Creating a workplace AED program

We are planning to install automated external defibrillators in all of our facilities, but we have not yet set up an official AED program. Aside from which AED to buy, what else should we be concerned with?

Answered by Hank Constantine, marketing director, AEDs, ZOLL Medical Corp., Chelmsford, MA.

Of course an AED program requires purchasing AEDs, but that is probably the easiest part of the whole process. Once AEDs are installed, the project has only just begun. Your ultimate goal is to provide the best possible rescue for a collapsed victim of cardiac arrest. To do this, you need to focus on what a complete rescue requires.

All AEDs are easy to use. All are approved by the Food and Drug Administration, and all deliver a defibrillating shock. Delivering a shock is not hard: Turn on the AED. Attach the electrode pads. If indicated, push the shock button. The hard part is maintaining your preparedness, recognizing cardiac arrest when it occurs, reacting quickly, and performing good CPR as quickly and as long as possible. This will not happen unless you develop and maintain a group of trained people with an AED nearby.

It is difficult to overemphasize the importance of CPR. Research shows that in almost half of all rescues, the AED's first heart analysis tells the rescuer the heart is not shockable. When this happens, only good CPR can restore the heart to a shockable rhythm. "Good CPR," according to the American Heart Association, means compressions on the center of the chest that are 1.5 to 2 inches deep, at a rate of 100 per minute.

But CPR is not only critical when no shock is advised. It can be even more critical when an AED does advise a shock. Research shows most victims have no organized heart rhythm a full minute after being shocked. During that time, the electrical system of the heart is struggling to reorganize the engine that is the heart. To do this, muscles of the heart need oxygenated blood to help the electrical system reorganize. The heart's ignition system is beginning to work, but now you need to "give it gas" with CPR. A just-shocked heart needs good CPR more than any other.

It also is difficult to overemphasize the importance of training. The simplest training requires reminding everyone – on a regular basis – where AEDs are, how to recognize a collapsed victim of cardiac arrest, how to activate trained responders on-site and how to call for an ambulance. In addition, training involves building a team of volunteers who know how to use an AED and regularly practice CPR.

Success requires you to make a plan, regularly check your preparation, retrain when needed, and that when a collapse occurs your rescuers react quickly and confidently. The final test will occur the day after a rescue. Regardless of whether the victim survived, you want everyone aware of the event to believe everything that could have been done was in fact accomplished, and your rescuers had the best possible support.

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