The designation of roles and the responsibilities of the leader and team members must be defined prior to the emergency.

Prepare, Decide, and Act: First Aid & CPR in the Workplace

Failure to act in a cardiac emergency can result in a preventable death.

At John Wiley & Sons' headquarters in Hoboken, N.J., there are eight floors, each housing between 100 and 150 employees in a labyrinth of cubicles and offices. Like many workplaces—whether in multistory buildings or sprawling suburban campuses—it can be difficult to navigate quickly for first-time visitors. "Each floor has a different layout, so I often consult a floor plan before I go up to a different floor," said Laurice Riley, a senior security specialist for the publishing company.

In a medical emergency, getting help quickly to a person in need is critical to survival, and seconds count. "At one point it took 10 to 15 minutes for EMS to respond to this area, so having someone on site who can help in any type of emergency is extremely important," Riley said.

First Crucial Minutes
Research shows that patient outcomes are better when CPR is administered in the first four minutes (or sooner) of a cardiac emergency. Even if the emergency is witnessed and help is called immediately, those four minutes can easily evaporate before emergency medical crews arrive.

In a best-case scenario, the call to the 911 dispatcher will take between 30 to 90 seconds to be processed. Once an EMS team is contacted, it can be another one and a half to two and a half minutes before it's en route. Much of the crucial four minutes can be used up before an ambulance or fire truck even starts its engine, and then there’s still travel time and the time it takes to get into a building and to the person who is experiencing an emergency.

Unfortunately, the longer it takes for CPR to be initiated, the less chance it will be successful. That's why a workplace CPR and first aid training program is so critical to employee safety. A trained employee can often intervene quickly and prevent something major from happening. Failure to act in a cardiac emergency can result in a preventable death.

Building a Robust Program
Having someone prepared to start CPR or provide other aid in an emergency takes careful training, planning, and practice. Cardiac emergencies are only one part of a comprehensive CPR and first aid program. Basic first aid skills are another important part of mitigating what could become a more serious injury or medical emergency.

A good workplace CPR and first aid training program includes several key components and can include course materials that are presented online or in a classroom setting. Whether employees prefer an online or in-person course for written materials, the training should also include hands-on practice and skills testing. Typically, program components include:

  • First aid basics
  • Medical emergencies
  • Injury emergencies
  • Environmental emergencies
  • Adult CPR and automated external defibrillator (AED) use

Robust programs train employees how to recognize various types of emergencies and first aid—a crucial component that goes hand in hand with knowing what action is needed. In the case of allergic reactions, for example, a good program will help trainees understand both how to identify that the emergency is happening and how to assist the person in administering an epi-pen to deliver a lifesaving dose of Epinephrine, if necessary.

Helping the person in need is just one part of the training programs. Today's first aid programs also teach how to plan for an emergency, make sure the scene is safe, thereby preventing injury to others.

Cardiac arrest is a leading cause of death in the United States, and effective CPR can double or triple a victim’s chance of survival, making CPR and use of an AED a cornerstone of any first aid program. Unfortunately, 70 percent of Americans feel helpless to act because they were unsure of what to do, either not knowing how to administer CPR or because their training significantly lapsed.

The 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care recommended a C-A-B approach, prioritizing compressions when administering CPR. C-A-B stands for Initiating Compressions to the chest to keep the blood pumping to vital organs, then opening the Airway and providing Breaths. Administering CPR to someone experiencing a cardiac arrest buys time, up to a 10 percent chance per minute, for an EMS team to arrive by keeping blood pumping to the vital organs, which improves the opportunity for survival.

In many cases, a bystander can successfully resuscitate a cardiac arrest victim using CPR and an AED before an ambulance arrives.

Building Confidence to Act
But being prepared to act during an emergency isn't as simple as having read the training materials beforehand. It's crucial that employees feel confident about what they know so that they will take action. A key part of building that confidence is investing time to develop the psychomotor skills to correctly perform in a stressful situation, something that requires regular training and practice.

In addition to classroom instruction, programs can offer a blended approach to training to those who want more options and convenience of both online and classroom learning. Students develop cognitive skills online or in the classroom, then practice and test those skills with an instructor through hands-on training to better retain the knowledge. The hands-on training and practice are crucial to helping employees build lifesaving skills that they call on in an emergency, something they can do by "reflex" or automatically without having to review a training guide first.

It's not enough to learn the information once. Maintaining those skills is crucial. Regular reviews of the information and drills to practice the hands-on skills are important to keeping the information top of mind. During stressful situations, many people have difficultly remembering information that isn’t reinforced by hands-on practice.

John Wiley & Sons, which operates offices around the country, has maintained a CPR/AED and first aid training program for the last decade, offering employees courses that include hands-on training components. A family-owned company that is more than 200 years old, John Wiley & Sons considers regular, consistent CPR/AED and first aid training for employees to be an important part of employee safety and emergency preparedness. "It's all about getting that repetition so that our people can fall back on that training, even if they haven’t had to use it," Riley said. "We want to know that our employees will be able to jump in to respond."

A workplace program also should include awareness campaigns to help all employees recognize when an emergency occurs and how to get help quickly. At John Wiley & Sons' Hoboken headquarters, key employees are trained for each of its eight floors, an important part of reducing the time it takes to get help when an emergency happens. Employees who have undergone CPR/AED and first aid training have special stickers at their workstations so their colleagues can quickly identify who can help.

"Responding to an emergency can be scary, so we want to make sure we have trained colleagues on each floor to get someone there as soon as possible," said Riley.

For many people, the uncertainty of performing a skill correctly is enough to prevent them from taking any action. Performance is really dependent on employee confidence and feeling good about what they know they can do. Empowering all employees to be prepared to take action is important. Even someone who hasn't undergone CPR training may be able to administer lifesaving compression-only CPR, guided over the phone by a 911 dispatcher, if action is taken quickly enough.

The biggest impact on improving survival for victims of cardiac arrest won't come from training more paramedics, nurses, or doctors. It will come from training laypeople who are prepared to take action as bystanders when an emergency strikes. Emergencies can strike at any time, anywhere, and while EMS crews, firefighters, and police can provide important emergency response, having trained responders is a critical part of the "Chain of Survival" for emergency cardiac care. Training employees to help in an emergency also creates a culture of supporting each other in a team environment, an important component for successful workplaces.

"Employees have expressed more confidence in responding to emergency situations, both personally and in the workplace," Riley said.

CPR and first aid training programs certainly cost money, but it's a minimal investment compared with the costs, both tangible and intangible, if a tragedy strikes and no one is prepared to help.

Creating Lifesaving Bystanders for the Community
Having a good training program in the workplace sends an important message to employees. It also prepares more people to act outside the workplace if an emergency happens at home or somewhere else in the community. When someone must act, chances are the victim will be someone they know, love, or care about.

Companies taking time to train their employees also are investing time to ensure more lifesavers are in their community. The same team prepared in the workplace will now be more confident to help when they are shopping in grocery stores or playing in the community park. They will be ready to act in an emergency, and that’s important for the community.

Those employees also will be prepared to act should an emergency take place at home, where a majority of cardiac arrests occur.

At John Wiley & Sons, the knowledge that they may be prepared to help their family members resonates strongly with employees. "It's not just something they can use at work; it's something they can use in everyday life," Riley said.

Riley hasn't had to employ her CPR or first aid skills in an emergency situation, but she has heard from colleagues who were able to successfully turn to them in a crisis, including one who saved his daughter after she began choking while out to dinner. "First aid and CPR skills are part of life safety, and you never know when you're going to need to draw on it," she said.

This article originally appeared in the February 2015 issue of Occupational Health & Safety.

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