Page 70 - Occupational Health & Safety, October 2018

DEFIBRILLATORS & CPR
five football fields. Since we don’t know where SCA will occur, we need millions more AEDs than are found in workplace and com- munity settings today.
Strategies Most Likely to Improve Survival Rates
With these characteristics in mind, what strategies can be em- ployed that are most likely to improve aggregate SCA survival rates? Here are some suggested examples:
■ Rethink the notion of training: A volunteer “SCA re- sponder squad” is needed to ensure someone is almost always nearby who feels ready and willing to help. Today’s emphasis is on formal CPR and AED training, but less than 5 percent of the U.S. public is formally trained due to time and cost barriers. This leaves most SCA victims without the potentially life-saving interventions they need. Adding a large-scale, informal “training” and empower- ment model to the mix—reinforcing that anyone can help—and leveraging online training tools and streaming media have the po- tential to build the capacity for community response to meet what SCA demands. The CPR quality in this model admittedly won’t be perfect (it isn’t now, even under the formal training approach), but for the three out of four SCA victims who don’t get CPR now, less- than-perfect CPR is much better than none.
■ Legally require AED placements: In the absence of leg- islative mandates, organizations generally have no obligation to buy and place AEDs. Only two states (Oregon and Rhode Island) require AEDs in many public locations. Targeted mandates re- quiring AEDs in places such as health clubs, schools, govern-
ment buildings, and the like can be found in only a few states. As a result, most AEDs have been placed in public settings vol- untarily, but in relatively low numbers. The only way to acceler- ate AED placements to the numbers needed is for legislatures to pass broad mandates. Yes, this has financial implications for organizations of all sizes, but they are far less than the cost of lawsuits filed as a result of not making AEDs available in the event of an SCA. And while structure fires are far less common than SCA, we long since abandoned the debate over whether fire extinguishers are a necessary expense. They are mandated and, therefore, universally available. We should learn from this.
■ Fix Good Samaritan immunity laws: Contrary to popular belief, existing Good Samaritan immunity laws offer very little pro- tection to the organizations and people involved in SCA response programs. Legitimate fear of legal liability (Google “heart attack lawyers,” and you’ll quickly understand) and the lack of solid le- gal protections are significant reasons why many organizations don’t have AEDs, and so, few people are willing to help when SCA strikes. State legislators have the power to fix this. We need to en- courage them to do so.
■ Recognize that SCA response is about logistics as much as medicine: Properly preparing for and responding to SCA emer- gencies is largely a logistics problem. The goal is to have enough people and equipment in place and deploy those resources quickly once SCA is recognized. This requires comprehensive operating policies that ensure an organization is prepared for and performs well when SCA strikes. EMS has made great strides in this effort,
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