Page 70 - OHS, June 2023

DEFIBRILLATOR & CPR According to the American Heart Association, even the best CPR will not provide enough circulation of oxygen to the brain and heart for more than a few minutes. In fact, a patient whose brain is deprived of oxygen for 10 minutes or more seldom recovers. This is where defibrillation with an AED comes into play. blood to return from the lungs. The heart filling and then pushing blood out is what is felt as the pulse. All body systems rely on a properly functioning circulatory system. When something disrupts circulation, shock can occur. If multiple cells of an organ die from oxygen deprivation, the organ dies within minutes. When critical organs die, the victim can also die within minutes. The goal of CPR is to circulate oxygenated blood to keep vital organs alive until help arrives. Signs and Symptoms of Cardiac Compromise Think of the circulatory system as the body’s blood transportation system and the heart as the engine. Amazingly, the heart generates its own electrical impulses, pumping in a regular, rhythmic manner. As with any engine, the heart requires a certain amount of pressure to function and doesn’t work well when clogged with grease or debris. The most common causes of sudden cardiac arrest include a heart attack, electrocution and asphyxiation—all of which could occur in the workplace. Common signs and symptoms of cardiac compromise include: ■ Chest pain accompanied by a crushing or squeezing sensation, ■ Pain that radiates to the jaw or arm, ■ Irregular pulse and/or abnormal blood pressure, ■ Shortness of breath, ■ Cool and sweaty skin, ■ Nausea and vomiting, and ■ Anxiety or feeling of impending doom. CPR and early defibrillation are part of the emergency medical services (EMS) chain of survival that signifificantly improve the chance of cardiac patient survival. However, according to the American Heart Association (AHA), even the best CPR will not provide enough circulation of oxygen to the brain and heart for more than a few minutes. In fact, a patient whose brain is deprived of oxygen for 10 minutes or more seldom recovers. This is where defibrillation with an AED comes into play. Giving the Heart a Jump Start For every minute a patient is in cardiac arrest, their chances of survival decrease dramatically. When a patient doesn’t have a pulse and isn’t breathing, CPR should be performed until an AED is available. Though CPR and defibrillation are used in tandem as part of the chain of survival, it’s important to note that CPR alone does not restart the heart. CPR is an oxygen circulation procedure. AEDs, on the other hand, are meant for lifesaving intervention. AEDs, when “analyzing,” are determining heart rhythms that indicate ventricular fibrillation (V-fib). When indicated, an AED uses an electric shock, called defibrillation, to stop and reorganize a chaotic heart rhythm. The AED delivers a high-voltage current through the patient’s skin that traverses the heart muscle and stops the chaotic electrical pattern. The high voltage is why responders and others are instructed to clear from the patient before shocks are administered. The heart is temporarily paralyzed, allowing its natural pacemaker to kick in again. Essentially, the heart has been given a jump start. AEDs in the workplace can save precious treatment time and increase the odds of patient survival. These lifesaving tools are light, portable, easy to use and inexpensive. They are best placed near high-hazard areas such as confined spaces, near electrical energy or in remote work areas. Response time to reach AEDs should be kept within three to five minutes. OSHA Requirements Regarding CPR OSHA 1910.151 requires first aid treatment be provided in the absence of an infirmary, clinic or hospital in near proximity to the workplace used to treat injured employees. This may include assisting a victim of cardiac arrest using CPR or defibrillation. OSHA requirements for CPR and defibrillation differ considerably. Standards requiring CPR include: ■ 1910.146 Permit-required Confined Spaces ■ 1910.266 Appendix B: Logging Operations – First Aid and CPR Training ■ 1910.269 Electric Power Generation, Transmission, and Distribution ■ 1910.410 Qualifications of Dive Team and ■ 1926.950 Construction Subpart V, Power Transmission and Distribution OSHA recommends basic adult CPR refresher training and retesting every year, and first aid training at least once every three years. CPR training includes facilitated discussion along with “hands-on” skills training that uses mannequins and partner practice. OSHA recognizes AEDs as important lifesaving technology that plays a role in treating workplace cardiac arrest. However, OSHA doesn’t currently require the use of AEDs in the workplace. OSHA and the AHA formed an alliance in November 2003 68 Occupational Health & Safety | JUNE 2023 www.ohsonline.com