The Road to Deployment

Navigating the steps leading to AED deployment in a workplace seems tough to many, but a key element--training--can be done with relative ease.

"WHAT is a smoke detector?" Such a question would draw raised eyebrows and possibly snickers in an average gathering of office employees. "What is an AED?" Unless you're in the business, a techie, a safety director, an EMS responder, or a medical professional, you may have no idea the initials AED stand for automated external defibrillator--the portable version of the famous shock paddles depicted in decades of medical dramas, shocking a cardiac arrest victim back to life.

Today's AEDs are simple enough for even a child to operate. The shock cannot be administered manually or at someone's will. The AED will tell you to push the shock button only after the need has been determined by the AED.

During a cardiac arrest, the victim's heart ceases normal rhythm and no blood flows. The victim loses consciousness, falls to the ground, and his breathing stops. This is when the clock starts ticking. For every minute that passes, the chance of surviving a cardiac arrest diminishes by 10 percent. In other words, after five minutes your chance of survival is only 50 percent. After 10 minutes, you have a minimal chance of surviving, less than 10 percent. The most critical moments are during the first four minutes.

Realize the heart has not stopped moving, it has only lost its rhythm. Merely delivering a mild electrical shock to the heart can restore its normal rhythm.

Don't Wait for the Ambulance
You may hear this: "I would just call an ambulance, why should I get involved?"What's very sad is that the national average ambulance response time in this country is 10 minutes or more. With that said, a sudden cardiac arrest victim has technically no chance of survival waiting for the ambulance to arrive.

Now that AEDs are readily available, anyone can get involved. Anyone with minimal training in using an AED and cardiopulmonary resuscitation (CPR) can save a life. CPR alone cannot revive a heart that has stopped. CPR however, does two important things. First, it forces the blood to continue flowing through the body. Second, it gets oxygen to the brain. CPR buys critical time until defibrillation can be performed.

Today, an AED is a reality in the workplace. Many companies are voluntarily implementing AEDs as part of their safety and emergency response programs, even though AEDs are not mandated by any OSHA regulation. At this point, OSHA has published bulletins on them for informational purposes only.

More Accessible AED and CPR Training
A key element in an AED program is proper AED and CPR training. From CEOs to lay workers, people are being trained and certified to operate an AED.

All AED and CPR training courses are being taught in classes where a certified instructor is present, guiding students and exposing them to simulated scenarios and hands-on trainings. The course is normally four hours long, consisting of two hours of CPR plus two hours of AED training. New advances in technology have made it possible for people to be trained whenever and wherever they want.

In fact, you can be trained by your own computer at your office or in the comfort of your home. All you need to do is insert a CD into your computer's CD-ROM drive, and you're in the class. An interactive computer software program teaches you how to use an AED and how to perform proper CPR with simple clicks of the mouse. You might ask, how is this possible? Real-time, interactive multimedia and sophisticated flash animation can virtually recreate scenarios that are close to the real thing. You can stop at any time, save, and come back to where you left off.

This entire course is approximately five hours in length and follows guidelines set by the American Heart Association. You can take a test at the end of the program. Upon successful completion, the final test result is sent via the Internet for review and analysis. If you pass the test, a hard-copy certification is then mailed to you.

Ideally, every workplace and even every home should have an AED. AEDs are as important as smoke detectors and fire extinguishers. More than 250,000 Americans die each year of sudden cardiac arrest, making SCA a leading cause of death in North America. It can happen to anyone, at any time, anywhere.

AEDs generally are easy to use, but proper training in AED and CPR can sometimes mean the difference between life and death.

Answers to Frequently Asked AED Questions

What is Sudden Cardiac Arrest, and to whom can it happen?
Sudden cardiac arrest, also known as ventricular fibrillation (VF), is an electrical malfunction of the heart. With VF, the regular, systematic pumping action of the heart's chambers stops because the normal electrical signal that runs through the heart in a prescribed sequence has been interrupted for some reason. Electrical chaos ensues and results in uncontrolled, non-productive quivering of the heart chambers. There are many causes--congenital defects, illness, heart attack, environmental conditions, even physical contact. A hard blow to the chest can knock a healthy youngster or a well-conditioned athlete into cardiac arrest. Dehydration or heat exertion can do the same. Did you know that most drowning victims go into cardiac arrest, as well? The bottom line is that anyone, at any age, can become a victim of sudden cardiac arrest.

Are there any warning signs of SCA?
No, and sadly enough, the first sign of heart problems in most men is sudden cardiac arrest. SCA claims more than 350,000 lives each year, primarily because lifesaving treatment, that is, early defibrillation, does not reach the victims within the first critical minutes.

Is SCA the same thing as a heart attack?
No! A heart attack and SCA are two different things, although they can occur together. A heart attack is caused by a blockage in a coronary artery which results in a sustained lack of blood flow (and consequently oxygen) to a part of the heart. If the blockage is not resolved in a timely manner, the heart tissue below the blockage will "infarct" or die. If the dead tissue also happened to be part of the heart's specialized electrical system, SCA could be triggered. During a heart attack, the heart can continue to beat, and often the victim remains conscious. In fact, people can be having heart attacks and not even know it. (This is known as a silent heart attack.) Typically, however, a person having a heart attack experiences considerable discomfort or pain in the chest, left arm, jaw, back, or neck, and at some point may lose consciousness.

How does an AED "treat" SCA?
A heart in SCA is very much like a hysterical person who can't be calmed down. A shock to the heart acts just like a slap in the face for the hysterical person. It stuns the heart tissue, disrupting the electrical chaos, and allows the normal electrical sequencing of the heart (and subsequently, pumping action) to resume.

The paramedics are close by; why should we have an AED?
Although your local fire station may be just around the corner, there are many factors that can delay their response. The engines may not be in when they get your call. There may be traffic issues. It may take them some time to get from the curb to the building and from the entrance to the victim. While a 6-8 minute response time seems very efficient, consider the fact a victim's chance of survival from SCA decreases by 10 percent with every minute that passes, and less than 5 percent of SCA victims survive with CPR alone. And ask yourself, how long was the patient down before he/she was found? How tragic it is when EMS arrives on the scene only to find that the patient has already died.

Does the AED take the place of CPR?
No. The AED is part of CPR. For maximum benefits (that is, best chance of survival) you must use the two tools together.

Can I hurt someone with an AED?
No. There are two things to remember here. First, a victim of SCA is essentially dead. Early defibrillation represents that person's only chance for survival. Second, AEDs will not shock someone who does not need to be shocked. It's that simple.

What about using an AED on metal or wet surfaces?
Always check with the manufacturer, but because most AEDs are self grounded, they can be safely used in wet environments and on metal surfaces with no risk to the victim or rescuer.

Aren't I at risk for a lawsuit if I use an AED?
Since mid-2001, all fifty states in the U.S. have passed Good Samaritan Laws, and many continue to expand the parameters of civil immunity in the hope of encouraging the deployment of more AEDs in the community, in the workplace, and at home. Clearly, this is something that all sectors of both the state and federal governments are in agreement on.

SOURCE: American Heart Science, www.americanaed.com

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

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