When Minutes Matter: CPR and AEDs at Work
Training is key to managing a cardiac event at work.
Too often and for too many employees, mandatory CPR/AED training is seen as an inconvenience that disrupts a busy workday for an emergency that may never occur.
It’s easy to adopt the “it-can’t-happen-here” mentality, but consider the numbers.
Nearly 10,000 people—more than 15 percent of workplace fatalities—suffer cardiac arrest on the job annually. It’s most often seen in industries where workers may be exposed to electrocution, lightning strikes, low oxygen environments or even overexertion.
OSHA estimates that having an automated external defibrillator (AED) available and an average time to defibrillation of three to four minutes can lead to a 60 percent increase in survival rates.
An observational study from the Swedish Registry of Cardiopulmonary Resuscitation published in Resuscitation Plus supports the OSHA data, finding that out-of-hospital cardiac arrest occurring at workplaces and crowded public places displayed the highest probability of survival from out-of-hospital cardiac arrest (OHCA).
Further, after finding better outcomes for OHCA cases that occur in the workplace, a 2015 meta-analysis published in the journal Resuscitation recommended that workplace safety requirements should include steps to address these types of major events.
Training is key to managing a cardiac event at work, where survival often lies in the hands of colleagues who can immediately start CPR and operate an AED.
Ensuring Employees are Ready to Act
Preparation and small details count when a life is at stake. The American Red Cross last year introduced “active learning,” where students take turns simulating the roles of student, coach and observer in CPR/AED skills sessions. This “peer-to-peer” format fosters a highly active learning environment that furthers memory retention and better prepares students for real world, team response situations.
“You are not responding to an emergency alone, so we realize we need to learn how to integrate that,” said Owen Long, then-president of Sertified, LLC, a Red Cross training provider.
The new format also emphasizes hands-on training where students can work on their technique and practice timing and pace. With up to 50 percent more time now spent applying skills, instructors can offer more personalized and effective evaluation that truly hones ability and knowledge.
Preparation Prevents Suboptimal Performance
Practice and repetition can help save lives, but they are only one part of the equation when responding to cardiac arrest. For every minute that a non-responsive coworker doesn’t receive effective defibrillation, chances of survival plummet by 10 percent.5 Having an AED in the workplace can make a defining difference in a patient’s outcome.
Setting up an AED program takes planning but is not difficult. First, designate a program director who will check and verify state requirements. Then the program director will involve medical professionals to offer guidance.
For example, every AED program should be integrated with the local EMS system since these will most likely be the first medical professionals on the scene. You’ll also want to ensure that a physician plays a role in your program’s set-up, be it making recommendations on training plans, policies and procedures or evaluating the use of an AED to recommend improvements.
Next, choose an AED and ensure that any manufacturer with whom you work offers sufficient support:
Technical support. Is there an 800 number to call for questions and are people available to respond in a timely fashion?
Program implementation. This may include placement of the device, medical authorization, registration and special training.
Ongoing maintenance. You want the AED to work when it is needed, so regular inspections are a must. A staff member could assume this responsibility or you could hire a service that monitors your AEDs for operational readiness.
Finally, develop a training plan and use it to raise awareness of the AED program. Employees should know the locations of all AEDs. And, although an AED only requires that the user turn it on and follow the audio prompts, training increases the confidence of responders.
Second Nature
The importance of CPR and AEDs is not lost to the employees of Shelby Electric Cooperative in Illinois. On May 8, 2018, forestry foreman Kevin Carlen lost consciousness while hanging mid-air as part of a pole top rescue training.
“I took two steps and then everything went black,” recalled Carlen.
His fellow linemen sprang into action, belaying him down the pole, calling 911, beginning CPR and getting the AED.
The AED restarted Carlen’s heart to a normal rhythm.
“I’ve seen how people are doing the training year after year after year—it was second nature to us when it did occur,” said Thad France, manager of line-worker development for Shelby Electric Cooperative. “As I started yelling instructions, everybody was already doing everything I was yelling.”
It took the ambulance three and a half minutes to arrive, during which the years of training and access to the right equipment kicked in. Being prepared made the difference in the most important three and a half minutes of their stricken colleague’s life.
Luke Brown, an apprentice lineman at Shelby Electric, summed it up: “If you can just save somebody, why wouldn’t you?”
Publisher's Note: The following appeared alongside this article as a sidebar in the OH&S Magazine September 2022 issue.
How It Works: The Red Cross Cardiac Arrest Chain of Survival
A worker suddenly collapses on the job. Someone recognizes that the unresponsive person is suffering cardiac arrest.
Step 1. That person activates the emergency response system, either by calling 911 or asking someone else to do so. Someone is sent to get the AED.
Step 2. Cardiopulmonary resuscitation (CPR) begins, preferably by a trained employee using chest compressions and ventilations. Compressions manually pump oxygenated blood to the brain and other organs while “rescue breaths” provide additional oxygen to the blood.
Step 3. A heart in ventricular fibrillation may only be restored to normal by an electric shock as early as possible. AEDs are designed to be simple. Once the pads are positioned on the victim’s chest, the AED will analyze the heart rhythm and advise the responder to deliver a shock if needed using voice prompts. If a heartbeat is present, the AED will not allow a shock to be delivered.
Step 4. The emergency medical services (EMS) team arrives. CPR continues until the paramedics are ready to take over. At that point, the immediate responders can step aside while EMS professionals begin advanced care.
Step 5. The patient is transported to the hospital, where a team of medical professionals goes to work.
Step 6. The recovery step begins as soon as the patient wakes up from the life-altering event. The Red Cross added this new step in 2021 to ensure that progress continues after the hospital stay concludes. Says Mark Whelchel, director of Healthcare and Prehospital Education for the Red Cross, “We may have saved their lives, but there is a long-term critical care need beyond the hospital because these patients’ hearts are severely damaged.”
This article originally appeared in the September 1, 2022 issue of Occupational Health & Safety.