How to Implement a Successful AED Program

Before taking steps to implement the program, you must understand the specific state and local requirements.

• By David Bingham
• Apr 01, 2011

Each year, more than 950,000 adult Americans die from cardiovascular disease, making it the number one cause of death in the United States. Of that number, at least 250,000 Americans die of sudden cardiac arrest (SCA) before they reach the hospital. SCA strikes people regardless of age or degree of fitness and often occurs suddenly and without warning symptoms. In emergency situations involving SCA, nothing is more valuable than a courageous bystander willing to provide assistance with a nearby automated external defibrillator.

According to the American Heart Association, the only way to effectively treat SCA is with an electrical shock delivered by a defibrillator, a device that returns the heart to normal rhythm. AEDs force an electrical current through the heart by means of pad, or electrodes, placed on the chest. This brief pulse of current calms the activity of the heart, allowing it to start beating again.

For each minute that passes without CPR and proper defibrillation, the chance of survival decreases 7 to 10 percent. In fact, only approximately 5 percent of sudden cardiac arrest victims survive in environments with no established AED program. Choosing to implement an effective, clear AED program in a facility or site is vital to making the commitment to saving lives in any workplace.

The components of a successful AED program are largely determined by the environment in which it exists. Among the necessary elements of all AED programs, regardless of the facility, are appointing a program coordinator, gaining support from decision makers, and reviewing the state and local AED requirements for the program.

Designate a Program Coordinator
Choosing a dedicated program coordinator is necessary to ensuring that a competent person manages the day-to-day activities and concerns of your program. He or she is responsible for communicating with key decision makers, facility employees, dedicated on-site responders, and the public about any activity related to the program.

The coordinator helps to ensure key decision makers are sufficiently educated about the importance of AED implementation by inviting them to related presentations or scheduled meetings about the topic. These decision makers can be external or internal and can include departments such as risk management, environmental health and safety, legal, human resources, corporate security, building or property managers, tenants, board members, or union leaders. Assigning a program coordinator can help facilities to identify program supporters, identify any potential barrier to the implementation process, and create overall advocacy for the program needed to get it done right.

State and Local Requirements
Before taking steps to implement the program, it is critical to understand the specific state and local requirements to set realistic expectations and understand potential limitations for your organization. Though each state has its own requirements, most specify what type of training is required, how to work with your state and local EMS services, and how to maintain and renew an AED program. A few things to be aware of in regards to state and local requirements are:

• Most state laws require a state licensed physician to act as a medical supervisor of the program.
• Most state laws require you to notify local EMS of AED programs or to register AED programs with local EMS.
• Most state laws require that responders complete a nationally recognized training CPR/AED course for lay responders, such as the Heartsaver® CPR/AED course offered by the American Heart Association.

Although every facility has its own unique criteria, these key steps developed by the American Heart Association will help guide you in establishing and successfully implementing an AED program to suit your workplace environment.

Medical Oversight and Quality Improvement
In light of the FDA clearance of AEDs for public use with a physician's prescription, medical professionals can serve as an extremely valuable resource for program coordinators. They act as advocates of the overall AED program, helping coordinators not only to launch the program, but also providing continuous guidance and support. Additionally, they can help to identify and explain local and state AED regulations to the coordinator, serve as program spokespeople, and ensure the overall quality of the program.

If you're not sure where to find a medical professional to oversee your program, you don't have to look far. They can be emergency medical physicians, occupational health physicians or nurses, state and local medical organizations, or local EMS workers.

Notifying Local EMS
A key step in implementing an AED program is notifying your local EMS system. Most states require that any AED program is coordinated with local EMS, particularly in regard to providing them follow-up data each time an AED is used. You should view EMS as a partner as you navigate through the implementation, management, and development of procedures for the AED program.

Key issues to discuss with local EMS include:

1. Location of on-site AEDs: Ensure EMS knows where the AEDs are located in an emergency.

2. Transfer of patient care: Written policies and procedures for transferring victims who needed defibrillation to local EMS should be developed. Ask them about their existing protocols to ensure this is done correctly.

3. Sharing event data: Regardless of the type of AED, data are collected on either a removable data card or by downloading to an on-site computer. The data should be shared with local EMS and shared according to state requirements.

Choosing, Placing, and Maintaining AEDs
The American Heart Association does not recommend one AED over another, and the selection of the device must be determined and influenced by the needs of the specific program site.

Generally, AEDs should be simple and easy to operate. The ideal AED should serve as a coach through the defibrillation process, creating the calmest, clearest environment possible to allow the responder to focus. As important as the type of AED you choose is the placement of the device. A three-minute response time should be used to help you determine how many AEDs you need and where to place them. Though it's impossible to predict where a sudden cardiac arrest incident will occur, the most strategic way to place AEDs is to identify locations where the incidence of SCA might be higher, such as corporate health clubs or high-traffic areas, including cafeterias or other meeting spaces. Additional possible locations for a facility's placement of an AED could include security guard stations, next to the first aid cabinets, main reception areas, and near elevators.

The American Heart Association recommends the following checklist to correctly conduct scheduled and preventative maintenance of any AED program:

1. Verify placement of AEDs and ensure proper placement.

2. Verify battery installation and expiration.

3. Verify the expiration of the AED's pads and that the pads are connected to the unit and sealed in their package.

4. Check the status and service of indicator light.

5. Inspect exterior components and sockets for cracks or damage.

6. Check to make sure all supplies, including razors, towels, barrier devices, and scissors, are included in the AED.

Designation and Quality Training of On-site Responders
Ideally, as many responders as possible would have access to defibrillators. However, issues such as budget constraints and training resources must be considered when designating on-site responders.

It is best to designate employees who operate throughout the day on the premises and already respond to emergencies as part of their job, such as security guards and members of safety response teams. Training requirements can be determined easily by reviewing the acceptable curricula, training organizations, and renewal intervals from your individual state or city.

A few examples of what responders should know, following their training, include:

1. How to recognize the warning signs of a heart attack

2. How to respond to an emergency

3. Why and how to activate local EMS

4. How to buy time for the victim by performing CPR until the AED can be used

5. How to assess the patient and determine whether an AED should be used

Conclusion
Today, companies, schools, and other types of facilities are working to set up defibrillation programs to help more people who suffer sudden cardiac arrest. Installation of AEDs is happening in high-traffic locations, emergency vehicles, and even in homes.

However, merely purchasing an AED does not guarantee that nearby responders will know what to do, how to use it, or even remember that it's there in a cardiac emergency. Implementing a comprehensive AED program helps to ensure that this lifesaving tool will be used correctly should the need arise.

This article originally appeared in the April 2011 issue of Occupational Health & Safety.