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Automated External Defibrillators in the Workplace

According to recent American Heart Association statistics there are nearly 300,000 out-of-hospital sudden cardiac arrests annually. Waiting for the arrival of emergency medical system personnel results in only five to seven percent survival. Studies with immediate defibrillation have shown up to 60 percent survival one year after sudden cardiac arrest.

Improving Survival from Sudden Cardiac Arrest

Rapidly implementing the "chain of survival" model can help increase the chances of survival from sudden cardiac arrest. The steps in the chain include activation of emergency medical services by calling 9-1-1, starting cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED) and accessing appropriate care. Studies have shown a survival rate of as much as 60 percent with immediate defibrillation.

Automated External Defibrillators

An automated external defibrillator (AED) is a medical device designed to analyze the heart rhythm and deliver an electric shock to victims of ventricular fibrillation to restore the heart rhythm to normal. Ventricular fibrillation is the uncoordinated heart rhythm most often responsible for sudden cardiac arrest.

Sudden Cardiac Arrest

Sudden cardiac arrest occurs when ventricular fibrillation takes place or when the heart stops beating altogether. Without medical attention, the victim collapses, loses consciousness, becomes unresponsive and dies. Many victims have no prior history of heart disease and are stricken without warning.

Causes of Sudden Cardiac Arrest

  • Coronary Heart Disease
  • Blood Clot
  • Blunt Chest Trauma
  • Electrocution
  • Asphyxiation (loss of consciousness and death caused by lack of oxygen)

Rationale for Providing an AED in the Workplace

OSHA identifies sudden cardiac arrest (SCA) as the number one killer in the workplace, as it is the cause of 15 percent of all workplace fatalities. By its very nature, SCA is completely unpredictable and can strike anyone at any time. Tragically, 95 percent of SCA victims die before reaching the hospital.

Increased survival rates are the primary reason that hundreds of thousands of AEDs have already been deployed throughout U.S. workplaces and public places.

In November 2000, President Bill Clinton signed into law the Cardiac Arrest Survival Act (CASA) that provides Good Samaritan protection against liability for lay rescuers who have been trained to use an AED. In order to improve survival rates of individuals who experience cardiac arrest in federal buildings, the Public Health and Service Act also mandated that AEDs be placed in federal buildings.

Placement of AEDs

According to the American Red Cross and American Heart Association, place AEDs so that individuals can get to the device and return to a victim within three minutes. The absolute longest time that this turnaround should take is five minutes. This is known as the “collapse-to-shock” cycle.

OSHA suggests that AEDs are placed in locations where:

Many people work closely together, such as assembly lines and office buildings.
People gather, such as company fitness centers and lunch rooms.
Lightning strikes could take place, such as outdoor exercise areas or worksites.

Determining How Many AEDs Are Needed

To estimate the number of AEDs needed, consider:

How many locations there are.
The number of buildings and/or work sites per location.
The number of floors per building.
The “three minute response” rule from collapse-to-shock (are there more AEDs needed per floor or work site to meet this response time?)

AED Training

AED training courses usually last about three to four hours to allow adequate time for hands-on practice and to help increase user competence and confidence. AED training and related resources are offered through the American Heart Association, the American Red Cross, the National Safety Council and others. AED manufacturers and vendors also offer training resources.

AED training curricula vary, but generally emphasize:

A working knowledge of CPR.
Safety for both victims and rescuers.
Proper placement of electrodes.
Delivering the first shock as quickly as possible, ideally within 60 seconds from time of arrival at the victim's side.
Plenty of hands-on practice, with one instructor and one AED or AED trainer for every four to six students.

For more information, visit the OSHA Web site (www.osha.gov), or the Web sites of the following organizations:

American Heart Association
American Red Cross
National Safety Council