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HR June 1999Vol. 44, No. 6
Workers trained to use automatic extrnal defibrillators could save thoussands of lives.
o one can predict who will have a sudden cardiac arrest (SCA) or when the event will occur. But any HR professional can reliably estimate the probability of survival once SCA occurs at the workplace. Four time-dependent predictors form a patient’s "chain of survival."
According to a 1993 study from the EMS system of Seattle, the probability of surviving sudden cardiac arrest is 67 percent if all links of the chain are immediately applied. If a link is delayed or unavailable, there will be a decrease in a patient’s probability of survival.
According to the American Heart Association, if EMS is immediately contacted and CPR is immediately started, there still will be a 7 percent to 10 percent decrease in survival for each minute that the defibrillation link is delayed.
What is the probability of survival if it takes eight minutes for your community EMS responders to reach a coworker (not just the building), prepare themselves, set up equipment and use their defibrillator? It should come as no surprise that, of the approximately 1,000 Americans suffering SCA each day, 95 percent die before reaching a medical center.
An AED Primer
Consider this: A person collapses in the office, EMS is called, and a CPR-trained co-worker checks the victim. After the assessment shows no breathing and no pulse, she begins chest compressions and ventilations—CPR. The purpose of CPR is to deliver oxygen to the blood and to manually pump the oxygenated blood to the brain and other organs. CPR provides basic life support until advanced life support providers can take over.
The problem is that most sudden cardiac arrest patients are not actually in "cardiac arrest." Rather, the person’s heart is fibrillating—producing a disorganized, ineffective rhythm that interferes with the pumping of blood. This results in no blood circulation and the inability to feel a pulse. Worse, a fibrillating heart will not permit adequate circulation even if CPR is performed perfectly.
For the patient to survive, a defibrillation device must be used to stop the inadequate rhythm. After the heart momentarily stops, it can restart on its own or with CPR and pump with a normal rhythm. For workplace lifesaving efforts and outcomes, a fibrillating heart is much worse than a stopped heart if a defibrillator is not available, and much better if one is available.
The letters AED are used for the lifesaving procedure—automated external defibrillation—or for the device—the automated external defibrillator. "Automated" means that many or all of the processes are automatic or controlled by the machine, rather than the user. "External" means that the device is used outside the body, rather than inserted or implanted under the skin. "Defibrillation" refers to changing the activity of the heart by delivering an electric shock that attempts to convert the abnormal rhythm to a normal one needed to effectively circulate blood.
An AED is used only on a clinically dead person. If either breathing or a heartbeat is present, an AED will tell a user to check the patient. The defibrillation charge cannot be sent.
Using clear, easy-to-understand electronic audio voice prompts, the newest generation of AEDs follows three steps. They electronically assess the patient and determine if the reason why no pulse is felt is because the heart has stopped or the rhythm is disorganized. They prepare to release an electric "shock" that can interrupt the poor rhythm. Finally, they deliver a defibrillating shock only if it is needed.
AEDs thus save many lives that would be lost without their use. For example, with AEDs now in nearly all the Las Vegas casinos, survival following SCA has risen to 70 percent, according to the Clark County, Nev., Fire Department/EMS system. Compare this to 5 percent, the national average SCA survival rate.
Each year, more than 350,000 Americans die from sudden cardiac arrest. The American Heart Association estimates that at least 100,000 victims could be saved each year with prompt use of AEDs. American Heart Association CPR training classes now include information on AEDs. The Heartsaver-AED class, appropriate for workplaces, bundles use of an AED with CPR.
In March, the American Red Cross announced an initiative with two major manufacturers of AEDs to include AED training as part of standard CPR training courses for businesses.
Regulatory and Legal Issues
The acquisition of an AED is regulated by the federal Food and Drug Administration (FDA), but use is controlled by individual state codes. FDA policy requires a workplace to have medical approval in order to buy or lease an AED. Once authorization is received, the state has jurisdiction over use and management of the equipment.
The states consider two categories of AED users. Medical users are health care and allied health care responders in medical centers and EMS systems who would use an AED as part of their well-defined emergency medical procedures. State medical practice acts as well as health and EMS codes regulate the use of defibrillators by these people.
Public access users are nonmedical, lay and workplace first-aid responders who are not associated with a medical center or EMS agency and who would use an AED as part of basic life support procedures until arrival of EMS or advanced responders. Public Access Defibrillation Legislation (PADL) addresses the education of nonmedical users and their use of defibrillators.
PADL is being spearheaded by the American Heart Association and public interest groups. Bills are being introduced, supported and passed to allow AED use by any trained person for the purpose of saving the life of someone in cardiac arrest. Legislation is often attached to or integrated into a Good Samaritan statute to provide immunity to users.
At least three issues may concern employers considering whether to add an AED to their first-aid supplies. First, is there any legal reason why an AED may not be used by nonmedical workplace responders? The answer is no, once a licensed physician (or other professional included in a state’s Medical Practice Act) authorizes an AED for the workplace. States may have policies or requirements on how AED use is to be implemented, but all states allow use by workplace nonmedical responders.
Second, what is an employer’s potential liability when an AED is acquired or used? The answer seems to be little or none. Even in states that provide immunity to trained laypersons, AED manufacturers provide employer liability coverage. For example, Physio-Control Corp. of Redmond, Wash., offers a program for its LifePak 500 AED that will "indemnify, defend, save and hold harmless [the owner] from any liability, loss, cost, expenses, judgments, claims, liens, and demands of any kind arising from any act or failure to act ... arising from the use of its LifePak 500, except for those ... involving gross negligence or intentional acts." Other AED manufacturers (e.g., Hewlett-Packard/Heartstream and Survivalink) offer similar coverage.
Third, what company implementation procedures need to be created or adjusted in order to use an AED? This requires identifying and complying with any state training and reporting requirements, establishing quality control for the AED program and its administration, and creating proper protocols for integration into ongoing safety programs and procedures. Like any important change in information and technology, it is inappropriate to simply buy an AED without considering the barriers and enhancements to effective implementation.
Not too many years ago, a person without breathing or pulse had little hope of surviving. Now, with appropriate planning, training, a quick response and lifesaving AED equipment, a victim of sudden cardiac arrest has a much better chance to live.
Larry M. Starr, a member of the American Heart Association Cardiopulmonary and Critical Care Scientific Council, teaches in the Villanova University Human Organization Science program and is director of medical education, research and development for SOS International Inc. in Ardmore, Pa., a provider of environmental, health and safety programs and services. He can be e-mailed at
firstname.lastname@example.org for more information on AED use at the workplace.
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