It's a Matter of Time

Would your employees rise to the AED challenge? ShopRite's experience proves they will.

PROSPECTS couldn't be brighter for the automated external defibrillator market than they are right now. Liability concerns have receded thanks to "Good Samaritan" laws; new AEDs are lighter, smarter, more capable, and as much as 25 percent cheaper than older models; a battery of important authorities, from OSHA to the General Services Administration, the American College of Occupational and Environmental Medicine, and the Building Owners and Managers Association International, are urging widespread deployment. State legislation is putting hundreds of units into big-city public school systems. Some large retail chains and shopping malls are deploying AEDs.

It comes as a surprise, then, to learn that a recent survey found only 6 percent of U.S. workplaces are equipped with AEDs and only 16 percent of unequipped sites have discussed acquiring AEDs. However, RoperASW's telephone survey of 500 small, medium, and large workplaces also found 53 percent of workplaces that have deployed AEDs would definitely recommend them to other companies, and another 30 percent would probably recommend them. (The survey was conducted in September 2002 for Philips Medical Systems and released in June 2003.)

"I think to a large degree that our message has been education and awareness," Tracy Byers, marketing director in North America for Philips Medical Systems' Cardiac Resuscitation Solutions unit, said during an interview. "I do agree with you that it is concerning that only 6 percent of workplaces have early defibrillation programs in place. . . . We certainly hope to raise that."

Is the message going unheard? The influence of the authorities backing AED deployment might be easy to overlook, but they aren't small. OSHA asked employers in December 2001 to put AEDs in service, and potentially that encouragement could bring them to millions of private-sector workplaces. The General Services Administration provides computers, furniture, and other equipment for 8,300 federally owned and leased buildings nationwide housing more than a million employees. North American members of BOMA, the Building Owners and Managers Association International, oversee more than 9 billion square feet of commercial properties. Counting more than 6,000 physicians and health care professionals among its members, the American College of Occupational and Environmental Medicine is the largest U.S. medical society dedicated to occupational health.

A Supermarket Chain Embraces AEDs
Wakefern Food Corp. and its 200 ShopRite supermarkets in five northeastern states have fully embraced the AED concept. The Elizabeth, N.J.-based company's effort began with its warehouses three years ago, said David Sylvester, vice president of Loss Prevention.

"An outside vendor from out of state had died at a dock. We went, 'Boy, how could we have avoided this thing?' We worked on him with CPR, but he was dead at the dock. If we'd had an AED, we probably could have pulled him back," Sylvester said.

From that day forward, Wakefern's AED program took off. All of its stores and warehouses in the five-state region are equipped with them. Employees used the devices to make five saves within the first two years, administering shocks to all five victims' hearts in under four minutes, Sylvester said. "We realized early on that proximity to the machines is very important," he explained. "I have a feeling that if you don't get there in four minutes, they go from dead to dead-dead. We've shocked them one time. The national average is 40 percent saved, and we're batting a thousand."

ShopRite is a retailer-owned cooperative with 51,000 employees. The largest private-sector employer in New Jersey, it has a thorough training program--even training personnel on its night crews. It sends groups of two to four trainers to conduct sessions inside its stores, said Sylvester.

The company has certified 2,200 retail employees and 260 warehouse employees to operate AEDs. Using American Heart Association guidelines and trainers from an outside vendor, it trains 12 to 20 workers per location. Recertifying is done with a vendor's software program, he said. The training recently became more challenging because management added child defibrillation and CPR to the course.

Initial training costs about $75 per employee, recertifying training costs about $55 per person, and the AEDs cost ShopRite from $2,200 to $2,500 apiece. "It's an investment in people and it's worth it," Sylvester said of the program's cost. "We're backlogged. We've got more people signed up (for training) than we can even get to."

"It's a volunteer program," he added. "It does work: If you ask people, they respond." Most gratifyingly, he said, each employee who has been called upon to respond in a sudden cardiac arrest emergency has succeeded. "Nobody screws up. Everybody comes through for us every time," Sylvester said. "We've saved three customers and two employees--they're walking around today."

Public access defibrillation definitely is coming, he said, and in keeping with that philosophy, AEDs are prominently displayed in the ShopRite stores where a shopper could reach them. Several co-op members who own ShopRite stores have donated AEDs to law enforcement agencies and emergency medical teams in their own communities, Sylvester said.

Driving Growth in AEDs: EMS Response Times
OSHA in 2001 estimated as many as 120 workers' lives would be saved each year by placing AEDs in workplaces, especially at sites where workers are involved in shift work, hold high-stress jobs, or are exposed to certain chemicals or electrical hazards. These workers face a higher risk of heart disease and cardiac arrest, according to the agency.

About 240,000 people in the United States die of sudden cardiac arrest per year, although as many as 90 percent could be saved if defibrillators reached them in time. Each minute that passes before defibrillation decreases an SCA victim's chance for survival by about 10 percent. Few attempts are successful after 10 minutes.

With liability and cost barriers to AED deployment disappearing, the time factor--how many minutes it takes EMS responders in any given location to arrive after a 911 call--will cause many more employers to buy them, predicted Philips Medical Systems' Byers.

"The underlying assumption is that EMS is certainly going to get there on time, and that certainly is not the case," she said. "From our perspective, we really want to focus on the awareness of the EMS response. Once that awareness is created . . . once an agency does decide in fact to actually buy defibrillators and put in a defibrillation program, more than 80 percent would recommend that others do so."

Los Angeles, Calif., is getting there. EMS and fire units and the city's major airports received AEDs first. Now, the devices are deployed in all utility trucks, water department trucks, and inside the city's schools. Workplaces are allying with government agencies to set up defibrillation programs, said Byers. Health and fitness centers are buying them, too.

Online References

1. OSHA's AED card:
www.osha.gov/Publications/osha3174.pdf

2. BOMA's AED Task Force:
www.boma.org/wbm/committees/AED.htm

3. "Public Use of Automated External Defibrillators," written by Sherry L. Caffrey, E.M.T.-P., Paula J. Willoughby, D.O., M.H.P.E., Paul E. Pepe, M.D., M.P.H., and Lance B. Becker, M.D., and published in the October 17, 2002, issue of The New England Journal of Medicine (Volume 347:1242-1247):
http://content.nejm.org/cgi/content/short/347/16/1242

This article originally appeared in the October 2003 issue of Occupational Health & Safety.

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