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Automated external defibrillators (AEDs) are small, portable, battery-operated device capable of detecting life-threatening conditions of the heart that can be corrected with defibrillation. AEDs are widely available, safe, effective, portable, and easy to use. They provide the critical and necessary treatment for sudden cardiac arrest (SCA) caused by ventricular fibrillation, the uncoordinated beating of the heart leading to collapse and death. According to the American Heart Association, SCA leads to death resulting from the sudden, abrupt loss of heart function in a person who may or may not have diagnosed heart disease.
Sixty-one million Americans have cardiovascular disease, resulting in approximately 1 million deaths per year. One-third of these deaths (300,000-400,000) are due to sudden cardiac arrest (SCA), the unexpected loss of heart function. Survival rates for out-of-hospital cardiac arrest are only 1 to 5 percent. This translates into over 700 lives lost every day. Ventricular fibrillation may be restored to normal rhythm up to 60 percent of the time if treated promptly with an AED, a procedure called defibrillation.
Scope
OSHA does not have standards specific to automated external defibrillators (AEDs). However, exposures to first-aid hazards are addressed in specific standards for the general industry.
Regulatory citations
A variety of State and Federal Regulations affects the purchase and use of AEDs within the workplace. Because they are medical devices, the Food and Drug Administration (FDA) oversees the manufacture of AEDs. At the state level, various state regulatory agencies oversee the purchase and use of AEDs.
The Cardiac Arrest Survival Act (CASA)
The Cardiac Arrest Survival Act (CASA) requires the establishment of guidelines for placing AEDs in federal buildings, along with recommendations on:
- Implementing training programs
- Maintenance and testing of AEDs
- Coordination of oversight of training on the devices
- Coordinating the placement and incidents of use of the devices with local emergency medical systems
The Rural Access to Emergency Devices Act
This law authorizes the appropriation of $25 million in grants to certain “community partnerships” for the purchase of AEDs and for AED training.
The Airline Passenger Safety Act
This act requires the Federal Aviation Administration (FAA) to review the contents of medical kits carried on aircraft. The FAA has proposed rules that would require every commercial aircraft to be equipped with appropriately stocked first-aid and medical kits, including AEDs, and that flight crews be trained in their use.
How the heart works
The heart has four chambers that must beat in an organized rhythm in order to pump the blood throughout the body properly. This rhythm is governed by electrical impulses that are generated by specialized cells in the heart. When these impulses lose their rhythm, the heart does not bear normally and blood is not pumped effectively.
When someone becomes a victim of SCA, they lose consciousness, normal breathing stops, and pulse and blood pressure are lost. A heart attack is a different condition, with its own symptoms, and is usually caused by a lack of blood flow to the heart muscles. But heart attacks can lead to SCA.
Defibrillation refers to delivering an electric shock to the heart to restore a normal heartbeat. The electrical shock causes a heart suffering from SCA to “reset” its electrical impulses, which can often return the muscles to a normal function.
Chain of survival
Brain death and permanent death start to occur in just four to six minutes after someone experiences a cardiac arrest. Immediate treatment of an SCA event can result in greater than a 90 percent survival rate. A victim’s chances of survival decrease about 10 percent with each passing minute. A quick emergency response, including cardio-pulmonary resuscitation (CPR) and an AED, is essential for workplaces that are more than ten minutes away from the nearest medical help.
In the workplace, an AED is only one link in a chain of survival. The links in the chain of survival are as follows:
- Early access—To emergency medical services. This includes someone trained in emergency response to assess the scene, assess the victim’s responsiveness, and activate an emergency plan.
- Early CPR—CPR is a holding action that buys time until more skilled or extensive medical services can be accessed.
- Early defibrillation—With an AED. This is the primary factor in successful resuscitation from sudden cardiac arrest.
- Early advanced cardiac care—This is the final critical link. This is where stabilizing care and transport are provided.
How AEDs work
An AED is a small, portable, battery-operated device capable of detecting life-threatening conditions of the heart that can be corrected with defibrillation. Once on the scene, the AED begins to prompt you through the required steps.
The unit comes with a set of pads that are applied to a victim’s bare chest via the adhesive that is exposed by peeling off a covering of paper. There are graphics on the pads to help you with correct placement. After the pads are in place, the AED will analyze the victim to determine if a shock should be administered. If so, the unit will deliver the shock automatically or will prompt the operator to do so by pressing a button.
From there, the unit will analyze the victim’s heart performance again and prompt you through more required steps, which may include continuing CPR.
The strength of the shock is automatic, so you do not have to guess how much to deliver. You don’t even have to determine whether a shock is needed; the unit will tell you. If the unit does not detect a shockable condition, it cannot deliver a shock, so it cannot be used in an unsafe manner.
Training
The training required for using an AED is minimal and easily obtained from groups such as the American Heart Association and the American Red Cross. The training is normally offered in conjunction with CPR training, another link in the chain.
Modern AEDs are simple to use; so simple, in fact, that a study indicated that untrained sixth graders fared almost as well as trained professionals in using AEDs. This is by design. The easier it is to use the units, the more people will be comfortable with using them, and the opportunity for saving lives increases.
Good samaritan protections
When AEDs first came on the scene, many thought that there would be liabilities involved. Currently, the only cases that have stemmed from AED use are against those who did not have them. In 2000, the Cardiac Arrest Survival Act was signed into law in November 2000, giving immunity from civil liability for any harm resulting from the use of an AED by a layperson. If a person’s heart is in v-fib, the only method of survival is defibrillation, which makes the victim’s death virtually imminent if nothing is done. With this in mind, some workplaces are beginning to feel less safe without an AED.
The workplace
All worksites are potential candidates for AED programs because of the possibility of SCA and the need for timely defibrillation. Each workplace should assess its own requirements for an AED program as part of its first-aid response.
A number of issues should be considered in setting up a worksite AED program: physician’s oversight; compliance with local, state, and Federal Regulations; coordination with local EMS; a quality assurance program; and a periodic review, among others.
In 1999 and 2000, 815 out of 6,339 (13 percent) workplace fatalities reported to OSHA were due to sudden cardiac arrest. Assuming an average time to defibrillation of 5 minutes would produce a 40 percent survival rate, 1326 lives per year could be saved. Employers should consider use of AEDs at their worksites to reduce the time to defibrillation with the goal of improving survival.
Work factors that may aggravate or contribute to cardiovascular disease are carbon monoxide, carbon disulfide, halogenated hydrocarbons, smoking, extreme heat or cold, stress, and shift work. Electrical hazards may produce cardiac arrest (ventricular fibrillation). Exposure to noise, lead, or arsenic may produce high blood pressure, increasing the risk for heart disease.
OSHA published their views on AEDs in the workplace through a technical information bulletin, a fact card, and a news release in which OSHA states that “AEDs are easy to use and can make the critical difference in reviving individuals who suffer a cardiac crisis.”
The workplace is filled with employees from the baby-boomer era. Many of those employees, who are in decision-making roles in their companies, are learning that they could be sudden cardiac arrest victims, and this may be promoting the increase in workplace AED placement. When you factor in the low cost (under $3000); the lack of liability; the ease of use; and the all-around small payout in time, effort, and cost for an AED, it becomes easy to see why their popularity is increasing.