Page 58 - Occupational Health & Safety, June 2019

DEFIBRILLATORS & CPR
ing should play and the existence of un- helpful AED law training requirements. Successful AED programs leverage both trained and untrained volunteer bystand- ers to aid in SCA emergencies. A policy that specifically authorizes any willing bystander to voluntarily perform CPR and access, retrieve, and use an AED creates the highest likelihood someone will step in to help.
Many other design and policy elements guide and support a successful AED pro- gram. Learn more about these in the na- tional AED Program Design GuidelinesTM.8
AED Program Performance
AED program performance is gauged by what people do and how equipment func- tions at an AED program site when SCA strikes. Key performance elements include SCA recognition, 911 call for help, CPR, and AED retrieval and use.
■ SCA recognition: The CPR/AED response time clock starts running only after SCA is first recognized. But, when measuring AED program performance for CPR and AED use, it is essential to acknowledge that it remains quite difficult for lay bystanders—including those who have received formal training—to timely and accurately recognize sudden cardiac arrest. One recent study found CPR wasn’t started because of perceived breathing9 upwards of 46 percent of the time. In an- other, more than 20 percent of laypersons were unable to determine whether an SCA victim was breathing and required CPR.10,11 A recent National Academy of Sciences Institute of Medicine study high- lights how lay bystanders often mistake SCA for a seizure or fainting. While nei- ther desirable nor ideal, a failure to timely recognize SCA does not necessarily mean poor AED program performance. This issue comes up in negligence lawsuits claiming delayed CPR or AED use and should be judged by what can reasonably be expected of volunteer lay rescuers.
■ Summoning emergency medical services: Because of the importance of ad- vanced cardiac life support in SCA treat- ment, one measure of AED program per- formance is how quickly 911 is called to summon professional emergency medical services assistance. The good news is that 911 is called quickly in most cases of sud-
den cardiac arrest, even when SCA may not have been properly recognized.
■ CPR delivery and performance: The time it takes to start CPR after SCA is first recognized is another performance measure. Whenever started, it is impor- tant to note that CPR is a difficult skill to master for both volunteer bystanders and professional rescuers alike. CPR feedback devices—stand-alone or built into AED technology—are now emerging as a tool to help improve the quality of CPR, which is certainly a good thing. But this technol- ogy also has been used as a weapon in an administrative proceeding involving two EMTs fired allegedly because CPR feed- back technology showed poor-quality CPR. This sets a dangerous precedent that may discourage volunteer bystanders from providing CPR at all.
AEDs absolutely must work when needed. Yet more than 20 percent of AEDs deployed todayintheUnitedStates may not be ready.
■ Equipment readiness: According to industry standards, AED laws in more than 30 states, and manufacturer guidelines, AED owners have an obligation to properly inspect and maintain their devices. AEDs absolutely must work when needed, a key measure of AED program performance. Yet more than 20 percent of AEDs de- ployed today in the United States may not be ready. Whether using a do-it-yourself AED inspection program or a remote AED monitoring system like AED Sentinel®, AED program managers must ensure AED readiness, even over long periods of time. This is perhaps the most non-negotiable and binary element of AED program de- sign and operations.
Many other performance elements make up a successful AED program. Again, learn more about these in the national AED Program Design GuidelinesTM.12
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. AED programs offer significant benefits to an organization’s health and safety program, its employees and visitors, and, ultimately,
to the survivors of sudden cardiac arrest. It’s a worthy endeavor indeed, and one that shouldn’t wait for a new, idyllic world in or- der for us to start taking the steps toward achieving it.
Richard A. Lazar is a leading national AED program design, operations, and compliance expert and President of Readiness Systems. Readiness Systems designed and offers AED Sentinel, the industry’s first remote AED monitoring system built for every AED pro- gram; provides AED program compliance support; publishes national AED Program Design Guidelines that describe industry standards for AED programs; and manages the AED Law Center. Learn more at www. readisys.com.
REFERENCES
1. https://ohsonline.com/articles/ 2018/10/01/squad-goals.aspx
2. https://ohsonline.com/articles/2019/01/ 01/a-new-model-for-increasing-sur vival.aspx
3. https://readisys.com/the-aed-shortage/ 4. https://readisys.com/get-to-know-the-
aed-program-rules/
5. https://readisys.com/aed-program- design-guidelines/
6. https://readisys.com/get-to-know-the- aed-program-rules/
7. https://readisys.com/avoid-the-3- minute-aed-response-time-trap/
8. https://readisys.com/aed-program- design-guidelines/
9. Bystander-witnessed cardiac arrest is associ- ated with reported agonal breathing and leads to less frequent bystander CPR. Brinkrolf et al. Resuscitation 127 (2018) 114-118.
10. Abnormal breathing of sudden cardiac arrest victims described by laypersons and its association with emergency medical service dispatcher-assisted cardiopulmonary resuscita- tion instruction. Fukushima et al. Emerg Med J 2015;32:314-317.
11. See also, ‘She’s sort of breathing’: What linguistic factors determine call-taker recogni- tion of agonal breathing in emergency calls for cardiac arrest? Riou et al. Resuscitation 122 (2018) 92-98. (“[L]ay rescuers often mistake agonal breathing for effective breathing and thus [cardiac arrest] patients can be incorrectly assessed as breathing.”)
12. https://readisys.com/aed-program- design-guidelines/
54 Occupational Health & Safety | JUNE 2019
www.ohsonline.com