Defibrillation Comes Out from Behind the Desk

Everyone knows to look for a fire extinguisher. That knee jerk reaction should be as common in the case of a sudden cardiac arrest.

Look around: Automated external defibrillators (AEDs), which give life-sustaining defibrillation therapy to a sudden cardiac arrest victim, are popping up all over the world. You’ll see AEDs in U.S. airports, Japanese dental offices (where they are mandated), Australian Defence Force aid kits, Dutch train stations, and maybe even your workplace. At least, I hope so. According to the Occupational Safety and Health Administration, 13 percent of all workplace fatalities result from sudden cardiac arrest.With improved early defibrillation efforts, 40,000 more lives could be saved each year in the United States alone1 -- more than a cure for breast cancer would save, based on recent statistics.2

Putting It in Perspective
Ninety-six people die in the United States from sudden cardiac arrest for every one fire death.3 You have extinguishers because your employees expect a safe environment. You need automated external defibrillators, arguably, even more, because defibrillation within one minute lifts the chance of survival to 90 percent.

Local EMS services typically can’t respond that quickly.Median response time is 6.6 minutes for emergency medical services in mid-sized urban communities. 4 It is even worse for the “typical” community, where the average call-to-shock time is nine minutes.5 You need to have your own AEDs on hand to bridge the victim over that crucial period until help arrives because after 10 minutes, the chances for resuscitation are practically gone.

The Hidden AED
“It’s a tragedy for time to be wasted looking around for an AED,”said Chris Bartzis,managing director of AEDs for STS Safety Training Seminars, a Toronto-based supplier of AEDs and provider of training sessions to North American companies since 1991. “It’s time for AEDs to come out from behind the security desk.”

“The fire extinguisher provides a perfect analogy in our training sessions,” he explained. “We just got back from a deployment today where the security personnel were insistent on safeguarding the device rather than making sure it was out in front on the wall.‘We’re worried about it getting stolen,’ was what they said. I answered,‘Do you worry about your fire extinguishers being stolen?’”

Bartzis had another fire extinguisher analogy. “It used to be that companies were apprehensive to locate AEDs in prominent places, [thinking] their employees and guests would presume that heart attacks were common there. I would tell them, ‘Does having a visible fire extinguisher where a bystander can grab it mean you’re prone to fires?’”

Promoting General Awareness
Typically, one AED in the lobby of the building is not good enough, Bartzis said.He said he sees many organizations that prefer to place an AED in their lobby versus the shop floor,where the majority of the workforce is present. “It’s important to have AEDs in both places so the device is accessible within a one-minute distance of the victim, anywhere on or around the facility.”

As part of the Chain of Survival (early detection, early CPR, early defibrillation, early advanced care), the American Heart Association recommends defibrillation within the first three minutes of collapse. Thus, the one-minute distance that Bartzis recommends. “By the time you get the defibrillator and return to the scene, you’ve already used up two minutes,” he pointed out. He again drew the analogy between AEDs and fire extinguishers. Everyone knows to look for a fire extinguisher, and Bartzis said he wants that knee-jerk reaction to be as common in the case of a sudden cardiac arrest.

He said a key to success is to go beyond training a particular portion of a company’s workforce and ensure there is at least general awareness among the entire staff at a facility.His company, for instance, adds a lunchbox session to the typical training package, making it more likely that everyone knows what the company’s policies are, how the AEDs fit into them, and where the units are. It’s even better if each person in the group takes a turn opening the cabinet and practices lifting it out.New employee orientation is the best time to do this.

Fire Drills, Part Two
Bartzis recommends AED drills, akin to the fire drills that practically all responsible organizations carry out on a regular basis. As straightforward and intuitive as your AED deployment may be, you can save precious seconds and even minutes if employees don’t have to shout directions on how to find an AED or fiddle with a cabinet on which they have never laid their hands before.

With AEDs, it also can be useful to remind workers to be ready to grab an AED at a school, a health club, or hotel. The training process at work can help team members save a life when sudden cardiac arrest hits outside the office, as well.

Shopping for an AED Program
The best AEDs offer technology such as a rescue-ready indicator, which tells users whether the device is ready to go and all of the elements are ready for a rescue. Every day, these devices self-check all of their major components. If anything is amiss, the status indicator on the AED should let you know about it.

The device itself is only part of the solution. Pick a management system that will integrate with your general emergency preparedness planning and training schedule.

Keep in mind, some AED deployments are more complicated than others. Factors include the number of facilities in your organization, the type of work your employees do, and your turnover rate. A Web-accessible program management system can help to maintain facility contacts,AED inventory, locations, serial numbers, and expiration dates.

Also, you can use program management services to maintain training rosters, certification dates, and employee training records. Look for a system that sends e-mail reminders to schedule training updates or order supplies.

Ultimately, while AED awareness improves, training and familiarization need to keep pace. Set up a steady and regular program to ensure a well-trained group of employees who are comfortable with AED operation around the facility. These steps today may well save a member of your team tomorrow. Good luck.

References
1. American Heart Association. 2004 Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association, 2003.
2. National Center for Health Statistics. National Vital Statistics Report. Hyattsville, Maryland: Public Health Service. 2003; 54(13).
3. National Fire Protection Association, Fire Loss in the U.S. During 2006; AHA. 2008 Heart and Stroke Statistical Update.
4. Braun O, McCallion R, Fazackerley J. Characteristics of mid-sized urban EMS systems. Ann Emerg Med 1990 May; 19(5):536-46.
5. Mosesso VN Jr., Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med. 1998; 32:200-207.

This article originally appeared in the October 2008 issue of Occupational Health & Safety.

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