| Safety & Health
Defibrillator
Programs Can Achieve 40+% Survival
 According
to the American Heart Association (AHA), a specific heart condition
called sudden cardiac arrest (SCA) claims the lives of an estimated
250,000 Americans each year. Unlike a heart attack, which is caused
by a blockage in an artery, SCA is an electrical malfunction of
the heart typically associated with an abnormal heart rhythm known
as ventricular fibrillation (VF). Defibrillation, delivery of an
electrical current to the heart, provides the only effective treatment
for ventricular fibrillation; however, defibrillation is most effective
if received in the first few minutes after SCA occurs. For every
minute that goes by without defibrillation, the chance of survival
decreases by 7-10 percent. After 10 minutes, survival is very unlikely.
While many ambulances carry defibrillators, it takes an average
of nine minutes for them to reach a cardiac arrest victim. As a
result, fewer than five percent of victims survive.
Roper ASW’s national survey on workplace health and safety,
found that only six percent of the U.S. workplaces polled (in September
2002) are equipped with portable defibrillators. According to the
U.S. Department of Labor Occupational Safety and Health Administration
(OSHA), 13 percent of workplace fatalities reported to the agency
during the past two years were due to cardiac arrests.
Today, fewer than five percent of cardiac arrest victims survive,
largely because defibrillators do not reach them within the first
few minutes following an arrest. For each minute that passes before
defibrillation therapy, the chance for survival decreases by about
10 percent. Due to this small window of time, defibrillators in
the workplace are essential because building security, high-rises,
large campuses, heavy urban traffic and other hindrances often make
it impossible for emergency medical services to arrive in time to
successfully treat an SCA victim. However, rapid response defibrillator
programs have achieved survival rates greater than 40 percent.
Part of the answer
Shop-Rite Supermarkets, owned by Wakefern Foods Corp., Elizabeth,
New Jersey, is an early adopter of portable defibrillator technology.
In spring 1999, Shop-Rite supermarkets investigated obtaining defibrillators
for its 200 stores in a five-state region, dominant in New Jersey,
New York, and Connecticut. Today, Code Blue is used in Shop-Rite
(shoprite.com) warehouses and stores when someone appears to be
in cardiac arrest.
“Members (employees) became interested right away,”
says David Sylvester, vice president of loss prevention, Wakefern
Food Corp. In 3.5 years we saved six out of six people with the
defibrillator when the national odds are 4 out of 10 for survival.”
The defibrillator was used on three customers, two associates, and
one outside vendor; the oldest person was 78; the youngest 52. “The
machine is a miracle in a box,” says Sylvester. “People
in cardiac arrest are dying. If defibrillation is not done quickly
the person will go from ‘dead’ to ‘dead dead’.
It’s all in how fast you can respond. We put our faith in
our employees. A lot of people have volunteered and employees have
been trained by shift so there is always someone who knows how to
operate the defibrillator 24/7.” Further, Shop Rite employee
groups have donated over 50 defibrillator units to other community
services organizations, so they will become more commonplace.
“We have trained 2200 people [including Wakefern’s
president and vice president] on how to use the defibrillator,”
Sylvester explains. “We have 12 to 20 people trained per store.
The protocol for Code Blue really works because when we announce
over the intercom there’s a Code Blue, the off-duty nurses
and firemen come running to that aisle.” Shop Rite acquired
the Philips Heart Start On-Site Defibrillator which was designed
for use by lay responders to cardiac arrest. There is one unit per
Shop-Rite store and three to four per warehouse based on size. Training
sessions are provided by former paramedics who have defibrillated
hundreds of people. Wakefern thinks it is also important because
after the training, employees have a sense that the organization
really care about the employees and the customers.
Protecting employees and customers
“It used to be that companies like airlines, wanted to protect
customers and now it has shifted to protecting employees,”
says Tracey Byers, director of marketing for defibrillators for
Philips North America. “Customers don’t just buy the
unit but they are able to obtain training at no charge to determine
how many defibrillators are needed, where to place them, and how
to communicate to the workplace or retail environment that you actually
have them. For businesses that have a high turnover, this is crucial
because new people have to know about the defibrillators. For companies
operating across states or even countries, Philips finds local CPR
training through the American Heart Association, American Red Cross
or others in the region,” says Byers.
One life lost; 52 units installed
Ten years ago, an emergency response program began at Safeco,
a comprehensive insurance and investment products company that offers
a network of independent agents, brokers and financial advisors
nationwide, (safeco.com) based in Seattle. All employees were trained
in CPR. Then, four years ago, a Safeco employee had a heart attack
at work and died; it took nine minutes for emergency services to
arrive. The CEO of Safeco inquired as to how his life could have
been saved and decided to have defibrillators installed and employees
trained at all offices with 30 or more people. Safeco office managers
with fewer than 30 may budget to obtain one as well, according to
Heather Kelly, life safety program manager for Safeco.
“It’s an employee benefit. At employee orientation
they are told, annual broadcasts are delivered about office safety,
and there are ten minute safety talks every quarter for all employees
to remind them of safety procedures,” says Kelly. Further,
information about defibrillator locations is posted on the intranet.
In total, Safeco owns 52 defibrillator units in 48 offices. A minimum
of two people per office are trained on how to use the device. Service
centers open 24 hours or weekends, or offices with extended hours
always have someone who knows how to use the AED. Further, security
guards contracted with Safeco must have these skills before working
at Safeco.
Like ShopRite, the maintenance program consists of one person in
each office conducting the manufacturer’s recommended self-test
once a month. An email reminds the tester to do so and post the
result on the intranet.
According to the Roper survey, 53 percent of workplaces that currently
have portable defibrillators said they definitely would recommend
that other companies have portable defibrillators on site. Another
30 percent said they probably would recommend. But the survey also
found that only sixteen percent of unequipped workplaces have discussed
the idea of acquiring defibrillators. Of those workplaces that have
discussed the need for defibrillators, 23 percent now have a plan
to purchase. Among those workplaces that have a plan to place defibrillators
at their site, 59 percent said the awareness of emergency medical
services’ (EMS) inadequate response time influenced their
decision. Across the country, EMS response times are currently averaging
8 to 10 minutes.
In December 2001, OSHA issued an advisory statement urging employers
to deploy automated external defibrillators in the workplace. A
few months prior to this advisory, the American College of Occupational
and Environmental Management (ACOEM) published guidelines to increase
awareness of the value of defibrillators and provide guidance on
their use in the workplace. In addition, the Building Owners and
Managers Association (BOMA) International has advised its membership
that, commercial office buildings can benefit from obtaining defibrillators
and training employees to use them as part of a public access defibrillation
(PAD) program. Even the White House has defibrillators; the Secret
Service has been trained how to use them.
Use of AEDs for Public
Access Defibrillation doubles survival from SCA
Results from the Public Access Defibrillation (PAD) clinical
trial were announced this past November at the American Heart
Association Annual Scientific Sessions in Orlando, Florida.
The large multi-centered trial funded by the National Heart
Lung and Blood Institute, in cooperation with the American
Heart Association, was designed to determine whether deployment
of automated external defibrillators (AEDs) and training laypersons
in their use would lead to improved survival from sudden cardiac
arrest (SCA). A large body of research has shown that defibrillation
by trained public safety and emergency responders is a highly
effective approach to treating sudden cardiac arrest. However,
the PAD trial is the first large-scale study to test the effectiveness
of layperson use of AEDs.
According to investigators, survival rates doubled in locations
with AEDs, compared to locations without AEDs. In addition,
there were few adverse events and no cases in which devices
shocked inappropriately. Study results also indicated that
there was one treatable cardiac arrest per study facility
every 6.7 years.
“We now have the results of the world’s largest
test of public access defibrillation,” said Joseph P.
Ornato, MD, chairman of the PAD steering committee, who presented
the results in Orlando. “We trained almost 20,000 volunteers.
They did an incredible job and there were no major injuries
or serious safety issues.” Ornato is Professor and Chairman
of the Virginia Commonwealth University Medical Center’s
Department of Emergency Medicine in Richmond, Virginia, and
an adviser to the National Center for Early Defibrillation.
The study, based at the University of Washington, was conducted
at 21 sites in the U.S. and three in Canada. Researchers recruited
993 facilities and approximately 20,000 volunteers to participate.
Study units were selected on the basis of having “higher
risk” populations. This was defined as locations with
at least 250 persons over age 50 for an average of 16 hours
per day. They included residential sites such as apartment
complexes, and public sites such as shopping malls, senior
centers, office buildings and sports venues. The sites were
randomized to one of two treatment groups. In half the sites,
volunteer rescuers were trained to recognize sudden cardiac
arrest, call 9-1-1 and perform basic cardiopulmonary resuscitation
(CPR). In the other half, volunteers also were trained to
use an AED. A total of 1,500 AEDs were deployed in these sites.
All study facilities developed response plans to ensure rapid
recognition and intervention. Data collection began in 2000
and sites collected data for an average of 21.5 months.
Twenty-nine persons survived SCA at the AED sites compared
to 15 persons at non-AED sites (p=0.04 using two-sample t-test).
Increased survival was found primarily in the AED public sites,
rather than in residential locations. Overall, there were
292 resuscitation attempts, indicating that a typical site
would have one treatable cardiac arrest every 6.7 years.
“The PAD study results strengthen the concept that
automated external defibrillators should be widely available
in public locations,” according to Vince Mosesso, MD,
Associate Professor of Emergency Medicine, Principal Investigator
for the Pittsburgh study site, and Medical Director of the
National Center for Early Defibrillation at the University
of Pittsburgh.
Device placement alone is not the answer, though, according
to Mosesso. “The increase in survival in the AED arm
was not simply the result of hanging AEDs on facility walls.
Rather, survival depended on the development of an emergency
response plan, awareness of that plan, and training a team
of volunteer rescuers. The key to success remains immediate
bystander action,” said Mosesso.
What is especially noteworthy, said Mosesso, is that the
use of AEDs was safe for both rescuers and patients. “The
fact that no patient was shocked improperly with an AED and
that there was such a low rate of adverse events should alleviate
any concerns about the use of these devices by laypersons
who undergo relatively brief training.
Likelihood of intervention
Volunteer rescuers responded to victims of cardiac arrest
nearly twice as often at AED sites compared with CPR sites
(59% vs. 33% of cases). Volunteers also were more likely to
perform both ventilations and compressions at AED sites, compared
with CPR sites (23% vs. 11% respectively). The reason for
this difference was not identified, but researchers suspect
the presence of an AED may increase the willingness of lay
bystanders to provide assistance.
Source: National Center for Early Defibrillation web
site - www.early-defib.org
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Resources on the Web: AED Manufacturers
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