On Guard Against a Major Killer

AEDs are life-saving technology for battling Sudden Cardiac Arrest.

SUDDEN cardiac arrest (SCA) is an abrupt disruption of the heart's function that causes lack of blood flow to vital organs. This lack of blood flow results in loss of blood pressure, pulse, and consciousness. Most commonly, SCA is caused by a type of arrhythmia (abnormal heart rhythm) called ventricular fibrillation, or VF.

According to the American Heart Association, SCA is one of the leading causes of death in the United States, claiming more than one-quarter of a million victims each year (2003 Statistics, www.americanheart.org). There are more deaths each year from SCA than from breast cancer, prostate cancer, AIDS, house fires, handguns, and traffic accidents combined.

OSHA states that approximately 400 workplace deaths from cardiac arrest are reported annually. OSHA believes employers should consider use of automated external defibrillators at their work sites to reduce the time to defibrillation, with the goal of improving survival. Workers who are involved in shiftwork, hold high-stress jobs, or are exposed to certain chemicals or electrical hazards face a higher risk of heart disease and cardiac arrest, which means they could become SCA victims. The only way to help such a victim is with good cardiopulmonary resuscitation and defibrillation.

If it is required, the earlier that defibrillation is administered, the better. Time is the most important factor with SCA. With every passing minute, an SCA victim's survival rate decreases by about 10 percent, according to the American Heart Association (AHA), which estimates early defibrillation could raise survival rates 20 percent or more. Making it possible for infrequent rescuers to rapidly administer defibrillation, therefore, could save more than 40,000 lives a year in the United States alone.

Following the Chain of Survival
To make early defibrillation possible, AHA advocates placing AEDs in targeted public areas, as well as workplaces, so infrequent rescuers can assist victims before trained medical professionals arrive. An AED is a portable device that analyzes the heart's rhythm and, if necessary, allows a rescuer to deliver an electric shock to an SCA victim. This shock, called defibrillation, may halt the rapid and chaotic heart activity of SCA and help the heart to reestablish an effective rhythm of its own.

While early defibrillation is important to help SCA victims, early CPR is often overlooked. Both defibrillation and CPR are vital links in the Chain of Survival. The chain addresses the fact that most SCA occurs outside of a hospital, with death often occurring within minutes of onset. The chain includes Early Access, Early CPR, Early Defibrillation, and Early Advanced Care.

Every step helps to save lives. Any break in the chain compromises survival. Remembering and following every step in the Chain of Survival is the best way to increase the chance of saving SCA victims. Put simply, an AED--combined with the Chain of Survival--may save a life. Knowing how and when to use AEDs, anyone can be prepared to deal with SCA in the first vital minutes, when critical, decisive action can help victims the most.

When a victim collapses from SCA, rescuers do not know whether defibrillation or CPR is appropriate until an AED is attached and the victim's heart is analyzed. About half of all collapsed victims initially require defibrillation. For other victims, however, who may have non-shockable heart rhythms, the critical action is effective CPR. While roughly half of unresponsive victims need defibrillation, every one of them needs temporary circulatory support with CPR.

A Success Story
Consider the success one company, Carnival Cruise Lines, has had. Three days into her Caribbean vacation, Jeanne Tiffany and her family were sitting down for the evening show on the Carnival Conquest when she collapsed. A concerned bystander began performing CPR while the ship's nurse was notified and quickly rushed to the scene with the first-response bag and an AED. The nurse quickly attached the one-piece electrode to Tiffany, and analysis began. She was in cardiac arrest.

The AED assessed her heart rhythm, called for multiple shocks, continued to guide the rescuers through CPR, and then successfully converted her heart back to a normal rhythm. She spent the night on a ventilator in the ship's infirmary and was transported the following day by air ambulance to a Miami hospital. Doctors in Miami implanted an internal cardiac defibrillator. A few days later, Tiffany was on her way back home.

"I am so grateful for the nurses on board the ship and the availability of a defibrillator; they saved my mother's life," said Tiffany's daughter, Linda Jensen.

Given such success, there is a growing interest in making such programs mandatory.

Legislative Action for Early Defibrillation Programs
It has been said that today's public opinion might be tomorrow's legislation--for better or for worse. In the case of mandating AEDs and early defibrillation programs, legislation is for the better. Take these cases from Massachusetts:

  • A man went into cardiac arrest on a train that was not equipped with an AED. He died despite attempts by passengers to revive him. His widow is suing to ensure all commuter trains are AED-equipped in the future.
  • A man who collapsed at a health club remained in cardiac arrest for nine minutes before paramedics restarted his heart. Consequently, he suffered permanent brain damage that left him completely disabled. He and his family settled with the health club, which did not have an AED on the premises, for $1.8 million.

As of now, 11 states have passed legislation that mandate AEDs in one form or another (for example, in schools, state buildings, nursing homes, health clubs, or police vehicles): Arizona, California, Delaware, Florida, Illinois, Louisiana, Nevada, New York, Ohio, Pennsylvania, and Rhode Island. Another nine states (Connecticut, Georgia, Massachusetts, Michigan, New Jersey, North Carolina, Tennessee, Texas, and Virginia) are considering legislation.

Why are legislative bodies mandating AEDs? Because there is clear evidence that early defibrillation saves lives. With nearly 1,000 people in the United States suffering SCA each day, pressure is building on legislators to better protect the public.

Consider the positive impact legislation has had. The Federal Aviation Medical Assistance Act of 1998 required that all commercial aircraft carrying passengers be equipped with AEDs. In June 2004, American Airlines--the first U.S. carrier to deploy AEDs on its entire fleet--saved its 50th victim. To date, American has had 89 AED events. While not all of the victims have survived, the airline has achieved a 56 percent survival rate, which is extraordinary when you consider that only 5 percent of people survive from out-of-hospital cardiac arrest in the United States.

Early defibrillation programs such as American's save lives. Why, then, wait for legislation that mandates AED programs? Being proactive by planning and assessing your needs makes more sense than waiting for legislation to mandate what your company must do. You can find out specifics about implementing an AED program by contacting your local EMS agency or organizations such as the American Heart Association, the American Red Cross (www.redcross.org), or the National Center for Early Defibrillation (www.early-defib.org).

An AED defibrillation program not only saves lives, but also is good for company morale. It shows that an employer is doing all it can to protect its employees. And such programs can positively affect a company's bottom line. When you weigh the average $2,000 cost of an AED against the cost of lost productivity, a potential lawsuit, or a disabled or deceased employee, it would seem to be a wise investment.

Cost considerations aside, early defibrillation programs are the right thing to do because they help save lives. Period.

Steps in the 'Chain of Survival'

Step 1:

Early Access to Care (i.e., calling for medical help)

Step 2:

Early Cardiopulmonary Resuscitation (CPR). "Cardio" refers to the heart, "pulmonary" to the lungs. CPR is a manual life support system that delivers oxygen to the brain, heart, and other vital organs. It involves blowing air into a person's lungs by mouth-to-mouth resuscitation to get oxygen into the victim and pushing on the chest to pump the heart to maintain circulation. Without oxygen and circulation, a victim will die.

Step 3:

Early Defibrillation (if necessary)

Step 4:

Early Advanced Care (as needed)

Source: Engdahl J, et al. Resuscitation. 2002; 52(3):235-245. Guidelines for CPR and ECC. Circulation. 2000;102(suppl I): 1-23.

This article appeared in the December 2005 issue of Occupational Health & Safety.

This article originally appeared in the December 2005 issue of Occupational Health & Safety.

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