Lives in the Balance

Workplace AED response is quicker and more effective than waiting for EMS. Speed is the most important factor in saving the life of a sudden cardiac arrest victim.

• By Greg Slusser
• Jan 01, 2013

The sudden cardiac arrest survival rate has been stuck at about 8 percent for more than 30 years, according to a study published in the American Heart Association's Circulation: Cardiovascular Quality and Outcomes.¹ Compared to a heart attack survival rate of more than 80 percent, this 8 percent sudden cardiac arrest survival rate due to the lack of available AEDs is dismal, especially considering that AEDs can be easily placed in workplaces and public places but often are not.

The resistance to placing AEDs is puzzling, especially considering that sudden cardiac arrest is the one common cause of workplace death that can be successfully treated by virtually anyone with an automated external defibrillator (AED). Yes, the leading cause of death in the United States, killing about 1,000 Americans each day, can be treated by your employees -– and treated more effectively than waiting for EMS to arrive. Other common causes of serious injury in the workplace -– ranging from accidents involving the use of vehicles or machinery to fires and falls – require intervention by medical professionals.

The Circulation study attests to the importance of AEDs. The study's authors noted that sudden cardiac arrest survival was "greatest in locations in which a defibrillator is available." They also observed that most out-of-hospital cardiac events are witnessed by bystanders; therefore, efforts to improve sudden cardiac arrest survival in the workplace should focus on enabling co-workers to save lives with an AED and CPR.

Improving the Odds
AED treatment before EMS arrival greatly improves a victim's odds of survival. An increasing number of workplaces recognize the importance of AEDs and CPR and are providing training to their workers. Receiving this training strengthens an employee’s confidence to use an AED quickly in an emergency, rather than waiting for EMS to arrive.

A Johns Hopkins study published in the Journal of the American College of Cardiology emphasized the importance of speed when responding to a sudden cardiac arrest victim.² The authors found an average survival rate of 7 percent in a review of 13,769 out-of-hospital cardiac arrests. However, the survival rate increased to 38 percent when victims received an AED shock before EMS arrival. The highest survival rate (40 percent) was achieved by non-medical volunteers operating the AED, followed by health care workers (16 percent) and police (13 percent).

"On average, early AED defibrillation before EMS arrival seems to nearly double a victim's odds of survival," the authors wrote.

The importance of speed is leading many workplaces to have AED/CPR training programs. Some follow a rule of thumb to train five individuals per shift for each AED; a workplace with three AEDs and three shifts would have 45 people receive training and certification. Plus, through a "train the trainer" approach, these 45 people acquire knowledge they can pass on to even more employees, strengthening the safety net even more.

Technology enhancements making AEDs easier to use than ever make this approach to training very practical. For example, Cintas employees Kyle Smith and Alex Torda used an AED to save John Breuel, according to a FOX Dallas-Fort Worth news report. The AED's real-time video feature visually guided them through each step of the rescue.

"I could tell [he was] in shock, you know, not really responding. I took control of the situation. I told the guy to grab the AED and started doing CPR. At that point, Alex ran over," Smith said.

"The first thing that went through my head is, let's get the AED on this guy," Torda said. "Once we do that, it'll walk us through CPR. It'll walk us through everything else we need to do."

"We got his shirt off, slapped the pads on. [The AED] analyzed his heartbeat and advised the shock. It was done," Smith added. Just minutes after suffering sudden cardiac arrest, Breuel was talking to Torda and Smith.

SCA is Different from a Heart Attack
The difference in the heart attack and sudden cardiac arrest survival rates stems from the different nature of the two conditions. A heart attack occurs when arteries leading to the heart become blocked and prevent blood flow. Sudden cardiac arrest, on the other hand, is a heart rhythm disorder that causes the heart to stop. More than 80 percent of attack victims survive from the initial onset of symptoms through the treatment process.

However, only 8 percent of sudden cardiac arrest victims survive because AEDs needed to shock the heart and correct its abnormal rhythm often are not readily available. When these lifesaving devices are on hand, survival rates dramatically improve -– about 90 percent of sudden cardiac arrest victims who receive shocks within the first minute after arrest survive, according to the Sudden Cardiac Arrest Association. The chances of survival decrease by 7 to 10 percent with each passing minute. After 10 minutes, fewer than 5 percent of victims survive. That’s why having an easy-to-use AED nearby is important.

Fortunately, AEDs have reached a tipping point similar to when the iPhone revolutionized smart phones. Several years ago, smart phones and AEDs were viewed by many as difficult to operate. Today, improvements in the user interfaces of both kinds of devices make them more intuitive and simple to operate.

Some new AEDs also fulfill the modern expectation of mobile video. Just as individuals can watch YouTube videos on their smart phones, users can receive real-time instruction via video during a rescue, a feature developed in response to Defibtech and Harris Interactive survey data showing that video instruction would increase rescuers' confidence. Without video, only about 50 percent of those surveyed expressed confidence in using an AED. With video, text, and voice, 97 percent of the respondents said they would use an AED to save a life.

In addition to providing guidance during a rescue, the video feature can be used during training to review the critical steps of a rescue. Having this ability to practice on a live AED provides reassurance to rescuers that they will be ready during the stress of an emergency. The video also serves as a status screen showing the readiness of defibrillation pads and the AED’s battery, as well as the overall AED operational status.

Liability Pendulum Swings in Favor of Having AEDs Available
In the past, employers sometimes cited liability concerns as an excuse to not have AEDs available, fearing a lawsuit stemming from an unsuccessful rescue attempt. However, no one has ever successfully sued an AED rescuer whose efforts were unsuccessful, and mounting evidence in favor of AEDs is causing legislators to pass stronger laws protecting Good Samaritans from legal action or, in some cases, even mandating AEDs to be present in certain kinds of workplaces.

On the other hand, organizations have paid significant damages when an AED was not available to save an SCA victim, and not having one of these lifesaving devices may indeed place a workplace in more legal jeopardy than having one.

Many workplaces have decided to place AEDs in their facilities to be prepared in case sudden cardiac arrest occurs to an employee or customer. A case in point: Sportime, a 45,000-foot Long Island sports complex, decided to purchase an AED seven years ago. The AED was not used in a rescue until February 2012, when Zach Young, a 22-year-old roller hockey goalie, suffered sudden cardiac arrest before a game, according to a CBS New York report. Two of his fellow hockey players were able to revive him and save his life because the AED was there.

Sportime had the satisfaction of knowing it was prepared to save the life of the young man. The alternative would have been a life lost. Now is the time to implement an AED program, as new technology is making it safer and more effective than ever to have one or more of these lifesaving devices at your workplace.

References
1. Sasson, C, et al: Predictors of survival From out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circulation: Cardiovascular Quality and Outcomes, 2009, American Heart Association, Inc.
2. Weisfeldt, ML, et al: Survival after application of automatic external defibrillators before arrival of the emergency medical system. Journal of the American College of Cardiology, April 2010;55(16): 1713-1720

This article originally appeared in the January 2013 issue of Occupational Health & Safety.