Get Used to the New Guidelines

An American Heart Association expert explains how to follow the 2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

1. Mary Fran Hazinski, RN, MSN, Senior Science Editor for Emergency Cardiovascular Care for the American Heart Association (Dallas, TX): We don't think anyone has or should interpret the new guidelines as "discrediting" on-scene defibrillation. The new guidelines now emphasize early, high-quality CPR plus early defibrillation as the best combination to improve survival from sudden cardiac arrest.

2. The guidelines emphasize the importance of "planned and practiced response," correct? What are the basic elements of P&PR?

Hazinski: A planned and practiced response requires, first the development of a plan, and then practice of the planned response. The plan should include:

  • A link with the local EMS service.
  • Appropriate training of anticipated rescuers in CPR and also training in the use of an AED (if an AED will be on site).
  • Ready availability of emergency equipment (CPR manikin[s] for practice, face masks with one-way valves, a telephone, and, possibly an automated external defibrillator with replacement pads, stored in a central location).
  • Practice of the response at regular intervals (e.g., every 4-8 weeks, if possible). The practice should involve anticipated rescuers simulating an actual emergency and enacting their response, including simulated call to the local emergency response number (e.g., 911), retrieval of an AED (if on site) CPR using a manikin and pocket mask, and use of an on-site AED (if available).
  • A process of ongoing quality improvement. (This includes review of emergencies and methods of monitoring and improving performance.)

3. How much training is enough for lay rescuers in a workplace setting?

Studies have documented skill erosion within weeks of a CPR course, so anticipated rescuers (especially in the workplace) should practice a response to a cardiac arrest every 4-6 weeks.

Hazinski: Rescuers in the workplace setting with a duty to respond should take a CPR and AED course that provides a credential in CPR and AED use. The purpose of the credential is to document that the rescuer has completed a course that requires skill demonstration to an instructor. The American Heart Association offers several courses that are all consistent with AHA Guidelines for CPR. To find American Heart Association training for the workplace, visit

4. How often should retraining be conducted?

Hazinski: To maintain a current course completion card, the American Heart Association recommends that training be renewed every two years. However, several studies have documented skill erosion within weeks of a CPR course, so anticipated rescuers (especially in the workplace) should practice a response to a cardiac arrest (including practice of CPR and use of an AED) every 4-6 weeks, if at all possible.

5. How and how often should they practice actual response?

Hazinski: They should practice CPR and AED use as part of a simulated response to an emergency, rather than as a separate skill (separated from any context or interaction with other members of the response team).

6. What do you recommend owners do in terms of AED maintenance, which I understand is also discussed in the guidelines?

Hazinski: Each manufacturer provides very specific recommendations regarding maintenance of AEDs. AED program sites and AED users should follow those recommendations. All include a check for "readiness for use." The AEDs will indicate when battery replacement is needed. At least two sets of pads (three if child pads are also available) should be available with each AED, and those pads should be replaced at regular intervals (all have expiration dates).

7. There is a recommendation to have a link with local EMS. Do companies usually count on this without actually reaching out and assessing the timeliness of response under various scenarios?

Reports documenting the effectiveness of the new guidelines in increasing survival from sudden cardiac arrest are already appearing in the scientific literature.

Hazinski: It is the responsibility of the AED program director or the director of the emergency response plan to contact the local EMS service and the EMS dispatcher (they may not be the same organization) to provide details regarding the on-site response plan. The EMS service personnel and the local EMS dispatcher may have questions regarding number of buildings, access to the buildings and equipment (e.g., AEDs) and responders on site.

8. Are the new guidelines likely to make lay rescuers more willing/competent to do CPR?

Hazinski: We think that the new guidelines will make rescuers more willing and committed to perform effective CPR. Training in the new guidelines is designed to help rescuers be more competent in performing effective CPR.

9. Are most lay rescuers likely to know about the new guidelines and what they call for?

Hazinski: There has been a great deal of publicity about the new guidelines, so many people are aware that some changes have been made in the recommendations. With media attention, we hope to reach more potential rescuers and encourage them to take a CPR course. With Family & Friends CPR Anytime, available through the AHA website, rescuers can learn CPR in less time than it requires to get their car's oil changed. A CPR Anytime kit would make a great Valentine's Day gift for a family member or loved one.

10. With this article, OH&S magazine has published AED articles for a decade. National survival rates for out-of-hospital sudden cardiac arrest haven't improved much during that time, have they? How much can we expect the 2005 guidelines to accomplish in improving the rates?

Hazinski: I am answering both questions together. The lack of improvement in survival rates for sudden cardiac arrest and the increased evidence that there were too many interruptions in chest compressions, plus the evidence of high survival rates reported by some lay rescuer AED programs, all provided impetus for changes in the 2005 AHA CPR Guidelines. The 2005 Guidelines contain the most substantial revisions ever published. Reports documenting the effectiveness of the new guidelines in increasing survival from sudden cardiac arrest are already appearing in the scientific literature.

This Q&A appeared in the February 2007 issue of Occupational Health & Safety.

Jerry Laws is Editor of Occupational Health & Safety.

This article originally appeared in the February 2007 issue of Occupational Health & Safety.

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