by Robert I. Thompson
For safety and health professionals who have successful fire protection and respiratory protection programs, the implementation of an automated external defibrillator (AED) program involves some familiar territory. Like fire extinguishers and respirators, the AED is an important, potentially life-saving device, but it is not a magic box. Its effectiveness is determined by much more than simply having the device. A complete program that includes risk assessment, training, maintenance and recordkeeping must be in place.
Whether you have AEDs or are considering implementing an AED program, the following questions will help you determine priorities and best practices, and avoid the pitfalls. These questions include:
- Do I really need an AED program?
- What should my program include?
- How many AEDs should I have?
- Where does training fit in?
- How do I know if it's working?
How you answer these challenges, and what you do with the information you learn, can be a matter of life or death.
Do I Really Need an AED Program?
AEDs are portable, battery-powered devices that analyze a sudden cardiac arrest (SCA) victim's heart rhythm, determine if a shock is necessary, set the proper charge and instruct the responder to shock the victim. Every day, according to the American Heart Association (AHA), SCA kills 600 Americans, at least half of whom could be saved by timely CPR and defibrillation. OSHA estimates that more than one out of every eight workplace fatalities is the result of SCA.
AEDs can now be found in police cruisers; trains and airplanes; shopping malls, casinos and turnpike service plazas; office and manufacturing workplaces; schools and health clubs; and even homes, now that models specifically for home use have received Food and Drug Administration approval. OSHA recommends but does not mandate AEDs. Federal government workplaces have been strongly advised to implement AED programs, and states are beginning to require AEDs in certain public places, most notably public schools in New York.
For many organizations, the answer is, yes, they need to consider purchasing AEDs. Just as important, however, is to have a management program in place to ensure the devices are properly positioned, used and maintained.
What Should a Complete Program Include?
Consistent with guidelines developed by AHA, the American College of Occupational and Environmental Medicine, and the General Services Administration/Department of Health & Human Services, Complient Corp. recommends an eight-step program:
- Project management, which includes establishing responsibility, goals, budget and timeline.
- Site assessment to determine the risk of SCA among workers, customers and other visitors to your site; and identify possible locations for AEDs.
- Medical direction and oversight to meet most states' requirements that AEDs be prescribed by a state-licensed physician.
- Training, which should be provided to people in various jobs, work locations and on all work shifts.
- Equipment selection by choosing among several major AED manufacturers. Despite some differences in the products, all AEDs are FDA-approved medical devices that use voice prompting to guide the responder.
- Maintenance, which involves tracking expiration dates on supplies, including electrode pads and batteries.
- Post-event service, which includes cardiac event data download and replenishment of consumables such as gloves and electrode pads.
- Documentation and recordkeeping, which should include the site assessment, maintenance and testing records, and training logs.
Complient recommends that AEDs be integrated into a broader Emergency Medical Response System that provides for training and equipment for CPR, emergency oxygen, first aid and bloodborne pathogens protection and cleanup. Companies that do not have the resources and expertise to implement a complete program should consider outsourcing it, as many have done with their fire protection programs.
How Many AEDs Should I Have?
This is a risk assessment question, not a matter of "more is better." You should focus on locations where AEDs can do the most good, be accessible to the most people and be available on short notice. The number of people in the workplace is not the most important factor in evaluating how many AEDs are needed. The most important consideration is the physical size of the work area, which determines how long it takes to get an AED to the victim of SCA to deliver a shock the so-called "drop-to-shock" time frame.
AHA recommends that early defibrillation occur within 3 to 5 minutes of the onset of SCA. In fact, in settings where defibrillation is administered to SCA victims within 3 minutes, survival rates of more than 70 percent have been achieved, compared with the national SCA survival rate of 5 percent. For every minute without defibrillation, the odds of survival drop 7 to 10 percent. A cardiac arrest victim who is not defibrillated within 8 to 10 minutes has virtually no chance of survival, according to AHA. On average, it takes EMS 8 to 11 minutes to arrive on the scene from the time of a call.
Typical locations for AEDs include lobbies, main hallways, gathering places such as large conference rooms, and near restrooms. These devices should not be kept in remote offices or storage rooms. For small, concentrated workplaces, one AED will be sufficient, while large, spread-out facilities could require several devices.
Where Does Training Fit In?
AEDs are easy to use they talk the responder through the process and they deliver a shock only when the machine determines it is needed. Nonetheless, training of designated lay responders is perhaps the most critical success factor in AED programs. Complient recommends that the training cover five key topics: CPR, AED use, emergency oxygen, bloodborne pathogens and first aid. Employees should receive refresher training on an ongoing basis.
Despite the increasing popularity of "public access defibrillation" (PAD) programs, you should not rely on an untrained, casual bystander to respond effectively or safely. Trained responders will protect your organization from liability and ensure a quick and effective response to any emergency. FDA defines public access as "the accessibility for trained responders to use AEDs in public places" and further stipulates that "it does not mean that any member of the public witnessing an SCA should be able to use the device." The criteria for successful PAD programs are often misunderstood or ignored.
Complient recommends that responders reflect the variety in a particular workplace people in various jobs and work locations, on all work shifts, and both genders. One common mistake is focusing training in one group, such as site security personnel or the EMS team. As a result, response times may be too slow and those people may not be available because of their other responsibilities during emergencies.
As a general rule, you should expect to have 10 trained responders for every AED, although some organizations train many more people to improve response time and because of the employee involvement benefits of an AED program. Individual responders have strong legal protection under state Good Samaritan laws.
How Do I Know If the Program Is Working?
The most dramatic measure of success is if a life is saved. When it happens, AED responders and their SCA survivors develop a special bond that can inspire an entire workplace or community. You can also evaluate your program by tracking "small wins," such as having a budget approved, training, installation and the effectiveness of the maintenance program.
Companies need to remain vigilant and disciplined when it comes to managing their program. Otherwise, as we all know, if something can go wrong, it will go wrong. A program that is properly managed and provides for ongoing training will almost certainly overcome Murphy's law and achieve life-saving results.
The bottom line is that employers should strive to have an active, effective program that can be executed at a moment's notice. Three to five minutes is not a lot of time to gain control of an emergency situation, but with a solid AED/medical response program in place, it is just enough time to save the life of a co-worker or friend.
About the author: Robert I. Thompson is chief executive officer of Complient Corp., Solon, Ohio, a premier outsource provider of emergency medical preparedness programs, including workplace and public access defibrillation, for large, multi-facility organizations. For more information, visit www.complient.com.
Sidebar: Gillette Co.: A Razor-Sharp AED Program
The Gillette Co., the $8 billion manufacturer of male and female grooming products, alkaline batteries and manual and power toothbrushes, was one of the first companies in America to implement a comprehensive automated external defibrillator (AED) program. Gillette began planning its AED program in 1997, with J. Brooks Watt, M.D., who joined the company in 1996 and became corporate medical director in 1998, as the driving force.
Watt sold the idea of a comprehensive AED program as "the right thing to do" and the next evolutionary step in Gillette's robust occupational health program. Since launching the program with Complient Corp.'s help in 1999, Gillette has deployed approximately 70 AEDs in nine U.S. locations and one in Canada, and more than 600 volunteers have been trained as workplace emergency responders.
Though Watt administers the program from Gillette's corporate offices in Boston, each facility is largely responsible for local implementation and budget for the program.
"I knew that any program that is locally driven and locally supported produces better buy-in," Watt said. "To stress that this is a cost-effective program, I remind our domestic facilities that OSHA requires them to teach bloodborne pathogens protection, first aid and CPR. The only add-ons here are AED operation and emergency oxygen administration."
Based on his experience at Gillette, Watt was instrumental in the development of the American College of Occupational and Environmental Medicine's AED guidelines, which provide for:
- Medical direction and control of the program
- Awareness of and compliance with federal and state regulations
- Coordination with local emergency services
- Integration with overall emergency plan for the site
- Ancillary medical equipment and supplies
- Establishment of a quality assurance program
- Periodic reviews and modifications to protocols
Watt said, "People were a little hesitant at first to use these devices because they feared they could harm someone by doing something wrong. We had to reassure them that, with proper training, AEDs are completely safe and reliable. I think the greatest risk now is in not having an AED. At Gillette, we are at the point that employees expect this type of safety initiative."