AED, CPR, and First Aid Preparedness for the Real World
Lay rescuers must possess not only the technical skills, but also the ability to overcome fear and concerns that often accompany emergency situations.
THE typical response to sudden cardiac arrest is not the stuff of Hollywood movies
or TV medical dramas. Rarely is the most-trained, clearest-thinking person on the
scene first, taking charge and saving a life against long odds. Rarer still are
bystanders who instantly become part of the solution instead of a distraction
or impediment. Panic, confusion, fear, people getting in one another's way--now,
that's often the real world.
the all-too-typical workplace emergency response when an employee suffers
sudden cardiac arrest (SCA): Perhaps only one person in the area has had
cardiopulmonary resuscitation training, and that may have been at least a
couple of years ago. While precious seconds tick away, human nature takes over
and there is a debate about what should be done, who should do it, and a
variety of legal and personal concerns.
someone begins CPR and puts his hands on the victim's chest and pushes hard.
Something cracks. He pushes again. Something cracks again--it's the ribs. The
sound stuns the rescuer and bystanders. On the third push, lines of thick clear
fluid stream down both sides of the victim?s purple-gray face. Concerned about
doing more harm than good, the rescuer keeps pushing but not as hard. The
rescuer knows he should give mouth-to-mouth resuscitation, but he just cannot
bring himself to do it.
security arrives, there is a shuffle of equipment, and the guards start CPR.
Then an ambulance and fire truck arrive and the professionals take over. They
have an automated external defibrillator and place the pads on the victim's
chest. After a shock, the pulse returns. The victim arrives at the hospital
alive but dies later in the day.
Immediate Action Is Essential
heroic efforts by lay rescuers and professional emergency responders, the
scenario above is quite typical. In fact, more than 325,000 Americans die each
year from SCA--more than from cancer and automobile accidents combined. And
when cardiac arrest occurs outside a hospital setting, fewer than 5 percent of
victims survive, primarily because CPR and defibrillation are not performed
brain begins dying within four to six minutes of SCA onset. However, if no more
than 3 minutes elapse between collapse and defibrillation, survival rates of 74
percent have been achieved.
in the real world, what can you do to give an SCA victim the best hope for a
second chance at life? Technical training for would-be rescuers remains the
most critical component. To be able to make a difference, people from across
the workforce and work shifts should be trained in first aid, CPR, and AED use--with
all three areas being important. In the workplace, providing first aid training
to all employees, rather than limiting it to a small number of designated
responders, may help to reduce both the frequency and severity of occupational
injury and illness. Training has been shown to improve participants' motivation
to avoid injuries.
AED programs are becoming common in America's workplaces, but they should not
overshadow the more traditional first aid and CPR programs. All three areas are
prominent components of a total solution. AEDs on their own are seldom enough
to save lives; victims of cardiac arrest need immediate CPR. CPR provides a
small but vital amount of blood flow to the heart and brain, and it increases
the chances that an AED shock will allow the heart to start working
effectively. Eighty percent of SCAs are caused by ventricular fibrillation, a
heart rhythm variance for which defibrillation and CPR are the only effective
training is also essential, and it is more important than ever now because new
first aid, CPR, and AED guidelines have been published. For example, the new
CPR guidelines for adults recommend 30 chest compressions for every two rescue
breaths (compared with the previous 15-to-2 ratio). The new guidelines also
recommend beginning chest compressions immediately after the two rescue breaths--not
waiting to check for a pulse or other signs of life, which is often difficult
for lay rescuers to do and delays delivering potentially lifesaving chest
addition, the recommendations for combining CPR and defibrillation have
changed. The new recommendation is for a single shock from a defibrillator
followed by immediate CPR for two minutes, beginning with chest compressions.
The 2000 guidelines recommended up to three AED shocks before returning to
chest compressions for one minute. There is an important new focus on "effective"
chest compressions to maximize the quality of CPR. "Effective" means
that the rescuer needs to push hard, push fast, allow complete chest "recoil,"
and minimize interruptions in CPR. Rescue breathing without chest compressions
is no longer taught in programs that follow the new guidelines.
help people learn and perform CPR and AED better, all nationally recognized
training programs are now encouraging instructors to talk less and help
students practice much more. Training is moving away from large-group,
instructor-focused, lecture-based programs to small-group, student-focused,
scenario-based, interactive programs. But even that is not enough for giving
your program the best chance of success in the real world. Employers should
consider integrating their first aid, CPR, and AED training programs into their
emergency response drills so that would-be rescuers have an opportunity to "rescue"
their manikins in a workplace setting, not just under calm, ideal classroom
conditions. These special drills also can be helpful in uncovering any rescue
equipment problems and supplies shortage that might have been missed by the
ongoing maintenance and recordkeeping program.
What Are You So Afraid Of?
discussed above, technical training, the right equipment, and timely
maintenance are critical for a successful workplace emergency care program. But
there is also a softer, more emotional side that can have just as much impact
on a company's program. That factor is overcoming people's fears, which can be
seen at all levels of an organization.
the management level, the safety and health professional has to be concerned
about the compliance obligations, including protection against bloodborne
pathogens. The CFO may be focused on costs and return on investment in these
programs, while the legal folks know that the American judicial system is
fraught with complexities and time-consuming, costly litigation. Any one of
these issues could cause an organization to drop or severely cut back its
emergency care program, with potentially tragic consequences. The best way to
address these concerns is to involve the key stakeholders in the creation,
implementation, evaluation, and reauthorization of the program.
the individual level, several recent studies have shown that both trained and
untrained bystanders are reluctant to perform CPR and use an AED. For example,
a six-year study in Michigan, published in 2006, interviewed 684 bystanders in
SCA cases. Seventy percent of the bystanders were family members, and 54
percent of those family members had been taught CPR. And yet, only 21 percent
were actually willing to start CPR. The rest said they were not willing to
because they panicked, thought they would not do it correctly, were afraid they
would hurt the person, or were concerned about contracting a disease or
infection by performing mouth-to-mouth resuscitation.
2003 study of North Carolina high school students found that 86 percent of
students surveyed were trained in CPR and 21 percent were trained in AED use.
However, only 32 percent of the students trained said they were actually
willing to use an AED and around 50 percent were willing to perform CPR. Again,
they were held back by fear of infection, legal consequences, and harming the
Overcoming the Fear Factor
issues and health concerns are among individuals' primary fears. Overcoming
these fears is paramount to reducing a leading cause of death for Americans.
Quality training materials cover these issues, and a good trainer will take the
time to share the knowledge and skills that can help students manage these
is advice on how to tackle the most common fears:
- Fear of infection: Much-publicized health risks, which include everything from AIDS and hepatitis
C to staph infections and bird flu, have had a chilling effect on people's
willingness to perform CPR. Scientifically speaking, however, the estimated
risk for acquiring infection during CPR is extremely low, about one in a
million. Simple infection control measures, including use of barrier devices,
can significantly reduce the risk of acquiring an infection disease during both
CPR and CPR training. If no mask or shield is immediately available, rescuers
can still perform compression-only CPR by placing the victim on his or her back
and using two hands (one on top of the other) to push hard and fast on the
center of a victim's chest.
- Fear of legal consequences: Good Samaritan laws protect people who "gratuitously
and in good faith" give CPR or use an AED. There has never been a
successful lawsuit in the United States against a person providing first
aid/CPR in good faith. However, to protect yourself, once you start CPR, do not
stop until a person with equal or more training takes over, you are exhausted,
or the scene becomes too dangerous to continue. For AEDs, there is an extremely
low liability risk in establishing AED programs; most lawsuits result from lack
of an AED program.
- Fear of harming the victim: Rib and breastbone fractures occur frequently during chest
compressions in adult CPR but are not major complications. Although CPR should
be "done right" and with high quality, remember that a person in
cardiac arrest is dead (without breathing or a pulse); it is hard to make them
any worse. Mistakes in CPR may reduce the chances for successfully
resuscitating a victim, but they do not "kill" the person. Their
original condition is the cause.
- Fear of failure: Lay people who participate in first aid, CPR, and AED training programs provide
a great service to their families, workplaces, and communities. They want to
make a difference, and there are many wonderful stories of lives saved. But
there are many more, unfortunately, where the victim cannot be saved. Perhaps
nowhere else in American society is a 5 percent success rate celebrated--and it
should be; without the fast response, there would be no survivals. However,
employers and safety and health trainers must manage would-be rescuers'
expectations. They need to know that situations where victims cannot be saved
do not represent failure on their part. The root of the word "resuscitate"
is from the Latin revivere, which translates as "to live again."
underlying lesson is that even the best equipment, even the best training, can take
you only so far in emergency response. At some point, you have to deal with the
emotional issues and overcome people's base fears. My best-practices
recommendation is to deal with these real-world preparedness issues now, long
before a would-be rescuer is thrust into service in a last-ditch attempt to
save a co-worker, family member, friend, or stranger.
This article appeared in the December 2006 issue of Occupational Health & Safety.
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This article originally appeared in the December 2006 issue of Occupational Health & Safety.