Best Practices for Using AEDs and Performing CPR

Best Practices for Using AEDs and Performing CPR

Workers should learn CPR in case of emergencies.

Workplace first-aid providers who quickly apply cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills can significantly increase chances of survival from cardiac arrest. A worker may experience cardiac arrest due to personal medical conditions or workplace exposures like an electric shock.

Trained first-aid providers can deliver emergency medical care, and the outcome of occupational illnesses and injuries may depend upon prompt, adequately administered first aid.

CPR and AED Skills

Workplace first-aid responders who learn CPR and AED skills might never need them but should remain prepared. Numerous studies have shown a retention rate of 6-12 months of these critical skills.

OSHA references the American Heart Association’s Emergency Cardiovascular Care Committee, which encourages CPR and AED skills review and practice sessions every six months. Instructor-led retraining for life-threatening emergencies should occur at least annually. Retraining for a non-life-threatening response should occur periodically.

Doctors and medics use various interventions to restart the heart of a cardiac arrest victim, including IVs, breathing tubes and defibrillation. However, based on recent studies, none of those advanced techniques saves lives as well as CPR. In fact, the studies found that simple and sustained chest compressions dramatically increase survival rates.

Researchers encourage trained rescuers to focus on consistent chest compressions rather than trying to juggle compressions with mouth-to-mouth or other treatments. Compressions need to be applied to the center of the chest at a rate of about 100 a minute. Many repeated chest compressions are required to begin driving blood through the heart and circulate oxygen.

An AED can be used with CPR to restart a victim’s heart. It works by administering an electrical shock to the worker’s heart. The shock can restart the worker’s heart, allowing it to beat normally again and continue circulating oxygen-rich blood throughout the body.

The C-A-Bs of CPR, not A-B-Cs

The American Heart Association (AHA) re-arranged the ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Previously, the Association recommended that lay and professional rescuers use the A-B-Cs (Airway-Breathing-Compressions) of CPR to revive victims of sudden cardiac arrest. Now, chest compressions are recommended as the first step, followed by airway and breathing or C-A-B for short.

The Association’s previous guidelines recommended looking, listening and feeling for normal breathing before starting CPR. People were instructed to open a victim’s airway by tilting their head back, pinch the nose and breath into the victim’s mouth and then start chest compressions—this delays oxygen-rich blood from being circulated through the body. Now the Association recommends starting compressions immediately on anyone who’s unresponsive and not breathing normally.

All victims in cardiac arrest need chest compressions. In the first few minutes of a cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so starting CPR with chest compressions can pump that blood to the victim’s brain and heart sooner. Research shows that rescuers who started CPR with opening the airway took 30 critical seconds longer to begin chest compressions than rescuers who began CPR with chest compressions.

Is Your AED Program on Life Support?

AEDs have a proven track record of saving lives. They are now widely available, safe, effective, portable and easy to use. As a result, the popularity of AEDs in the workplace is increasing.

For this reason, you may be thinking of purchasing, or already have purchased, one or more AEDs for your workplace as part of your first-aid management plan. You should also have a written program to help you effectively manage the AEDs in your workplace.

Obtaining an AED

OSHA recommends but doesn’t require that you have an AED in the workplace and doesn’t have any standards for AEDs. State laws and the Food and Drug Administration (FDA) actually regulate AED use.

Each company should assess its own requirements as part of its first-aid response. However, OSHA does say that an employer should consider having an AED available if:

*Many people work closely together (e.g., assembly lines, office buildings)

*Confined spaces are present *Electric-powered devices are used

*Lightning may occur at outdoor worksites

*Workers may seek treatment for heart attack symptoms

*Fitness units and cafeterias are located on-site

*Companies operate remote sites (e.g., off-shore drilling rigs, construction projects, marine vessels, power transmission lines and energy pipelines).

The FDA requires that you have a physician’s prescription to purchase an AED. The name of the physician and the date of the prescription should be noted in your written program. When deciding upon the number of AEDs to purchase, keep in mind that responders must reach the victim, make an assessment and begin treatment within three to five minutes.

Assigning Responsibility

The written program should identify the individual who has overall responsibility for your AED program. AEDs need to be properly maintained and readily available for use. Placing one individual in charge makes it easier to ensure that maintenance schedules are followed, required training is completed and AED inspections and testing take place per manufacturer recommendations.

Some state laws require that a physician provide oversight of your AED program. Besides providing the prescription to purchase the AED, your medical professional can provide guidance on the number of AEDs needed, their distribution, user training and developing an emergency response plan. This information should be detailed in your written program.

Providing Training

The written program should include detailed training requirements for those who will use the AEDs. Training is inexpensive and readily available from various sources such as The American Red Cross and The American Heart Association.

AED training can usually be added to the cardiopulmonary resuscitation (CPR) classes that workplace emergency responders receive. OSHA suggests that employees responding to an emergency be trained to:

*Recognize sudden cardiac arrest and notify EMS personnel

*Perform CPR

*Provide early defibrillation with an AED

*Care for the victim until EMS personnel arrive

You should include employees from various departments and shifts in training to ensure broad coverage, especially over holiday and vacation time. With the recent pandemic, many employers are shifting to online learning; however, online training doesn’t meet OSHA’s basic first aid and CPR training requirements with a hands-on component.

In a Letter of Interpretation dated August 2, 2012, OSHA addressed the use of online training (computer-based training without a hands-on skill component or verification of competent skill performance by a qualified trainer) for meeting the intent of the basic first-aid and CPR requirements under several of its standards, including:

*1926.269, Electric power generation, transmission, and distribution

*1910.410, Qualifications of dive team *1910.151, Medical services and first aid

*1910.146, Permit-required confined spaces

*1910.266, Logging operations

*1926.950, General (safety requirements for Electrical Power Transmission and Distribution). OSHA says that online training alone would not meet the requirements of these training standards. The Agency went on to quote Webster’s II New Collegiate Dictionary (1995, p. 1,169) definition of the word “train,” which is “[t]o make proficient with special instruction and practice.”

OSHA said that the standards require training in physical skills, such as bandaging and CPR. However, the standards cited above don’t require verification of competent performance, except for certain work activities like confined space entry and diving operations. Also, OSHA’s “Best Practices Guide: Fundamentals of a Workplace First-Aid Program” (2006, p. 11)states that a first-aid training program should have trainees develop hands-on skills using mannequins and partner practice. Even if not specifically required, hands-on training allows for better performance during the stress of an emergency.

The written program should spell out who’s authorized to use the AEDs. If only trained members of your emergency response team will use the AED, you should provide a list of names in the written program. If you allow anyone who’s trained and certified to use the AEDs, that should be in writing, as well.

Ensuring Maintenance

AEDs must receive regular and proper inspection, service and maintenance to ensure they operate correctly. Your supplier and the AED’s written instructions will provide you with this information. This can vary by manufacturer, but once the unit gets used, service is always required. As recommended by the manufacturer, periodic self-diagnostic tests and regular battery replacement will help ensure that it’ll operate as designed when needed.

AED service records should be part of the written program. Keep a written record of each individual AED in your facility in case your company is ever asked to produce that information. This includes specific information on all tests and maintenance done to the unit, when they were done, and by whom.

Note each time the unit was used and what maintenance was performed following use. Also, record when pads and batteries have been replaced (reference the manufacturer’s recommended maintenance schedule).

Using an AED and CPR together is a must-have to increase a worker’s chances of surviving a cardiac arrest. While chest compressions can circulate blood, a stopped heart cannot be restarted by chest compression alone. So, train responders to use the C-A-Bs of CPR with a properly maintained and working AED.

This article originally appeared in the June 1, 2021 issue of Occupational Health & Safety.

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