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Around 10,000 sudden cardiac arrest events occur each year in the workplace, according to the Occupational Safety and Health Administration (OSHA). Most of those victims will die, often within minutes.
In fact, sudden cardiac arrest—when the heart stops beating, abruptly and without warning—is the leading cause of death in the workplace, however most employers have not prepared their workforce to respond when a colleague goes down. Only four percent of the 7 million businesses in the U.S. have an onsite automated external defibrillator (AED)—a medical device that sends an electric shock to the heart to try to restore its normal rhythm.
An AED is the only treatment for restoring a regular heart rhythm during sudden cardiac arrest (SCA). The devices are not only easy to operate for laypersons with no medical background, but imperative to administer in the critical minutes before medical professionals arrive. Ninety-five percent of those who experience SCA die because they do not receive lifesaving defibrillation within four to six minutes; the average response time for paramedics to arrive on the scene is eight to 10 minutes.
With a national SCA survival rate of less than seven percent, an AED used in conjunction with cardio pulmonary resuscitation (CPR) can increase survival rates to more than 70 percent, said John Ehinger, CEO of CardioReady, a provider of turn-key cardiac emergency response solutions to organizations nationwide. “That means saving both lives and the reputation of your organization,” he said.
Sudden Cardiac Arrest and the Chain of Survival
When sudden cardiac arrest strikes, being prepared and acting fast is the only way to save lives, said Frank Poliafico, director of training at Emergency University, a provider of CPR and AED training and certification.
Without swift action, survival following sudden cardiac arrest decreases rapidly. “The odds of surviving a sudden cardiac arrest without prompt intervention are less than one in ten,” said Ehinger. Several studies have found that for each minute of untreated cardiac arrest, the probability of survival decreases by 7 percent to 10 percent. Conversely, survival rates as high as 90 percent have been reported when the collapse-to-defibrillation time is within one minute, according to the American College of Occupational and Environmental Medicine (ACOEM).
To give someone a second chance at life when they go down means everyone being prepared to respond, said Poliafico. An effective SCA response program does that, he added. “Response is not just showing up. Response means activating a plan, contacting emergency medical services [EMS], starting life support, using an available, well-maintained AED and interacting appropriately with EMS when they arrive.”
The American Heart Association (AHA) defined a five-link Chain of Survival for responding to sudden cardiac arrest:
Unfortunately, less than one-third of witnessed, out-of-hospital SCA victims receive lifesaving first aid according to the AHA.
Focus on the Program, Not the Device
The focus has to be on the people responding and acting, not on the equipment, Poliafico stressed. “The devices are simple to use, but not human-nature proof. You will be using it during one of the most stressful, traumatic times in your life. It takes preparation. That’s why the program is so important.”
Unfortunately, for many companies it may be easier to set up a response program than it is to maintain it, remarked Bill Clendenen, the CEO of MEDIC First Aid, a corporate CPR, AED and first aid training program provider. The sad reality is that when an AED is needed and available, it’s not used, said Poliafico, who experienced incidents of people dying near unused AEDs on the wall from his time as the director of New York City’s emergency medical services.
A January 2014 Harris Interactive survey commissioned by CardioReady found one in two Americans expect to find AEDs in manufacturing facilities and office locations, “so it’s apparent that the workforce values a company that safeguards its employees against the threat of SCA,” Ehinger said. Research has also shown that there’s a strong connection between workplace safety and employee morale and productivity, he added. “SCA response programs represent an integral component of mainstream safety expectations. If your employees don’t feel that they’re being looked after, particularly when the cost for doing so is not significant, that’s a negative blow for the work environment.”
Before you begin establishing a workplace AED program, you need to have a plan, including basic risk-management protocols, said Ehinger. “Recognize and appreciate what the particular features and needs of your organization are. Gyms are going to have different needs than a law firm, for example,” he said. Employee turnover and the nature of your customer base are a couple of the factors to consider. “Does your workforce want it? How many employees do you have? Do you have people willing to be trained?” are questions you should ask, said Poliafico.
It’s also key to obtain buy-in for the goals and costs of the program from the organization’s leadership. “One of the most critical elements for success with your company’s AED program is to have an internal champion,” said Clendenen. “Motivation is the key. Ask for a volunteer to help you promote and educate your co-workers. See if one of your employees has had a personal or family experience with SCA and is willing to help promote the program internally,” he said.
Another key facet is designating someone to own the program, both overall and at the individual site level, Ehinger said. “If someone has responsibility, it’s a lot less likely that something is going to fall through the cracks once the program has been implemented. If the champion for the program left the organization seven years ago and no one has thought about it since then and the batteries in the device are dead, you’ve got a problem.”
Some businesses fail at basic communication. “Let your employees know you have a program in place and what to do in an emergency,” said Ehinger. Elements of successful communication include visible signage for the AEDs, and informational talks and materials about the program, including information on what defibrillators are, how they work, where they are located and who is on the company’s internal emergency response team.
SCA Response Program Elements
Centralized management system. The ACOEM recommends that each workplace have a centralized management system with clear lines of responsibility for those who oversee and monitor the program.
Medical direction. AEDs require a prescription from a physician for purchase and placement in the workplace. In addition, many states require medical oversight of the program. The ACOEM recommends that all workplace AED programs be medically supervised by an appropriately qualified physician or health care provider. “What you want is a doctor with heart expertise, to spell out the objectives and help develop the program components, and review the components to make sure it will insure focus on outcomes,” said Poliafico. Specific areas where medical direction is important include providing the written authorization required in most locations to acquire an AED, ensuring provisions are made for appropriate initial and continued AED training, performing a case-by-case review each time an AED is used at the site, compliance with regulatory requirements and ensuring proper interface with EMS.
Regulatory compliance. Programs need to be compliant with state laws on public access defibrillation and the federal Cardiac Arrest Survival Act. As these regulations are different from state to state, a single corporate policy may not be sufficient. Employers should prepare a written document describing the workplace AED program for each location where a device will be placed and communicate this information to local EMS providers.
Integration with worksite emergency response plan. Experts recommend SCA response programs fall under the workplace emergency response plan, rather than a freestanding program. According to ACOEM, emergency response plans should describe in detail the personnel, equipment, information, and site activities associated with managing the range of anticipated occupational injuries and illnesses, including those in sudden cardiac arrest. All employees should be prepared to notify trained internal and community emergency responders in the event of a suspected cardiac arrest, said Poliafico. “Not everyone is going to want to touch the body, or use the device, but everyone needs to know how you activate the plan, and who to call for help, both trained onsite personnel and EMS.”
Device selection. All the devices on the market work, but you should still shop like you would for anything else, advised Ehinger. There are several third-party providers out there that can help you make your decision regarding different device features and in which environments to place them.
Device coverage and placement. Be smart where you put the device, said Ehinger. “It’s really more a function of logistics and building layout than headcount. You don’t need to get 10 AEDs for the sake of getting 10 AEDs - proper planning can help you to reduce expense while at the same time improving coverage, and you could find that 5 AEDs are more than sufficient to cover your space,” he said. AEDs should be placed in locations throughout a workplace that will allow it to be used (the “drop-to-shock” interval) within three to five minutes of recognized cardiac arrest. OSHA recommends placing AEDs in areas where many people work closely together, near confined spaces, areas where electric-powered devices are used, employers’ fitness centers and cafeterias, and at remote sites, such as off-shore drilling rigs, construction projects and energy pipe lines.
Maintenance. It is supremely important that AEDs be maintained in optimal working condition and AED servicing should be included in employers’ safety program schedule. “Most devices have warning signals such as loud beeps and lights to notify personnel when the device is not ready for use,” said Clendenen. However, these methods still require an employee to notice these warning signals, he added. Clendenen advised using an asset management tracking system to record the expiry dates of AED batteries and pads. “There are AED specific tracking computer programs and externally managed systems that you can use to assist you in making sure your device is ready,” he said. “These systems can also send you updated summaries on the state of your AED program and notify you of upcoming scheduled maintenance and training.”
To preserve your Good Samaritan protection in a majority of states you’re going to need to complete your monthly maintenance according to manufacturer’s recommendations and record all servicing and testing,” said Ehinger. “If you do the maintenance and don’t document it, and god forbid something goes wrong, you’re going to be in a difficult position to prove you were doing the right thing.”
Training. Training is two parts—the initial training and ongoing learning, said Poliafico. “Don’t just teach technical CPR/AED skills, but teach how to apply those skills in an emergency situation,” he said. In addition to reviewing how to operate the defibrillator, make sure that your trained employees can recognize when the device is in need of service.
Clendenen is an advocate of integrating the use of AEDs into companies’ emergency response drills. “These exercises help identify weaknesses in the emergency response system that could be overlooked, plus it gives employees the opportunity to practice their emergency skills outside the classroom,” he said.
Everyone should be trained, but that’s not going to happen, said Poliafico. “Realistically and economically, about 15 percent to 20 percent of the workforce can be identified for training.
“Think about who you’re training,” said Ehinger. “Think about who is most likely to be on site. Think about who will be on which shift. At bigger companies for cost considerations, it’s practical to have trained trainers on site, but in general, I recommend having an external trainer unless you’re doing it regularly, just because they’re going to be better at it,” he said.
The training itself can be in person, online or a blended approach.
Ehinger puts a lot of value on refreshers. “Research on CPR/AED training suggests retention starts to trail off at three months and drops pretty significantly at six months,” he said. “So anything you do to refresh your employees about the program or the devices, like an e-mail or a training talk to keep it front and center in peoples’ mind is a good thing.”Roy Maurer is an online editor/manager for SHRM.
Follow him @SHRMRoy
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