Assessing Your AED Needs

Deploying a workplace defibrillation program protects a company's greatest investment--its employees.

LOSING a valuable employee heavily impacts the organization on many levels: the loss of productivity, the impact to company morale, the employee safety and security issues, and risk and liability issues. Sudden cardiac arrest (SCA) is the number one killer of people in the United States. Over 450,000 Americans a year die from this silent killer. Not surprisingly, OSHA identifies SCA as the number one killer in the workplace, as it is the cause of 15 percent of all workplace fatalities. By its very nature, SCA is completely unpredictable and can strike anyone at any time, often without regard to someone's age or health. In fact, studies tell us that SCA is the first sign of heart disease for as many as 50 percent of SCA victims annually. Tragically, 95 percent of SCA victims die before reaching the hospital.

That's the bad news. The good news is there is a solution through the prompt delivery of a defibrillation shock--an electrical pulse through the heart--delivered by an Automated External Defibrillator or AED, which restores a normal heart rhythm. The chance of a SCA victim's survival decreases by 10 percent for every minute that passes. To be effective, defibrillation treatment must be administered within the first few minutes of the arrest. The American Heart Association (AHA) estimates that roughly 50 percent (or more than 200,000 people) could survive an arrest with prompt and proper treatment using an AED.

Increased survival rates are the primary reason that hundreds of thousands of AEDs have already been deployed throughout U.S. workplaces and public places. Every time a life is saved with an AED--and, unfortunately, every time a life is lost when no AED was available--the pressure to do something to protect and safeguard the employees and customers in the organization is recognized.

The importance and reliance that organizations place on their employees and customers would justify the small investment of time and money required to implement an AED program as well as other employee safety programs. The simple question is do organizations "walk the talk" with respect to the value of their employees and customers?

For example, why do we have safety programs, safety and health professionals, and life saving equipment? The answer is easy and can be summarized with three simple reasons. First and foremost, organizations need to protect all employees and customers from safety and health dangers. Second, to ensure that the latest safety and health programs are put in place to protect the assets of the company. And finally, by creating a safe and healthy work environment, organizations honor their commitment that the employees and customers are their most valuable assets.

Many organizations have developed comprehensive safety plans for these three simple reasons. All three factors are evident with many safety and health priorities--safety training, control of hazardous materials, fall protection, fire protection, electrical safety, and more. The aforementioned reasons are how these programs get to be priorities.

"We believe it and live it in safety, but sometimes we have trouble convincing others outside of our field," says Tom Keelty, CSP, co-founder of Industrial Risk Control, LLC, a Philadelphia-area safety and risk control consulting firm focused on the pharmaceutical industry.

This issue is often the challenge with the still-emerging area of comprehensive emergency medical response systems that include AEDs. Workplace defibrillation programs (WDP) save the lives of SCA victims, so that makes them valuable and essential programs. These programs support the fact that employees and customers are the most important assets in the organization.

Why AEDs?
Increased survival rates are one of the major reasons that thousands of AEDs have already been deployed throughout U.S. workplaces and public places. Lawmakers also have begun to recognize the public health policy importance of AEDs. This growing legislative activity has helped safety professionals lobby for workplace defibrillation programs in their organizations.

Regulations and legislation at the federal and state level have helped AED deployments. In November 2000, President Bill Clinton signed into law the Cardiac Arrest Survival Act (CASA) that provides Good Samaritan protection against liability for lay rescuers who have been trained to use an AED. In order to improve survival rates of individuals who experience cardiac arrest in federal buildings, the Public Health and Service Act also mandated that AEDs be placed in federal buildings.

The Federal Aviation Administration issued regulations in 2001, requiring U.S. airlines to carry AEDs and enhanced medical kits on planes that have at least one flight attendant. In December 2001, OSHA issued a Technical Information Bulletin and information resource outlining the potential benefits of AED programs and encouraging employers to make these devices available. In 2002, a statewide mandate was made for AEDs in New York public schools. Legislation also is pending in several other states mandating AEDs in schools and other venues.

Understanding the AED investment
As with most workplace safety programs, employers may sometimes ask themselves, "What return will I see when implementing an AED program? Do I have a significant risk exposure? Will it be cost effective for my company to start a workplace defibrillation program?"

Regarding the question of need, time is the critical decision point when considering a WDP. The AHA recommends an AED Program be considered if a location cannot expect a consistent five-minute response time from local EMS response. This five-minute response time is measured from the time the SCA victim collapses to the time the shock is delivered to the victim. An analysis of a location's response time will, more often than not, show that this five-minute window will not be met by most EMS agencies. The simple fact is that if an employee or customer collapses from SCA, they will die. This is proven again and again, as the national SCA survival rate for the United States is a dismal 5 percent.

According to OSHA, workers involved in shift work, holding high-stress jobs, or exposed to certain chemicals or electrical hazards face a higher risk of heart disease and cardiac arrest. An aging or out-of-shape work force also should be considered significant indicators of high sudden cardiac arrest risk.

Another way of evaluating the cost-effectiveness of a WDP is to compare it to other employee benefit programs. To put the cost of an AED program in perspective, on a monthly basis, it often costs less for a WDP than providing coffee and drinking water for the same employees. The simple fact is that a WDP is one of the least expensive insurance policies that a company can buy.

Some organizations are successful in driving their AED programs when they link them to protecting key employees--a significant economic consideration. The preventable loss of just one key person can devastate an entire company and cost people their jobs and their financial investments. "Employee protection is becoming a very big issue for industry. We are encouraged by the growing list of corporations implementing WDPs," says Keelty.

Managing the Costs
When managing a WDP, it is important to realize that the AED, which typically costs anywhere from $2,000 to $2,500 per unit, is not the only investment. A comprehensive emergency medical response system can include "hardware" items such as the AED, emergency response kit, and possibly an emergency oxygen unit; and "software" items such as the AED/CPR training, medical direction, prescription, and program management. Each category is essential to a successful program. These items are often "hidden costs," as the person initiating the AED program does often not plan for them.

A WDP also must meet all of the applicable state and local laws governing the use of AEDs, assuring that the program is in compliance with applicable laws and regulations.

There should be a "game plan" for addressing all worksites, from the smallest to the largest organizations. Ideally, you would want an organization-wide deployment so that all facilities can take advantage of the AED's life-saving benefits. Whether the organization needs to train its employees, ensure and track compliance, or call for a 24-hour toll-free medical consultation by phone, a complete WDP should be available to guide the employer through every step of the process.

Focus on Implementation
Just having an AED is not enough. A vital component of every AED program is proper training, medical direction, and program management. Because the chance of surviving SCA decreases by 10 percent with every minute that passes, defibrillation must be administered quickly following the collapse. Having a well-thought-out program that addresses all of these issues will give a responder the best chance of saving someone's life from SCA.

We recommend a total WDP that includes training in a four-hour AED/CPR training format covering CPR and AED use. Typically, employers should expect to train approximately 10 people for each AED installed, but this may vary by location and size of deployment. Most companies plan for annual training as they experience employee turnover, and often there are additional employees interested in the training.

Traditionally, buyers of AEDs arrange for their own training with non-profit organizations or off-duty paramedics, coordinate their own site assessment and deployment, and assure ongoing compliance with recertification and other regulations. This approach can be problematic, as it is somewhat fragmented. A more systematic approach, by a single point of contact, is often preferred to assure that the WDP implementation is efficient and effective.

"AED programs have become so successful that it's hardly worth building a strong first aid/CPR/emergency response program if you're not going to include AEDs," Keelty adds. "Some companies train extensively in CPR, which has a survival rate on its own of only 1 to 2 percent, while the AED survival rate can be 60 to 70 percent or more. I'd say there is a lot of misplaced effort that needs to be redirected from a CPR focus to support a full AED/CPR program."

Keelty believes the AED is a technical marvel that needs to be widely deployed and understood. "Not only can these portable boxes save a life, but they can talk the rescuer through the process," Keelty remarks. "I can't think of any other safety equipment that comes with an automatic, built-in user's manual like this. Yes, you absolutely need training, but the fact that you don't have to be an emergency room physician to be successful is amazing. It's an ideal blend of the human and technology."

The Bottom Line
Today, AEDs can be found in police cruisers, trains, airplanes, shopping malls, casinos, turnpike service plazas, offices, manufacturing workplaces, schools, health clubs, and even homes. There have been many early adopters, and the survival rates during the first wave of implementation have caused other organizations to take notice. People are alive today because of the foresight and commitment to protecting the most valuable assets in an organization--the employees and customers. WDPs are becoming more commonplace. Protecting employees and customers from America's number one killer should be a priority for all employers.

How many? Where?

Automated external defibrillators are an investment, and for every AED deployed, there should be a program that includes first responder training, medical direction and oversight, and program management. Thus, to maximize the strategic value from your AED investment, consider these three critical questions:

  • How many AEDs do I need?
  • Where should I put them?
  • How do I manage the program?

Time is the single most important consideration when determining the number of AEDs for a location. For every minute that goes by, a sudden cardiac arrest victim loses about a 10 percent chance of survival. The number and placement of the AEDs directly impacts response times. One AED located on the first floor of a ten-floor office building will have minimal impact on the chance of survival of a sudden cardiac arrest victim on the eighth floor.

Determining the number and location of AEDs can be relatively an uncomplicated process. It is done with a stopwatch. First, determine the location(s) that the AED(s) are to be placed. The American Heart Association (AHA) advises that the following be considered when determining where to place your AEDs:

  • Employee or customer density: Employee cafeterias, reception areas, etc.
  • Risk areas: Exercise areas, hazardous areas (electrical or chemical), high-stress areas
  • Difficult access areas: Secure work areas, multiple doors, etc., and
  • High visibility areas: Reception areas, next to existing emergency equipment.

Once you determine areas that you would like to place the AEDs, you should calculate the area that will be covered by that AED. Walk the area with a stopwatch. The federal government recommends a three-minute response time as a guideline. To determine a three-minute response time, start at the point in which the AED is located. Walk briskly for 90 seconds. This point is the outlying point in which the AED can respond within three minutes, as it allows a rescuer 90 seconds to get to the AED and another 90 seconds to return and apply the AED to the sudden cardiac arrest victim. Consider the following when timing the AED response:

  • Barriers--Are there any physical barriers such as doors, locked doors, or stairs?
  • Vertical response--When calculating response times, vertical response must be given consideration. How will a rescuer respond on a different floor? How much time will it take to access the stairs or elevator? Most often, AEDs must be placed on every floor or at least every other floor.
  • Targeted Responders--If the workplace has selected targeted responders such as an onsite nurse or EMT, additional AEDs should be placed with them for quick and easy access.

Once you determine the location and number of AEDs, you must determine how you should deploy them. The AEDs should be wall-mounted in heavily used, widely accessible areas such as lobbies, cafeterias, conference rooms, and/or main corridors. They should not be stashed away in an often-locked or remote office or storage area.

For more complex deployments, consult professionals to determine location and number of AED placements.

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

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