Risk Management

The ABCs of AEDs

These life-saving devices belong in your facilities

By Ian McGregor, Ph.D., Ian McGregor & Associates Inc.

Background: Sudden cardiac arrest and AEDs

• Sudden cardiac arrest (SCA) is one of the leading causes of death in North America. It strikes more than 200,000 Americans each year, nearly one death every two minutes.[1]
• SCA is caused by ventricular fibrillation, a condition in which the heart’s electrical impulses suddenly become chaotic, causing the heart to cease pumping blood effectively. Many victims of SCA have no prior symptoms. SCA can strike anyone at any time. Victims of SCA will quickly lose consciousness, often without warning, and unless there is quick intervention, death will occur within a few minutes.
• SCA is treatable using an AED (Automated External Defibrillator).

Every minute counts!

There is a direct linkage between the ‘call-to-shock’ time[2] and the rate of survival:[3]

The problem: Ineffective planning

Although defibrillator technology to save lives is readily available, survival rates remain low – because organizations do not have an effective defibrillator plan in place.

The solution: The ‘Chain of Survival’

The American Heart Association (AHA) and other organizations have adopted a simple action plan to improve survival from sudden cardiac arrest – called the ‘Chain of Survival’:
 
Early Access
Early CPR
Early Defibrillation
Early Advanced Care

Use this table to determine your department’s overall readiness to handle Sudden Cardiac Arrest.

The Chain of Survival[4]

How does an AED work?

An AED is a device that analyzes the heart’s rhythm for abnormalities and, if necessary, delivers an electric shock (called defibrillation) which may help re-establish a normal rhythm. (Note: an AED will not deliver a shock to a person who is in asystole (flatline) where the heart has no electrical activity.)

AEDs require little training to use. The machine automatically diagnoses the heart rhythm and determines if a shock is needed. Automatic models will administer the shock without the user’s command. Semi-automatic models will tell the user that a shock is needed but the user must activate the shock. In most situations, the user cannot override a ‘no shock’ advisory by an AED. 

AEDs can even be used on children – all that is required is the use of pediatric pads. The American Heart Association recommends that if pediatric pads are not available, adult pads should be used to determine if the child is in a shockable rhythm. There is insufficient evidence to suggest that a child, in a shockable cardiac arrest, can be hurt by an adult defibrillation energy setting.[5]

AED equipment: Types, selection, cost and maintenance

• Two sub-types of AEDs are currently available – monophasic and biphasic. Older defibrillators use a monophasic high energy electrical impulse, while newer AEDs deliver two lower energy shocks, one from the chest pad, and one from the back or rib pad. Earlier models have caused cardiac injury in some situations, while use of the newer model results in fewer complications and reduced recovery time.
• There are several AED manufactures to choose from – research them well and choose based on your particular needs. Major manufacturers include:
   
  Heartsine Technologies
  Laerdal Medical Corporation
  Medtronic, Emergency Response Systems
  Philips Medical Systems
  Welch Allyn/MLR
  Zoll Medical Corporation
   
  Detailed information on these and other AED manufacturers can be obtained on the National Center for Early Defibrillation website.
• Costs for AED machines are currently in the $1500 - $2000 range.
• It is important to keep AEDs in a state of readiness. A regular AED inspection and maintenance program is required to determine whether machines are readily available, in good working order, and that there are adequate supplies on hand.

Implementing an AED plan in your department

A critical first step for departments developing a comprehensive AED plan is assessment. This involves reviewing issues such as location(s), training, equipment selection, and funding.

Legal Issues and State Legislation Issues

• Concern from individuals about being sued for improper use of an AED:
  Good Samaritan laws exist in all states. This means that no one can be held liable for the harm of a victim by providing improper or inadequate care if the harm was not intentional. There are no known cases of persons being sued for trying to help, although there have been cases where people have been sued for not helping when they could.
• Use of AEDs by trained non-EMT (Emergency Medical Technician) first responders:
  While most states require EMTs (e.g., firefighters and police) to know how to use AEDs as part of their job description, these states also permit the use of AEDs by non-EMT first responders and laypersons under certain conditions.
• Check with your local or state emergency medical services (EMS) department about current state AED legislation.

AED resources

For more information on AEDs, consult the following excellent resources:

• National Center for Early Defibrillation
• American Red Cross: Saving a Life is as easy as A-E-D
• FDA Heart Health Online: AED 
• National Safety Council (search for AED) 
• New England Journal of Medicine (search for AED)

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[1] American Red Cross

[2] ‘Call-to-shock’ time refers to the time gap between the 911 call and the first shock given by the AED

[3] National Center for Early Defibrillation

[4] National Center for Early Defibrillation

[5] American Heart Association

 

This and similar articles appear in “Risk Management Newsletter for Campus Recreation,” published by Ian McGregor & Associates.