Automated external defibrillators (AEDs) can now be found in many public places such as airports and airplanes, railway stations, shopping malls, sports arenas, health clubs, schools, public buildings and they are even starting to show up on construction jobsites, especially on larger projects. An AED is a small portable device that analyzes the heart’s rhythm. Once it is turned on, it provides prompts to guide the user through the steps needed to activate and operate the device.

Although the instructions are easy to follow in an emergency, training provides the operator with not only additional life-saving information, but also the confidence needed to remain calm in a life-or-death situation.

While OSHA requires construction employers to have personnel on site who are trained in first aid and cardiopulmonary resuscitation (CPR), they do not require AEDs. Nonetheless, many construction companies have taken it upon themselves to at least train employees how to use them and in many cases make them available. Before you decide to join their ranks, there are a few things you need to know.

Sudden Cardiac Arrest vs. Heart Attack

An AED is used in cases of sudden cardiac arrest (SCA), which is NOT the same thing as a heart attack. Sudden cardiac arrest is an electrical problem. When a sudden malfunction in the heart’s electrical system occurs, the heart’s lower (pumping) chambers contract in a rapid, unsynchronized way. The heart’s rhythm is so chaotic (called “fibrillating”) that the heart merely quivers and is unable to pump blood to the body and brain. Once a heart has entered fibrillation, sudden cardiac arrest occurs.

The victim typically collapses, loses consciousness and has no detectable pulse. In this situation, CPR is just a temporary measure used to continue a minimal supply of oxygen to the brain and other organs; it cannot restore the heart’s normal rhythm. Unless defibrillation (electric shock to the heart) is administered within 10 minutes of the collapse, 90 to 95 percent of victims die. Although preexisting heart disease is a common cause of cardiac arrest, SCA can happen without warning or symptoms to anyone at any age, including those who have never before had a heart problem. Risk increases with age. SCA can also occur after electrocution or asphyxiation caused by inadequate oxygen in the work environment, such as in a confined space.

A heart attack, on the other hand, is a circulation problem caused by the blockage of one or more of the arteries delivering blood to the heart. Since the oxygen in the blood cannot reach the heart muscle, it becomes damaged. Warning signs include chest, arm, upper abdomen or jaw pain. Weakness, dizziness, nausea, vomiting and sweating are also common. The victim generally remains conscious and alert. With fast and appropriate medical treatment, many people survive.

How an AED Works

It is always essential to call 911 immediately when a person experiences SCA, but if an AED is available, DO NOT WAIT for emergency services. If they are slow in arriving or do not carry a defibrillator, the delay in treatment could cost the person his or her life.

Typically, the AED first instructs the user to place the adhesive electrode pads on the victim’s chest. The AED will then proceed to analyze the victim’s heart rhythm using a built-in computer program. If the AED determines that a shock is needed to restart normal heart rhythm, it will instruct the user to stand clear and press the shock button.

It will then reevaluate the situation and indicate whether or not an additional shock is needed. AEDs have safeguards and are designed to deliver a shock only if the AED detects that one is needed.

Although the instructions are easy to follow in an emergency, training provides the operator with not only additional life-saving information, but also the confidence needed to remain calm in a life-or-death situation. Generally, AED training is now combined with CPR training so that potential AED users will know what to do if the AED indicates that no shock is necessary and CPR must be continued. Red Cross chapters and American Heart Association Training Centers are examples of organizations that provide such training.

Establishing an AED Program

All worksites are potential candidates for AED programs because of the possibility of SCA and the need for timely defibrillation. Employers should assess their own requirements for an AED program as part of their first-aid response. Each AED program will differ based on the needs of the organization; however, the initial steps necessary to establish the program are similar.

What should be considered includes, but is not limited to:

• the recommendations of Red Cross, American Heart Association, National Safety Council, etc.;
  
• physician oversight and medical direction (while some AEDs can be purchased over the counter, most require a physician’s prescription);
  
• local, state and federal regulations;
  
• liability issues (Good Samaritan laws);
  
• local EMS response time;
  
• jobsite location and accessibility;
  
• crew size and number of crew members over 40 years of age;
  
• criteria for choosing the program coordinator;
  
• determination of who will be trained to use AEDs; and
  
• budget needed to purchase the equipment, train employees, volunteers or other staff and provide program maintenance.
  

The price of an AED varies by make and model. Most cost between $1,200 and $3,000 and AEDs for home use can be purchased for under $1,000.

Setting up an AED program is similar to setting up any emergency action plan.

It is something you hope you never have to use, but if the equipment is not available, people are not trained and the plan is not ready to implement, someone’s life could be on the line. Remember: SCA strikes down more than 200,000 Americans each year — nearly one death every two minutes. According to OSHA, about 10,000 SCAs happen at work.

George Kennedy is NUCA Vice President of Safety.