Sudden cardiac arrest (SCA) can turn lunch in the company parking lot from picnic to panic in seconds. When an employee drops to the ground, his fate rests in the hands of his coworkers - who may or may not have the tools or training to bring him back to life.
Sprinklers, extinguishers, and alarms are not the only life-safety devices that facilities professionals today are purchasing and maintaining. As automated external defibrillators (AEDs) have become more cost effective and easier to use, building owners and facilities professionals are being tasked to develop public access defibrillation (PAD) programs for their properties. What follows is information on proactive, reactive, and retrospective actions to ensure that AEDs are at the ready and that tenants/occupants are prepared to use them.
Before an Event
Each year, 220,000 individuals in the United States die from SCA. Before it claims the life of a visitor or employee in your facility, develop a PAD program. A proactive approach ensures that when it’s time to react, tools and training can be put to good use.
Seek medical oversight. Because AEDs are considered Class III medical devices by the U.S. Food and Drug Administration, a prescription from a licensed physician is required before purchase. Additionally, several states mandate that a medical professional provide guidance during the development and implementation of a PAD program (commonly referred to as medical oversight or medical direction); the purpose is to ensure the safety and effectiveness of the program. Ask area Emergency Medical Services (EMSs) or organizations like the American Heart Association (AHA) for recommendations on physicians to partner with.
Make wise purchasing decisions. Ease of use is critical when purchasing AEDs. To judge this, ask for a demonstration from the sales representative or distributor. Rank the device’s capability to help responders 1) determine proper placement of pads on the victim’s chest, 2) decide if and when shock should be delivered, and 3) provide instructions for CPR. “Pushing a button is not the most difficult thing to do. People understand that part of defibrillation. Placing the pads and then remembering how to do CPR are the two tougher things,” says Jamie Froman, director of marketing, commercial AEDs, Philips Medical Systems, Seattle.
The Washington, D.C.-based Building Owners and Managers Association (BOMA) Intl., in its Managing an AED Program report, encourages facilities professionals to consider the following when selecting an AED:
- The reputation of the AED manufacturer for product quality and customer service.
- Compatibility with the equipment of local EMSs.
- Easy operation, with clear voice prompts.
- Technology that enables the AED to adjust shocks and energy levels to match the victim’s needs.
- Electrodes that are pre-connected to the AED to save precious seconds.
- Maintenance-free batteries.
- The availability of support services, such as a service team for on-site repairs and computer-based refresher course.
Additional features and factors to consider include:
- Fully automatic delivery of the shock (semi-automatic devices prompt the user to press a button and deliver the life-saving shock, while “fully automatic/automated” external defibrillators deliver a shock without prompting the responder to initiate the action).
- Self-testing capabilities (find out how often the device self-tests, what is monitored when it performs this function, and how it indicates the need for service).
- Reliability (inquire about whether the device has ever been recalled).
- Multi-lingual capabilities (if Spanish-speaking employees or visitors frequent your buildings, ask the manufacturer or distributor if the AED can be programmed to deliver voice prompts in other languages).
- Purchasing multiple brands (it may make management and training more difficult).
Place the AEDs where they are visible and within quick reach. “Have them within minutes of where people are; if somebody does collapse from sudden cardiac arrest, you can get the AED to the victim within 2 to 3 minutes,” advises David N. Fritzsche, vice president, sales and marketing, Guilford, CT-based Defibtech LLC. While no standard exists that provides a quick and easy calculation for both the number of AEDs a facility should have and the placement of those devices, it’s important to recognize that defibrillators are ideal anywhere large numbers of people congregate. Consider the floorplan of the building and any obstacles (e.g. stairs, elevators, shelving, etc.) that could increase response time. To determine whether an AED is ideally located, use a stopwatch and time responders walking at a brisk pace from a variety of locations to the AED and back. If the time reads 3 minutes or less, mount the AED along with appropriate signage. The manufacturer or distributor, along with the physician providing medical oversight, can offer advice on the proper placement of AEDs, if consultation is desired.
Develop a training program and select responders. Build awareness about the PAD program through numerous channels (e.g. newsletters, meetings, memos posted on bulletin boards, etc.). Both in-house facilities professionals and property management teams should promote the program. “We like to make as many people as possible aware of the fact that there are AEDs on-site so the employer can promote the fact that they’ve made this additional investment in the safety of their customers and/or employees. And, because they’re simple enough to use, as many people as possible should be aware of the nearest AED [in case there is] no trained responder present at the time of the cardiac emergency,” explains Elizabeth Parry, commercial product manager, Medtronic ERS, Redmond, WA.
It’s important to note that both awareness and training are necessary for a successful program. While AEDs are simple enough for untrained laypersons to deploy, training teaches CPR and AED operation, and helps individuals identify the signs of sudden cardiac arrest so responders can act fast and with confidence. “The training should be provided to designated responders that are going to be responsible for providing care [in an] emergency cardiac event,” says Parry. “We recommend five responders per AED.”
Training is offered by organizations such as the American Red Cross and AHA; contact the office nearest you for a schedule. Courses can train laypersons in a matter of hours. In Working Against Time, a brochure issued by the AHA in 2003, the organization explains: “These devices only require the user to attach pads to the patient’s chest, turn the device on, and follow audio instructions. They do not require the user to make decisions or interpret symptoms. Anyone can learn how to respond to a life-threatening emergency and use an AED by taking a course that lasts less than 4 hours, such as the AHA Heartsaver AED Course.”
According to BOMA’s report, at a minimum, refresher training should occur once every 2 years. To ensure that employees remember the necessary steps to take during an SCA emergency, use role-playing to gauge preparedness. “To have a good AED program, what you want to do is have a large number of people who have been trained in CPR and use of this particular AED, and then have the AEDs in place. In the best cases, [organizations] will even run simulations to find out what they remember and if they can [correctly deploy the] AED,” says Hank Constantine, marketing director, public access, ZOLL Medical Corp., Chelmsford, MA.
Don’t compromise the effectiveness of the program with lax documentation. It’s important to keep tabs on who is trained and when their training occurred. “There’s turnover at every company - people move on, companies grow, procedures change. Whatever the reason, you want to make sure folks are trained and are current in their training,” says Fritzsche. Keep records up to date and remind responders when it’s time for more training.
Don’t neglect management and maintenance of the AEDs. Just like the smoke detectors in your home, AEDs are only reliable as long as the batteries aren’t dead. “They’re not plugged into a wall; they have internal batteries to keep them operating. The pads have a lifespan as well,” explains John Friederich, industry segment manager at Redmond, WA-based Medtronic ERS. Typically, battery life is 5 years; you can expect to get 2 years out of your AED’s pads. “You should become familiar with the AED and find out how long the pads last, how long the batteries last, and how you can tell if a replacement is needed,” says Constantine.
Recognizing the difficulty of maintaining numerous units, many manufacturers now provide Web-based tracking programs. “These systems automatically e-mail the appropriate people saying, ‘Your batteries are going to expire in 3 months. It’s probably a good idea to start looking at replacing them. Your distributor is ABC company. Here’s the contact information,’ ” explains Fritzsche. Additionally, these programs can help track the trained responders and when their refresher training comes due.
Between these devices’ self-testing capabilities and the Web-based tracking, you might think routine checks are unnecessary. However, that’s not the case. Integrate quick AED inspections into the building’s routine maintenance schedule. “You need to regularly go around and check to make sure the low-battery indicator light isn’t lit or that the date on the pads hasn’t passed,” says Friederich.
Alert the EMS to the presence of AEDs. One of the recommendations issued by the American College of Occupational and Environmental Medicine (ACOEM) in its Automated External Defibrillation Position Statements/Guidelines is coordination with local EMSs. Communicating both basic information about the program to community EMS providers and sharing the number and locations of AEDs is beneficial for two reasons. First, EMS providers can lend assistance and suggestions for the development and improvement of the program. Secondly, when the 911 call is placed, the dispatcher can tell the caller that an AED is present. “If the 911 center has the infrastructure to do this, they would ask, ‘We show in our records that you have an AED on-site; has it been deployed yet?’” says Parry. In the 10 to 12 minutes it may take for EMS providers to arrive, the dispatcher can instruct responders (if they are untrained laypersons) on the use of the AED and CPR.
During an Event
When an individual experiences SCA, it’s usually due to abnormal heart rhythms called arrhythmias (the most common is ventricular fibrillation). “It’s a sudden chaotic quivering of the heart, and the person collapses very quickly,” explains Froman. Understanding and identifying the symptoms of SCA are critical. Training can help responders recognize the differences between a person having a heart attack and SCA. When an individual suffers a heart attack, although arteries may be blocked, he/she typically maintains consciousness.
When a person drops to the ground, witnesses should first assess the individual’s condition to determine if his/her unconsciousness is the result of SCA. Then the EMS should be alerted and the nearest AED retrieved. If multiple people are aiding in the rescue efforts, CPR should be administered while waiting for the AED. “When you just do CPR on a victim of sudden cardiac arrest, you’re only going to resuscitate them about 3 to 5 percent of the time,” says Fritzsche. “But when you place an AED on a victim who has suffered SCA and has a ‘shockable rhythm,’ you can resuscitate [at least] 70 percent of those folks.” According to the AHA, “Starting CPR immediately after cardiac arrest to circulate oxygen-rich blood to vital organs buys time for the victim until defibrillation can be given.”
To ensure a successful resuscitation, responders should power on the AED and attach the unit’s two electrode pads to the individual’s chest as quickly as possible. AEDs are highly sophisticated devices, despite how user-friendly they have become. Once the electrode pads are attached, the AED will assess the victim’s condition. “There’s an algorithm in the device that detects whether the rhythm is shockable or not,” says Parry. If the device’s microprocessors do not detect this rhythm, the AED will not deliver a shock. If the conditions are right, the device will either prompt the responder to press a button and deliver electrical shock or administer the shock itself. CPR should be administered between shocks. Once EMSs arrive, they will either continue defibrillation or administer advanced cardiac life support (ACLS) drug intervention.
After an Event
Conduct a review. At a minimum, information from the AED should be downloaded and provided to EMSs. “Depending on the AED used, this information is recorded on a removable data card or can be obtained by connecting the AED to an off-site computer via modem,” explains BOMA in Managing an AED Program. The medical professional providing oversight should be involved in an assessment of the event. It should be documented in a written report, and any suggestions for improvement implemented promptly.
Replace spent parts. It’s important that the AED be returned in good working order to its case. Used supplies, such as a CPR mask and gloves, should be replaced, along with the AED’s pads and (possibly) its battery. “When you peel the pads to place them on the victim, they have an electrode gel to improve the conductivity; once you’ve used those pads on a particular individual, you wouldn’t want to use [them] again,” says John Hinson, president and CEO, Cardiac Science Corp., Bothell, WA. While the pads can be used multiple times during one rescue, replacement is required before another rescue is initiated.
Remember: AEDs are only capable of saving lives if they are present and in good working order. A proactive program involving proper placement, training, and maintenance can turn a life-threatening situation into a life-saving event.
Jana J. Madsen ([email protected]) is managing editor at Buildings magazine.