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AED, CPR, and First Aid Preparedness
This article appeared in the December 2006 issue of Occupational Health & Safety.
Lay rescuers must possess not only the technical skills, but also the ability to overcome fear and concerns that often accompany emergency situations.
Once security arrives, there is a shuffle of equipment, and the guards start CPR. Then an ambulance and fire truck arrive and the professionals take over. They have an automated external defibrillator and place the pads on the victim's chest. After a shock, the pulse returns. The victim arrives at the hospital alive but dies later in the day.
Immediate Action Is Essential
Despite heroic efforts by lay rescuers and professional emergency responders, the scenario above is quite typical. In fact, more than 325,000 Americans die each year from SCA--more than from cancer and automobile accidents combined. And when cardiac arrest occurs outside a hospital setting, fewer than 5 percent of victims survive, primarily because CPR and defibrillation are not performed soon enough.
The brain begins dying within four to six minutes of SCA onset. However, if no more than 3 minutes elapse between collapse and defibrillation, survival rates of 74 percent have been achieved.
So in the real world, what can you do to give an SCA victim the best hope for a second chance at life? Technical training for would-be rescuers remains the most critical component. To be able to make a difference, people from across the workforce and work shifts should be trained in first aid, CPR, and AED use--with all three areas being important. In the workplace, providing first aid training to all employees, rather than limiting it to a small number of designated responders, may help to reduce both the frequency and severity of occupational injury and illness. Training has been shown to improve participants' motivation to avoid injuries.
Lay-rescuer AED programs are becoming common in America's workplaces, but they should not overshadow the more traditional first aid and CPR programs. All three areas are prominent components of a total solution. AEDs on their own are seldom enough to save lives; victims of cardiac arrest need immediate CPR. CPR provides a small but vital amount of blood flow to the heart and brain, and it increases the chances that an AED shock will allow the heart to start working effectively. Eighty percent of SCAs are caused by ventricular fibrillation, a heart rhythm variance for which defibrillation and CPR are the only effective treatments.
|Providing first aid training to all employees, rather than limiting it to a small number of designated responders, may reduce the frequency and severity of occupational injury and illness. |
Questions & Answers
Q: What can a company do to be better prepare for real world emergencies?
A: Provide first aid training to all employees, rather than limiting it to a small number of designated responders, may reduce the frequency and severity of occupational
In addition, the recommendations for combining CPR and defibrillation have changed. The new recommendation is for a single shock from a defibrillator followed by immediate CPR for two minutes, beginning with chest compressions. The 2000 guidelines recommended up to three AED shocks before returning to chest compressions for one minute. There is an important new focus on effective chest compressions to maximize the quality of CPR. Effective means that the rescuer needs to push hard, push fast, allow complete chest recoil, and minimize interruptions in CPR. Rescue breathing without chest compressions is no longer taught in programs that follow the new guidelines.
What Are You So Afraid Of?
As discussed above, technical training, the right equipment, and timely maintenance are critical for a successful workplace emergency care program. But there is also a softer, more emotional side that can have just as much impact on a company's program. That factor is overcoming people's fears, which can be seen at all levels of an organization.
At the management level, the safety and health professional has to be concerned about the compliance obligations, including protection against bloodborne pathogens. The CFO may be focused on costs and return on investment in these programs, while the legal folks know that the American judicial system is fraught with complexities and time-consuming, costly litigation. Any one of these issues could cause an organization to drop or severely cut back its emergency care program, with potentially tragic consequences. The best way to address these concerns is to involve the key stakeholders in the creation, implementation, evaluation, and reauthorization of the program.
At the individual level, several recent studies have shown that both trained and untrained bystanders are reluctant to perform CPR and use an AED. For example, a six-year study in Michigan, published in 2006, interviewed 684 bystanders in SCA cases. Seventy percent of the bystanders were family members, and 54 percent of those family members had been taught CPR. And yet, only 21 percent were actually willing to start CPR. The rest said they were not willing to because they panicked, thought they would not do it correctly, were afraid they would hurt the person, or were concerned about contracting a disease or infection by performing mouth-to-mouth resuscitation.
A 2003 study of North Carolina high school students found that 86 percent of students surveyed were trained in CPR and 21 percent were trained in AED use. However, only 32 percent of the students trained said they were actually willing to use an AED and around 50 percent were willing to perform CPR. Again, they were held back by fear of infection, legal consequences, and harming the victim.
The underlying lesson is that even the best equipment, even the best training, can take you only so far in emergency response. At some point, you have to deal with the emotional issues and overcome people's base fears. My best-practices recommendation is to deal with these real-world preparedness issues now, long before a would-be rescuer is thrust into service in a last-ditch attempt to save a co-worker, family member, friend, or stranger.
Ralph M. Shenefelt, EMT-P, is a former firefighter/paramedic, a member of the National First Aid Science Advisory Board, and the executive program director of the American Safety and Health Institute, the third-largest CPR and AED training and accreditation organization in the United States. He can be reached at firstname.lastname@example.org
Please Note: The information contained in this publication is intended for general information purposes only. This publication is not a substitute for review of the applicable government regulations and standards, and should not be construed as legal advice or opinion. Readers with specific questions should refer to the cited regulation or consult with an attorney.