"Early defibrillation means having immediate access to a properly working automated external defibrillator (AED). This allows trained lay rescuers to give a potentially lifesaving electrical shock to the victim's heart during a cardiac arrest."

By Dean B. Wisecarver

Automatic external defibrillators (AEDs) save lives. The following is a quote from the American Heart Association:

Early defibrillation means having immediate access to a properly working automated external defibrillator (AED). This allows trained lay rescuers to give a potentially lifesaving electrical shock to the victim's heart during a cardiac arrest.

Early defibrillation is often called the critical link in the chain of survival, because it's the only way to successfully treat most sudden cardiac arrests. When cardiac arrest occurs, the heart starts to beat chaotically (fibrillation) and can't pump blood efficiently. Time is critical. If a normal heart rhythm isn't restored in minutes, the person will die. In fact, for every minute without defibrillation, the odds of survival drop 7-10 percent. A sudden cardiac arrest victim who isn't defibrillated within 8-10 minutes has virtually no chance of survival.

As we have worked with rural electric utilities in our program, we have discovered that only about 75% have even heard of AEDs. About 50% have given at least some passing thought to purchasing an AED. About 25% have actually researched AEDs with an eye toward purchase. About 10% have purchased at least one unit but, so far, we have not found any distribution systems in our program that have deployed units in line trucks. We do have at least two G&Ts in our program that have deployed AEDs in their line trucks.

Considering the quote from the American Heart Association (and that’s just an authoritative example - there are hundreds of organizations that have publicly proclaimed the value and importance of AEDs) and considering the inherent risks associated with electrical energy, we wondered why AEDs were not already in widespread use by the RECs in our program. We did an informal survey, contacting many of you via telephone, email, or in person during consultations. We found most of you have important questions and concerns about these devices, so we decided to write this article in an attempt, at least in summary form, to answer the questions and concerns.

Frequently Asked Questions About AEDs

What is an AED and how does it work?

An automatic external defibrillator is a life-saving device that restores normal rhythm to a heart that is fibrillating. When a person goes into cardiac arrest, the most common initial rhythm is called ventricular fibrillation (VF). The ventricles of the heart are in a crazy, erratic rhythm. They are moving very fast yet no blood is being pumped out of the heart. CPR cannot correct VF but a defibrillator can. AEDs are devices that send an electrical shock through the heart that stops the ventricles from fibrillating, hopefully returning the victim’s heart to a normal rhythm.

The devices are called “automatic” because they are designed to work only as needed, according to the victim’s condition. In fact, an AED is so automatic it leads you through the entire process right from when you first turn it on. First, it will tell you to place the electrode pads on the victim's bare chest. The AED then will begin analyzing the victim's heart rhythm immediately. If the victim is in VF (or ventricular tachycardia, another fast, pulse less rhythm), the AED will charge up and tell you to push the shock button. When you push the shock button, the first shock will be delivered. If that shock does not stop the VF, the AED will tell you to shock again. After three shocks, the AED will tell you to check the victim's pulse and begin CPR if there is no pulse. After you do CPR for approximately one minute, the AED will begin analyzing the victim's rhythm again. You repeat this, following the AED’s displayed instructions, until EMS arrives. By the way, if you accidentally hit the shock button at any time, the AED will not go off unless it detects a heart rhythm that requires a shock.

AEDs do not replace CPR. CPR and defibrillation work together. CPR keeps the victim oxygenated. The defibrillator will stop the erratic VF rhythm in the heart so that the normal rhythm of heart can be established again.

The important thing to understand is that CPR is not effective on a heart that is fibrillating. A stopped heart can often be resuscitated with CPR techniques, but seldom a fibrillating heart. Furthermore, without an AED you can’t really tell if the victim is fibrillating or in complete cardiac arrest. Thus, while CPR would certainly be the correct method to use in the absence of an AED, CPR alone may not work.

How big and heavy, and how durable are the units?

AEDs are small (about half the size of an attaché case), lightweight (less than five pounds), convenient (they are operated by batteries that last up to five years), portable, and, as already described, almost fully automatic. The photos below, taken directly from several manufactures’ promotional material, give you an idea of the size and appearance of typical AEDs.

Durability varies by brand and style, but many units are now designed specifically for rough, outdoor use. These units are in protective, hard shell cases and are generally dust-proof and water-proof at least to the point of working even in a heavy downpour of rain (although they are not submersible). There are several units available today that would stand up to the rigors of being deployed in line trucks! If you do just a bit of quick research in the Internet, you will find manufacturers’ details on the durability of their various units.

Does the use of an AED require special training?

Yes. The training typically takes about 30 to 45 minutes, especially for those already trained in CPR. The training can be acquired in several very cost-effective ways. First, most manufacturers provide initial training as part of the package when you purchase units. Second, both the American National Red Cross and the American Heart Association, the two major sources of CPR training, offer AED training right along with their CPR courses, and that includes the refresher courses. Third, if you use some other source for your regular CPR training, the instructors probably have already been certified to provide AED training as well. Check with your source. Finally, if you have in-house certified CPR instructors, they can enroll in a course from the ANRC or AHA to become certified AED trainers. The only drawback to this last approach is the special dummy that is necessary to do AED training. The special dummy typically costs about $2,000.

The important thing to understand is that the required training is already widely available and adds only a few minutes to the training you already do regularly for CPR.

What are the costs involved in purchasing AEDs and setting up a program in our company?

The price of an AED varies. Typically, as of this writing, the units themselves run from a high of about $5,000 to about $1,800. In doing my research for this article, I discovered the average price is about $2,500, but there are units available for less that would handle being deployed in line trucks. The prices may vary, too, according to the quantity purchased.

The cost of the training varies and I think you could get a better idea by contacting your CPR resource for specific costs. What I do know, however, is that the additional cost for training is very small - probably the smallest component in getting a program going.

In most states, you need a licensed physician to oversee your AED program. In fact, most manufacturers, for their own protection because so many states require the physician oversight, will not sell you any AED without a doctor’s prescription. Thus, there is some cost associated with this aspect of setting up a program, but the largest portion is start-up only, with just annual monitoring after that. In the course of my research, I found references that suggested some doctors will work with employers to implement this important program for very little fee or, in some cases, for no fee. That’s something you should discuss with the clinic that provides your company with trauma care or other employment-related medical services.

The units require on-going inspection and occasional maintenance. The primary maintenance item, if the units were not abused, would be new batteries every 4 or 5 years. The cost of new batteries varies so much according to manufacturer that it would be useless to quote a cost here. Typically, however, this cost is not much of a consideration once the program is in place. Regular inspection of each unit is very important, just as it would be with any sophisticated tool or first aid kit. The inspections can be integrated into normal equipment inspections, including rubber cover-up inspections, so you already have the routine in place. You need only add a few moments to inspect the AED.

If you decide to do the required training in-house, you need the special training dummy. (Obviously, the dummy is quite different than the CPR dummy.) As I mentioned in an earlier section, the dummies typically cost $2,000 or so. The dummy, too, may need maintenance from time-to-time. Most distribution cooperatives that do their own CPR training could add the AED training with just one dummy. Large systems with remote branch offices and crews may need to consider more than one dummy or may need to find an alternative way to complete the training. (You can buy a lot of outside training for those multiples of $2,000 per dummy!)

If we deploy AEDs, what additional legal liability will we face?

Essentially, you incur no liabilities that you don’t already face from the use of (or failure to use) CPR. In fact, AEDs are already so widely recognized as important life-saving devices that all 50 states and the Federal government have amended their existing Good Samaritan laws to specifically address the use of AEDs. These amendments vary slightly by state, but most have common elements, each of which must be met to enjoy immunity from tort. The common items are that the person using the AED on another’s behalf must:

• Obtain the victim’s permission to use the AED (in most cases this is implied, since the victim is probably unconscious, but if it is a minor and a parent or guardian/parent is there, he/she must give permission).
  
  
• Have had proper AED training provided by (or otherwise certified as the equivalent to) the American National Red Cross or the American Heart Association. (Several states do not refer to these sources specifically.)
  
  
• Call or otherwise notify (or causes to be notified) local EMS before or as soon as possible around the time of using the AED.
  
  
• Exercise “normally prudent care” in using the device.

These are generally common provisions, and they presume all other provisions of each state's AED program requirements are met. If you would like to see a summary of your own state’s Good Samaritan law and its AED addendum, below are two Internet links that will take you to such summaries:

The bottom line is that, if you initiate a proper AED program, either in your offices, on your line trucks, or both, and one of your trained employees uses an AED to help someone (public or co-worker) as he/she was trained, both you and the employee are protected from liability arising out of that action. This protection, of course, is predicated on you and your employee doing all that any normally prudent person would do with similar training and in similar circumstances. I’m not a lawyer, but this doesn’t appear to be any different than if one of your people began CPR on someone at an accident scene. In fact, while doing my research, I found two articles that predicted the absence of an AED, and a trained person to use it, might eventually become more of a source of liability than actually using one.

Why should my company implement an AED program?

There are several very good reasons, I believe. Some I have already covered, but I’ll summarize the key aspects to think about here.

• The very nature of your business presents a variety of physical stressors that can bring on ventricular fibrillation. These include electrical contact, heat stress, extreme physical activity, and, in some cases, an aging employee force. The electrical contact stressor is almost certainly the biggest issue.
  
  
• Many rural electric cooperatives in our program are, indeed, rural. This means that line crews often work in remote areas where the response time for EMS crews can be long, if any EMS is available at all. If the AHA is right in saying, “A sudden cardiac arrest victim who isn't defibrillated within 8-10 minutes has virtually no chance of survival.” then it seems logical that the presence of AEDs on line trucks is virtually essential to save lives. (In fact, the remoteness of some areas of their operations was the most important reason given to us by two G&Ts as to why they decided to deploy AEDs on their line trucks.)
  
  
• The technology is well developed and the costs associated with implementing such a program have tumbled and continue to decline, making this level of “first aid” almost as normal as CPR was 35 years ago. Frankly, I would predict that within the next 5 years, AEDs will become as common as first aid kits in all work areas and that state and Federal (OSHA) requirements will be passed that will force the implementation of AEDs, at least for some industries.

Other than cost, which has shrunk considerably already, there is no logical reason not to implement an AED program. The decision to buy and deploy AEDs on line trucks in your industry really comes down to deciding when the life-saving value of this wonderful new technology outweighs the cost of making the devices available to every employee. I suspect that time is already here. AEDs are already in schools, courthouses, airports, many company offices, athletic facilities, health clubs, country clubs, etc. and they are showing up in more and more places every day.

Is there a proper way to develop and implement an AED program at our company?

I hope everyone that reads this article finally gets around to asking this question. During my research, I found one excellent site that sets a “best practices” outline for implementing an AED program. The outline is generic for all industries, not just for electric utilities, so you’ll need to adjust some actions accordingly. Even so, it is a very comprehensive outline and should serve you well. Below is the link address for the outline:

Conclusion

It is difficult to cover a subject as important as this in just a few paragraphs. My goal was to give you answers to basic concerns and questions so that you and your company might be inspired to do your own research into the value and costs of an AED program. As I mentioned earlier, our informal survey found that several cooperatives in our program have purchased and deployed one or two AEDs, but only in their offices, not out where they are most important - on line trucks.

AUTHOR'S NOTE: Right after I finished this article, I spoke to a Safety Coordinator from one of the cooperatives in our program that told me he heard a presentation from a doctor at a safety conference in Myrtle Beach sometime last year. The doctor told the group that cardiac arrest induced by electric contact does not induce ventricular fibrillation and that, therefore, defibrillation would not work. That sent me back to do more research and I quickly found several articles stating that electric shock not only can induce VF, it often does. One such article, from Columbia University Medical, is very clear on this. If you are interested, click on this link: http://cpmcnet.columbia.edu/texts/guide/hmg13_0006.html