after completing the course and serves as a quick reference tool in an emergency.
The National Safety Council (NSC) also offers CPR and AED skills courses, and both Lovett and Barbara Caracci, NSC's director of Program Development and Training for Emergency Care programs, agree that not only should training be an integral component when setting up an AED program, but it should be done on a recurring basis.
“Any skills that are not used will deteriorate,” Caracci states. “What we recommend is that after the initial training has been done, then the company should do drills for their response team. The more your practice and the more you drill, the readier you are to put those skills to use.”
“There are companies that get it, that understand and implement the plan as they should, and then there are those that are out there that may get devices and may not practice as much as they need to until an incident occurs,” Lovett says.
Benjamin Moore & Co. is an example of a company that correctly manages its AED program.
According to Kristin Kelley, Benjamin Moore's senior corporate environmental, health and safety specialist, the company fully implemented its AED program in 2007 with the help of Medic First Aid. Members of Benjamin Moore's employee volunteer first aid teams throughout North America are trained in several tiers of first aid, including the use of AEDs.
The teams can respond to a number of emergency situations, from minor cuts to an employee who is suffering sudden cardiac arrest. Kelley also notes that the teams receive “full-blown” training every 2 years and periodically get quarterly refreshers they can access on their computers.
To date, there hasn't been the need to use an AED, but Kelley asserts that she has full confidence that all of the first aid teams have the right processes in place to make sure that all other employees stay safe.
“Setting an AED training program was just the right thing to do,” she said. “Safety is our number one operating principle We're committed to the safety and well-being for all our employees. Our number one operating principle and getting AEDs was just something we could do for our employees to help create a safe and healthy work environment.”
The Psychology Behind a Lifesaving Event
Lifesaving efforts aren't just about physical wounds. They are about preparing workers who might have to use methods like AEDs while dealing with the psychological trauma of coming to the aid of a co-worker on the brink of death.
“It's not about just telling someone to go, grab a device, bring it over and the voice telling me to press a button, and that's it,” says Larry Starr, executive director for the Center of Organizational Dynamics at the University of Pennsylvania, who wrote AED guidelines for the American College of Occupational and Environmental Medicine. “So much more is happening in that instant.”
Starr urges people to consider this scenario: You are walking through the plant and see someone collapse and die. His head hits the floor, he's bleeding and he's lying face down. Someone is screaming and everyone around you stops. A worker yells, “Do something!” Then the safety team shows up, but they've never seen a dead person before and this is someone they know. They grab the AED, and the machine starts talking, telling them to press, press, press …
“These people are scared out of their minds,” Starr says. “And it's natural, because they're human beings. The psychology of the event is never dealt with adequately.”
So what's the solution? Starr says that workers who develop and execute their own AED training will have more experience and practice, and therefore are less likely to misuse the AED in crunch time. If word comes down from the top to participate in an AED training program designed by company management, for instance, the worker participates because he was told to do so. But if the worker designed the program himself, then he understands what it is really about and it would stay ingrained in his mind.
“No one has asked the users to design their own program, and yet these are who it's designed for,” Starr says. “If an organization wants to improve its AED program, they have to think about it in more realistic terms. They need to ask what [it]should look like in our facility and how should we build it so that makes sense to us. If this means changing some of the traditional techniques on how should it be done, then that's how it should be done.”
10 Tips for a Successful AED Program
Identify a program leader: This should include, at minimum, a medical director, a program director and/or a representative of the local EMS system.
Review laws, regulations and advisories addressing AED programs.
Determine program costs and develop a budget: Onsite AED programs costs can include training, costs for AEDs, insurance, batteries and electrodes, among other things.
Secure Program Funding: This can come from an organization's operational budget as well as outside funding sources such as local corporations, civic organizations and government grants.
Select AED brand and model and determine the number of AEDs needed: When determining the number of AEDs to buy, consider this: AEDs should be placed in locations that can be reached within 90 seconds by potential responders walking at a fast pace.
Recruit and train likely responders: Potential responders should undergo training to become familiar with the specific device that will be used in the on-site program, and to ensure they know how to provide CPR.
Develop a plan for emergency communications: This should ensure that on-site responders are summoned immediately and that 9-1-1 or the local emergency number is called immediately.
Develop, practice and follow a written response plan: This should include a number of things, such as coordination with EMS system and training AED users.
Cultivate awareness about the program: All employees should be informed about a company's AED program via newsletters, e-mail, staff meetings, signs and posters.
Institute measurements for continuous quality improvement: Reevaluate the response plan for effectiveness and revise as necessary.
Source: Sudden Cardiac Arrest Foundation