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 | Originally published June 1, 2019 in Occupational Health & Safety Magazine
This is the third in a series of articles on the state of affairs in public access automated external defibrillator (AED) programs and the challenges and opportunities we face in deploying them for optimum community preparedness.
In the first article1 in this series, “Squad Goals: Moving the Needle on Sudden Cardiac Arrest Requires 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 improving 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 maximize 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 cardiac arrest as a public health threat is easy to describe. Nearly 400,000 people experience SCA outside of hospitals 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 conclusively that quickly delivering cardiopulmonary resuscitation (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 defibrillation 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 perfectly) 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 policies—sometimes written; often not—that prepare an organization to help someone experiencing sudden cardiac arrest. These policies organize the people, systems, equipment, and activities of an AED program. Industry standards,5 applied in the context of an organization’s particular physical and human characteristics, 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 involves 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 setting SCA episodes will occur. And because these episodes are so geographically disbursed (e.g., a health club, shopping mall, office, warehouse, manufacturing plant, school, place of worship, coffee shop, grocery store, etc.), SCA occurrence in any single location is incredibly rare, with an episode expected perhaps once every 10 to 40 years. This means that, in a world with tens of thousands more AED programs, each AED program site must remain prepared for SCA emergencies that may happen at any time over long periods of time.
With this background in mind, here are some AED program design elements and policy examples (not an exhaustive list) that can help prepare an organization for long-term success.
Many other design and policy elements guide and support a successful AED program. Learn more about these in the national AED Program Design Guidelines™.8
AED Program Performance
AED program performance is gauged by what people do and how equipment functions at an AED program site when SCA strikes. Key performance elements include SCA recognition, 911 call for help, CPR, and AED retrieval and use.
Many other performance elements make up a successful AED program. Again, learn more about these in the national AED Program Design Guidelines™.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 order for us to start taking the steps toward achieving it.
9. Bystander-witnessed cardiac arrest is associated 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 resuscitation 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 recognition 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.”)
About the Author
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 program; provides AED program compliance support; publishes national AED Program Design Guidelines that set the industry standards for AED programs; and manages the AED Law Center. Learn more at www.readisys.com.
SOURCE: Occupational Health & Safety, reprinted with permission.