AED, CPR, and First Aid Preparedness for the Real World
Lay rescuers must possess not only the technical skills, but also the ability to overcome fear and concerns that often accompany emergency situations.
THE typical response to sudden cardiac arrest is not the stuff of Hollywood movies
or TV medical dramas. Rarely is the most-trained, clearest-thinking person on the
scene first, taking charge and saving a life against long odds. Rarer still are
bystanders who instantly become part of the solution instead of a distraction
or impediment. Panic, confusion, fear, people getting in one another's way--now,
that's often the real world.
Consider
the all-too-typical workplace emergency response when an employee suffers
sudden cardiac arrest (SCA): Perhaps only one person in the area has had
cardiopulmonary resuscitation training, and that may have been at least a
couple of years ago. While precious seconds tick away, human nature takes over
and there is a debate about what should be done, who should do it, and a
variety of legal and personal concerns.
Finally,
someone begins CPR and puts his hands on the victim's chest and pushes hard.
Something cracks. He pushes again. Something cracks again--it's the ribs. The
sound stuns the rescuer and bystanders. On the third push, lines of thick clear
fluid stream down both sides of the victim?s purple-gray face. Concerned about
doing more harm than good, the rescuer keeps pushing but not as hard. The
rescuer knows he should give mouth-to-mouth resuscitation, but he just cannot
bring himself to do it.
Once
security arrives, there is a shuffle of equipment, and the guards start CPR.
Then an ambulance and fire truck arrive and the professionals take over. They
have an automated external defibrillator and place the pads on the victim's
chest. After a shock, the pulse returns. The victim arrives at the hospital
alive but dies later in the day.
Immediate Action Is Essential
Despite
heroic efforts by lay rescuers and professional emergency responders, the
scenario above is quite typical. In fact, more than 325,000 Americans die each
year from SCA--more than from cancer and automobile accidents combined. And
when cardiac arrest occurs outside a hospital setting, fewer than 5 percent of
victims survive, primarily because CPR and defibrillation are not performed
soon enough.
The
brain begins dying within four to six minutes of SCA onset. However, if no more
than 3 minutes elapse between collapse and defibrillation, survival rates of 74
percent have been achieved.
So
in the real world, what can you do to give an SCA victim the best hope for a
second chance at life? Technical training for would-be rescuers remains the
most critical component. To be able to make a difference, people from across
the workforce and work shifts should be trained in first aid, CPR, and AED use--with
all three areas being important. In the workplace, providing first aid training
to all employees, rather than limiting it to a small number of designated
responders, may help to reduce both the frequency and severity of occupational
injury and illness. Training has been shown to improve participants' motivation
to avoid injuries.
Lay-rescuer
AED programs are becoming common in America's workplaces, but they should not
overshadow the more traditional first aid and CPR programs. All three areas are
prominent components of a total solution. AEDs on their own are seldom enough
to save lives; victims of cardiac arrest need immediate CPR. CPR provides a
small but vital amount of blood flow to the heart and brain, and it increases
the chances that an AED shock will allow the heart to start working
effectively. Eighty percent of SCAs are caused by ventricular fibrillation, a
heart rhythm variance for which defibrillation and CPR are the only effective
treatments.
Refresher
training is also essential, and it is more important than ever now because new
first aid, CPR, and AED guidelines have been published. For example, the new
CPR guidelines for adults recommend 30 chest compressions for every two rescue
breaths (compared with the previous 15-to-2 ratio). The new guidelines also
recommend beginning chest compressions immediately after the two rescue breaths--not
waiting to check for a pulse or other signs of life, which is often difficult
for lay rescuers to do and delays delivering potentially lifesaving chest
compressions.
In
addition, the recommendations for combining CPR and defibrillation have
changed. The new recommendation is for a single shock from a defibrillator
followed by immediate CPR for two minutes, beginning with chest compressions.
The 2000 guidelines recommended up to three AED shocks before returning to
chest compressions for one minute. There is an important new focus on "effective"
chest compressions to maximize the quality of CPR. "Effective" means
that the rescuer needs to push hard, push fast, allow complete chest "recoil,"
and minimize interruptions in CPR. Rescue breathing without chest compressions
is no longer taught in programs that follow the new guidelines.
This article originally appeared in the December 2006 issue of Occupational Health & Safety.