Page 68 - Occupational Health & Safety, October 2018

DEFIBRILLATORS & CPR
and concerns about legal liability. And while those billions spent have also aimed to alleviate these very fears, they persist.
■ Low AED use rate: Less than 4 percent of SCA victims are treated with a bystander-used AED before emergency medical ser- vices (EMS) arrives. One reason for this is the critical U.S. AED shortage. An estimated 4 to 5 million AEDs have been sold in the United States since the 1990s, which is great progress. But more than 30 million are needed to ensure an AED will be reasonably close to most people experiencing SCA in public settings. Other factors in- clude lack of general bystander knowledge about what an AED is and what it is used for, inability of bystanders to quickly locate an AED in the event one is nearby, a low percentage of bystanders will- ing to use an AED, and, again, that pesky fear of legal liability.
These factors are well known in the industry, and many people have written about them in books, journal articles, public relations materials, social media, and elsewhere for years. The real question is: If we know all this, why can’t we save more than 6 percent of the people who experience SCA in public settings each year? The answer is complicated and requires thinking about the problem in new and different ways.
Clearly defining the requirements of an out-of-hospital SCA response system is the first step toward meaningfully improving SCA survival rates. The focus here is on workplace and community settings rather than the home or hospital. Let’s start with the key characteristics of frequency, time, people, and equipment:
■ Frequency: In the aggregate, SCA happens often, striking
thousands of people every year. However, predicting the precise lo- cations where SCA will occur is impossible. On a per location basis (e.g., a health club, shopping mall, office, warehouse, manufactur- ing plant, school, place of worship, coffee shop, grocery store, etc.), a single SCA episode can be expected once every 10 to 40 years. So, while infrequent for any given location, being unequipped with an AED when SCA strikes is a virtual death sentence for the victim. This means lots more locations still need to put SCA response sys- tems in place.
■ Time: When SCA strikes, the clock starts ticking. CPR and defibrillation must happen in the first minutes after SCA occurs to be effective. That said, because SCA response systems rely on non- medical people, in settings not primarily focused on emergency medical services, there are limits on how quickly we can reasonably expect bystanders to react.
■ People: Lots of SCA responders must be available to provide CPR and retrieve and use AEDs. But the people who choose to help in SCA emergencies are volunteers who have no legal obligation to act (whereas professional emergency medical responders gener- ally do). As a result, they must be trained, aware, empowered, and legally protected if we expect them to step into the breach.
■ Equipment: If SCA victims are to receive the benefits of defibrillation, AEDs must be nearby in the places SCA events oc- cur. How nearby? Because defibrillation must be delivered within 5 minutes or less to have a positive impact on survival, an AED has a maximum coverage area of 283,000 square feet—about the size of
+ Immediate exposure data for analysis
+ Faster corrective actions and verification + Lower cost of silica exposure monitoring
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