Six Keys to Success

ClubCorp was among the first large companies to implement a corporate AED program. The company says member safety is critical to its success.

WHEN a man playing tennis at a ClubCorp Inc. resort in Austin, Texas, appeared to be suffering chest pains, ClubCorp employees responded quickly. Within 30 seconds, the company's specially trained team brought an automated external defibrillator (AED) to the man's side. On-site defibrillation was not required, but the company was pleased the team responded so quickly, said Steve Tharrett, ClubCorp's senior vice president for operations and athletics, golf, and tennis.

"An AED is a far better deal than a first aid kit--and if you go with the right program, it's not that expensive," Tharrett said. "Besides, what's the dollar value of a life? You can't put a price on that."

ClubCorp was among the first large companies to implement automated external defibrillation programs, which reduce deaths from sudden cardiac arrest. Sudden cardiac arrest is caused by an irregular heart rhythm and kills approximately 250,000 Americans each year. AEDs are devices that evaluate heart performance and can deliver an electrical shock that helps the heart regain a normal rhythm and blood circulation. Speed is critical. The chances of reviving someone with sudden cardiac arrest diminish an estimated 7-10 percent per minute without defibrillation. Few people survive untreated after more than 10 to 12 minutes.

ClubCorp, which owns or operates nearly 200 golf courses, country clubs, private businesses, sports clubs, and resorts worldwide, implemented AED programs at 86 tennis and athletic facilities in 20 states and trained 860 employees in AED use during a four month period in 2002. Why did ClubCorp move forward? "We distinguish ourselves from the rest of our industry by the quality of our client care," Tharrett said. "Several of our member boards told us they thought having AED programs in place at our facilities was a good idea, and we agreed. Member safety is critical to us."

American Heart Association Recommendations

AED programs place medical devices called automated external defibrillators in facilities that emergency medical services may find difficult to access, or that attract large numbers of people. AEDs analyze a victim's heart rhythm and deliver a shock if necessary so the heart can resume a normal beat and circulate blood throughout the body.

The American Heart Association describes early defibrillation as the most critical link in the "chain of survival," a four-step process designed to reduce deaths from sudden cardiac arrest. Studies show survival from sudden cardiac arrest is directly linked to the amount of time between onset of arrest and defibrillation. If no bystander CPR is provided, a victim's chance of survival is reduced 7-10 percent as each minute passes without defibrillation. Few attempts at resuscitation succeed if no treatment is provided within 10-12 minutes of collapse.

The association offers the following as critical to successful AED programs:

  • Training designated rescuers in CPR and the use of AEDs. Designated potential rescuers should complete training in CPR and AED use.
  • Securing physician oversight to help ensure quality control. AEDs are sold as medical devices in most states and require a physician's prescription. The American Heart Association recommends having a physician or other qualified health care provider provide medical oversight for your program and help you select an AED. Your local emergency medical services system or AHA office should be able to suggest qualified physicians.
  • Integrating with the local Emergency Medical Services system. Before implementing your AED program, check with EMS to determine local requirements. Some states require an application and filing a response plan. Local EMS also will want to know the brand and model of your AEDs, and how many and where the AEDs were placed in your facilities.
  • Using and maintaining AEDs according to the manufacturer's specifications. All AEDs work in a similar fashion. However, it is important for users to be trained to use the specific AED at your site. AEDs require little upkeep, but regular "readiness for use" checks will ensure batteries and pads have not expired. Reviewing the manufacturer's maintenance agreement is also important.

Implementing AED programs in sizeable companies such as ClubCorp requires organization, communication, and a well-thought out plan for ongoing maintenance, he said. The American Heart Association cites four critical success factors (see the accompanying sidebar) for AED programs. Here are additional factors that ClubCorp suggests companies implementing AED programs should consider carefully:

Key Success Factor #1
Communicate management support of your AED program

Securing executive buy-in for your AED program and then communicating that support builds enthusiasm, Tharrett said. ClubCorp developed a statement reflecting management's commitment to the program prior to announcing it, then communicated that commitment clearly to club managers and responsible department heads.

"It paved the way," he said. "ClubCorp's athletic and tennis clubs are in the business of helping people change their lives through better health. So it made sense to everyone that we have the tools on hand and programs in place to protect their health."

Key Success Factor #2
Think creatively to simplify internal funding issues

Funding for corporate AED programs can be handled several ways.

Some companies write it into their budgets as a line item. Others incorporate costs into several line items. For example, equipment is considered a one-time capital expenditure; implementation is included in the operating budget, and training is rolled into human resources.

Some companies ask individual cost centers to cover the cost. If departments contain multiple cost centers, AED program planners may need to "sell" each department on the program, which can be a time-consuming process. A simpler approach: rolling AED program costs into room rental or equipment charges. Doing so means approaching building services, as opposed to hundreds of department managers.

ClubCorp opted to pay for programs out of corporately allocated capital funds.

Key Success Factor #3
Know your facilities

Understanding facility differences can be a critical component of implementation, especially for corporations with many different buildings or types of facilities. The American Heart Association recommends a maximum five-minute response time to medical emergencies that appear to be sudden cardiac arrest. To ensure a rapid response, AEDs should be placed in the same place at each type of facility so designated responders can find equipment easily, even if they are unfamiliar with a specific facility.

What to do if office walls are moveable and are frequently rearranged? Placing AEDs on stationary walls near elevators and fire phones has proven to be a good solution for some companies. Others have opted to assign equipment to responders on each shift. ClubCorp outsourced implementation and training to an AED service provider who recommended where to place equipment at each property.

Key Success Factor #4
Develop a plan for ensuring enough trained responders

Another key success factor is ensuring trained responders are available on each floor during each shift. Responders should be employees whose jobs do not require them to leave the facility.

Many corporations select shift leaders, security personnel, and maintenance staff as first responders. Other companies use employee fire wardens, as required by some city codes. The numbers of fire wardens required per building often corresponds with the number of AED responders necessary to meet American Heart Association-recommended response times.

ClubCorp provided AED training for 10 employees at each of the 86 properties where it implemented AED programs. The service provider engaged by ClubCorp uses software to ensure sufficient employees are available during each shift to meet response times.

Key Success Factor #5
Communicate clearly with employees

Clear, frequent communication paved the way for a smooth rollout at ClubCorp, Tharrett said. The company developed a communications plan before implementation so employees would understand the program's purpose, the equipment selected, implementation procedures and scheduling, responder training, and ongoing maintenance. ClubCorp also wrote a sample "letter to clients" that individual clubs could use to communicate with customers, letting them know when the program would be operational.

Employees participated in Web conference calls explaining the program and received e-mails detailing installation and training times and procedures. They took part in selecting which brand of AED ClubCorp would purchase. An AED coordinator at each site received a binder with information about sudden cardiac arrest, defibrillation, and ClubCorp's program so he or she could answer employees' questions locally.

"We knew there would be some fear and anxiety on the part of employees," Tharrett said. "At the beginning, many perceived defibrillation as something only a doctor could do. We provided them with information and tools that helped dispel those concerns."

Key Success Factor #6
Develop a plan for ongoing maintenance

AED programs are not complex, but they do require some ongoing maintenance to ensure companies are always ready to save lives. AED batteries and pads expire and need to be replaced. Training certifications need to be updated regularly. Testing equipment often and conducting regular drills to evaluate emergency response plans also are important.

Maintenance can be handled internally, usually by building services, or companies can hire a service provider. (Some service providers provide turnkey solutions that provide implementation and training, as well). ClubCorp opted to outsource, choosing an AED services company that implements, provides training, and offers a Web-based software system that tracks training certifications and product expirations by location. The software alerts ClubCorp when actions such as replacing batteries or defibrillator pads are necessary and when responders need recertification.

"Knowing resources were available that would ensure our system's readiness was an important part of our decision to move forward with the program," Tharrett said. "We wanted to make sure that once we implemented, we would be able to maintain the integrity of the program."

Ongoing maintenance also is critical to manage liability under Good Samaritan laws offered by all 50 states. Many states provide limited immunity for the entity (company or facility) that purchases AEDs, the physician providing oversight, and people providing training. The federal Cardiac Arrest Survival Act provides limited immunity for lay rescuers and owners of property where AEDs are located. A growing trend is for companies and facilities to have increased liability if they are not prepared to respond appropriately to a cardiac emergency.

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

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