The Importance of CPR & AED Safety Training

One challenge with saving victims of cardiac arrest is that there is often a lag before bystanders take action.

• By Jeff Walters
• Sep 01, 2014

Before convincing a company's leaders to install automated external defibrillators in their offices and campuses, Marc Lawrence says he often has to start with a heart lesson. First, he has to explain that sudden cardiac arrest is not the same as a heart attack, that there often are no symptoms, and that it's not something that only affects mostly seniors, but can happen at any age.

"Customers just aren't aware of the prevalence of sudden cardiac arrest," said Lawrence, the president of Downing Digital Healthcare Partners. He has spent more than 25 years working in medical device sales and information technology. In speaking with groups about AEDs, Lawrence often asks his audience to guess how many people experience sudden cardiac arrest (SCA) in the United States each year.

"The highest number I ever received was 80,000, with everyone thinking it mostly affects people all over 65 years of age," he said. Actually, the number is about 424,000, with victims ranging in age from young children to adults.

Analysis of the workplace fatalities reported to the Occupation Safety and Health Administration showed that up to 60 percent might have been saved if AEDs were immediately available and companies were not just relying on EMS.

A Leading Cause of Death
Sudden cardiac arrest is the leading cause of death in the United States and Canada, with nearly four out of five cases occurring outside a hospital. Bystanders–whether in a public gathering space such as an airport or shopping mall, or in a workplace–play an in important role in improving the chances of survival, said Dr. Robert W. Neumar, M.D., Ph.D., who is a professor and chair of the Department of Emergency Medicine for the University of Michigan Health Systems. "In cardiac arrest, every minute counts," Neumar said. "If you consider the time it takes for a medical responder to arrive versus a co-worker or bystander, it can mean the difference between life and death."

Even when 911 is called immediately, it can often take seven or eight minutes or longer for EMS to arrive at the location; that doesn't account for the time it takes to locate the victim once they arrive. After 10 minutes without emergency care, resuscitation is rarely successful.

Cardiac arrest is not the same as a heart attack, which occurs when the blood supply to part of the heart muscle is blocked. Cardiac arrest, which may be caused by a heart attack, occurs when the heart's normal rhythm is disrupted and cannot generate blood flow. Chest compressions administered through CPR can generate a small amount of blood flow to vital organs, but defibrillation by an automated external defibrillator is the only way to deliver the lifesaving shock to the heart, bringing it back into normal rhythm and restoring blood circulation.

Every minute of delay for defibrillator decreases the success of restarting the heart. Approximately 10 percent of people who experience an out-of-hospital cardiac arrest survive, with survival significantly increased if a bystander quickly retrieves and employs an AED. Time is critical. The earlier a shock is delivered, the greater the chance the neurological damage can be prevented. Having an AED program in place can reduce the response time to an SCA victim by 3-5 minutes.

"Every minute delay in shock delivery can decrease the chance of survival by up to 10 percent," Neumar said. Understanding the value of those few minutes is what Lawrence said is key to helping companies recognize the importance of having AEDs readily accessible in the workplace. "Relying only on EMS means you could lose the precious time you may have to save a life," he explained.

AHA's Chain of Survival
The American Heart Association strongly encourages companies and organizations to implement AED programs to increase the chances of survival for people who have heart-related emergencies. With an AED program, an employee will be better prepared to save the life of a co-worker.

Early use of AED is one of the five time-sensitive actions in what the American Heart Association calls "chain of survival," along with early recognition, early activation of emergency medical services, bystander initiation of CPR, and early advanced life support and post-resuscitation care.

Since 1995, the AHA has promoted public access defibrillation programs–those focused on training "lay rescuers" to use AEDs in public gathering areas. Florida was the first state to mandate such a program in 1997, but it has been followed by many other municipalities and states for public sites such as schools, shopping malls, and gymnasiums. All 50 states had regulations mandating such access by 2001; AED access was mandated in federal buildings starting in 2002.

Such programs have been shown to have a significant impact on survival rates. Trials have shown that SCA survival rates doubled when CPR was combined with AED use, compared to CPR alone.

The Impact of Good Samaritan Laws
Lawrence said he often hears concerns from companies regarding potential liability for owning and using AEDS. It can be a complex issue. All 50 states and the District of Columbia now include using an AED as part of their Good Samaritan laws. But some companies still worry about what happens if the equipment is used incorrectly, or if the equipment is available but not used by bystanders.

"To me, risks can be mitigated and the investment is well worth it because at the end the day, you could save the life of an employee, customer, family member, or friend," Lawrence said. He recommends that anyone considering a program study the details of the Good Samaritan Act for their state for more specific program information and also have a member from their legal counsel, risk management, or safety team review any AED program under consideration.

Setting Up an AED Program
Unlike a heart attack, cardiac arrest often strikes suddenly and without warning. Signs include a sudden loss of responsiveness and lack of normal breathing.

The good news is that cardiac arrest is reversible in most victims if it's treated quickly, something that first became clear in the 1960s when doctors learned that electric shocks to the heart could turn an abnormally rapid rhythm into a normal one. The technology was limited to hospitals and trained professionals who could decipher a heart rhythm to determine when a shock was needed. The development of the AED, which automatically analyzes a heart rhythm and prompts the user to deliver a shock when necessary, enabled the shocks to be given by lay rescuers who aren’t medically trained. AEDs available today only require the user to turn the AED on and follow audio instructions when prompted.

Setting up an AED program takes careful planning. Here are the key steps to implementing one at your workplace:

• Get medical oversight. Depending on the program you plan to implement, a physician's prescription may be required to purchase an AED. The physician may also be required to sign off or make recommendations on training plans and policies and procedures, evaluating data recorded on an AED during a medical emergency, and helping assess each use of an AED to recommend improvements.
• Work with the local EMS service. Most states require you to coordinate your AED program with local EMS and to provide follow-up information to EMS each time the AED is used. It's also important for local EMS to know when AEDs may be available and where to find them.
• Choose an AED. There are many FDA-approved AEDs on the market that are suitable for a company's or organization’s AED program. Choose one that is simple and easy to use.
• Contact technical support. It's important to have good technical support when your AED requires it. Call the manufacturer’s number before purchasing an AED and see what kind of response you get.
• Make sure program support is available. Some AED manufacturers provide help with program implementation and ongoing support.
• Place your AEDs in visible and accessible locations. Effective AED programs are designed to deliver a shock to a victim within three to five minutes after a person collapses. Using the three-minute response time as a guide will help you figure out how many AEDs you may need and where to place them. For many companies, AEDs are placed near busy areas such as elevators, cafeterias, and the main reception area and on the walls in main corridors.
• Develop a training plan. AEDs are designed so that they can be operated without training. But training plays an important role in increasing the confidence of responders, eliminating the fear that prevents bystanders to act. Ideally, users should be trained in CPR and AED use. Some companies recruit and train employees as responders so there will always be someone available to respond to an emergency.

The American Heart Association offers CPR/AED training programs in both a classroom setting and online format. CPR/AED training is an important resource in an emergency. Effective bystander CPR provided immediately after sudden cardiac arrest can double or triple a victim's chance of survival. The training should include how to recognize a person experiencing sudden cardiac arrest, which often comes without symptoms.

Changes to CPR guidelines made in 2010 put new emphasis on chest compressions, rather than checking airways, in recognition that those compressions pump oxygen-rich blood to vital organs in an emergency, said Neumar, who chairs AHA's Emergency Cardiovascular Care Committee.

That early recognition and immediate initiation of compressions is important. "When someone is non-responsive and not breathing or having abnormal breathing, that's when CPR should be started," Neumar said.

While training can be an important confidence booster, Neumar pointed out that AEDs have been designed so that bystanders who have never had training can use them effectively in an emergency. "Make sure your employees aren’t scared to use it," Neumar said. "The defibrillator automatically measures the hearth rhythm and only advises a shock when it recognizes the abnormal rhythm it was designed to treat."

Emergency dispatch services are trained to advise 911 callers how to immediately initiate CPR and implement an AED by phone. One challenge with saving victims of cardiac arrest is that there is often a lag before bystanders take action. "If someone collapses and is nonresponsive, call 911 and start CPR right away," Neumar said. "It's better to start CPR than wait until you're more sure, because that time matters."

More key steps:

• Raise awareness of the AED program. Let employees know about your AED program, using a variety of communication tools, including internal newsletters, magnets, posters, or other signs to promote the program and let employees know where the devices are located. Continually raising awareness about the program is an important way to reinforce that your company is committed to employee safety.
• Implement an ongoing maintenance routine. It's important to do a regular visual inspection on your AEDs to make sure they are in working order, whether that's on a weekly or monthly basis. Develop a written checklist to assess the readiness of the AEDs and supplies. Stay in regular communication with the manufacturer to ensure you get the latest updates about software updates or upgrades.

Saving Lives
Lawrence says he hears from customers who were reluctant to launch an AED program, only to call back some time later to let him know implementing the program has saved the lives of their employees and/or customers. "They call back and say, 'We saved a life today,'" Lawrence said. "It's like they found religion."

This article originally appeared in the September 2014 issue of Occupational Health & Safety.