Page 56 - Occupational Health & Safety, June 2019

DEFIBRILLATORS & CPR
Imagining a World with All the AEDs We Need
In a world with more AEDs, setting up and running a thoughtfully designed, well-prepared, and high-performance AED program is a very attainable goal. BY RICHARD A. LAZAR
52 Occupational Health & Safety | JUNE 2019
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This is the third in a series of articles on the state of affairs in public access automated ex- ternal defibrillator (AED) programs and the challenges and opportunities we face in de- ploying them for optimum community preparedness.
In the first article1 in this series, “Squad Goals: Moving the Needle on Sudden Cardiac Arrest Re- quires a New Model,” we highlighted reasons the survival rate from sudden cardiac arrest (SCA)—the third-leading cause of death in the United States— remains at a stubbornly low 6 percent, despite more than 30 years of effort, and we offered a new model called the “AED Response Squad” for moving the survival needle. In the second article,2 “A New Model for Increasing Cardiac Arrest Survival Requires We Fix the National AED Shortage, Too,” we exposed the shocking shortage of automated external defibrillators (AEDs) in the United States and offered a Model AED Law that, if enacted in every state, would ensure an abundance of these life-saving devices and move us closer to our ultimate goal.
In this third and final installment, we imagine that we’ve been successful in broadly applying the AED Response Squad model and passing the Model AED Law, dramatically increasing available AEDs and im- proving SCA response. As we imagine this new world with lots of AEDs, we explore what it will take to fully leverage these critical public health resources to maxi- mize SCA survival. In order to be successful, this new world must also include AED program preparation and performance.
Sudden Cardiac Arrest Response in Context
At a macro level, the sheer magnitude of sudden car-
diac arrest as a public health threat is easy to describe. Nearly 400,000 people experience SCA outside of hos- pitals in the United States every year. Approximately 120,000 of these—roughly 30 percent—are stricken in public settings outside of the home. We know con- clusively that quickly delivering cardiopulmonary re- suscitation (CPR) and defibrillation with an AED can save the lives of many SCA victims. But as of 2019, only 6 in 100 survived in public settings because there were too few volunteer rescuers willing to help and too few available AEDs.3 That’s the macro story.
In a world where states pass the Model AED Law,4 resulting in the placement of millions more AEDs, it will certainly be true that a life-saving device will more often be nearby when SCA strikes. But, for AED programs, the timely application of CPR and defibril- lation therapies to the people who need them when they need them is the most critical requirement. It is at this micro level where things get challenging.
To understand this challenge is to understand that AEDs alone do not save lives. Rather, people quickly performing CPR and using AEDs save lives. For this to happen, organizations with AEDs must be properly prepared and must perform responsibly (not perfect- ly) in sudden cardiac arrest emergencies.
AED Program Preparation
The term “AED program” is used extensively in and around this industry. But if you ask 10 people what the term means, you’re likely to get 10 different answers. So let’s start by defining the concept.
An AED program is comprised of a set of poli- cies—sometimes written; often not—that prepare an organization to help someone experiencing sudden cardiac arrest. These policies organize the people, sys- tems, equipment, and activities of an AED program. Industry standards,5 applied in the context of an or- ganization’s particular physical and human character- istics, guide what to include in AED program policies (see Get to Know the AED Program Rules6 to learn why AED laws are not industry standards).
The first step in AED program preparation in- volves the development of an AED program design. AED program design decisions dictate the content of an AED program’s policies, influence how well- prepared an organization is for SCA emergencies, and impact how well it performs when one occurs.
Two important factors must be kept in mind when constructing an AED program’s design and policies. First, it is impossible to predict the precise locations where any of the annual 120,000 public set-
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