Medical direction key to success with AEDs

Communication, training also critical

Having automatic external defibrillators, or AEDs, installed in the workplace is of clear benefit, but there are a number of key strategies that should be followed to ensure program success, says Thomas W. Zoch, MD, FACP, FACEP, of Thedacare at Work in Appleton, WI.

And he should know. In the past year or so, Zoch’s occupational medicine division has assisted 10 companies with the implementation of more than 60 AED’s, and approximately five to 10 other companies and/or school districts are considering the program. Thedacare is an organization that supplies medical care for 250,000– 300,000 individuals and also interacts with two hospitals in the Fox Valley area of Wisconsin.

"I am a board-certified internist and emergency medicine physician who was in the ER [emergency room] for 18 years," notes Zoch. "We handled hundreds of cardiac arrest patients, including many from the [plant] floor, and one of the most frustrating experiences is to have an individual bought in way too late."

During those early days, he recalls, there was only a 2% survivability-to-discharge rate. After joining Thedacare, he was able to increase it to 7%, but, he concedes, "that was still not nearly good enough."

The key to getting the rate even higher, he concluded, was to get the defibrillators in the hands of first responders. "The companies in the area were very open to the program and very excited," Zoch recalls. "Many already had emergency response teams in place, and this was a natural fit, since those teams could be trained."

Four important components

His extensive ER experience had convinced Zoch that a workplace AED program required four key components for success. They include:

1. Strong medical direction: "The biggest issue is to have a physician medical director with passion and experience who believes in the program and the product, realizes these items save lives, and hopes that one day they will be as prevalent as fire extinguishers," says Zoch. He considers AEDs to be inexpensive, safe to use, and of course, they save lives. The devices cost anywhere from $1,200 to $2,000.

A medical director with passion can help convince reluctant would-be participants, he explains. "A few entities, including school districts, had concerns about litigation and costs," Zoch relates. "In terms of potential litigation, I turned the issue back on the organizations, saying that at some stage they might be held liable if they did not have AEDs."

He was able to obtain funding in some cases to underwrite the costs, all the while providing medical leadership and expertise and serving as advocate and spokesman for the program.

2. Emergency Medical Services (EMS) notification and interaction: In Wisconsin and in several other states, state law requires that the EMS system be notified of the presence of AEDs in a plant site. "This, in turn, leads to further discussion of where the AED is, what model it is, and how it can interface with their equipment," notes Zoch. "This way, it saves time when they get to the scene, and helps make the transition from first response to second response seamless." This communication works two ways, he adds. "In return, EMS personnel are more apt to share event documentation with the plant, so feedback can take place," he says. "In the future, this could save crucial minutes and save lives."

3. Overseeing proper initial and recertification training: This is another key responsibility for the physician/medical director; ensuring that rescuers are properly trained and their skills maintained. "There are several excellent programs out there; we use the American Heart Association’s [AHA] Heart Saver program, which is a four-hour course that needs to be updated every two years," says Zoch. "We recommend that programs go even a step further, and that at least once a year, the plant should go through a mock drill. This reduces anxiety and improves reaction time."

The Red Cross also offers an AED course, he notes.

4. Helping with the proper selection of the AED, the number required, proper location of the AED in the plant, and assistance in developing an internal response system at the work site: "This process requires the medical director to visit the plant and walk the site," says Zoch. "You want enough defibrillators in the plant that the drop-to-shock time is three minutes or less," he advises. "The AHA and other organizations, like ACOEM [American College of Occupational and Environmental Medicine], recommend three to five minutes. That’s fine, but I want to get a good feeling that I can be there in less than three." If you look at statistics, he says, each minute without a defibrillator can cause up to a 10% reduction in survivability.

A study of the plant layout will also give you a feel for how many AEDs you may need, says Zoch. "We try to have them in easily accessible locations, and most of the time they should be secure. From that point on you need to look at the demographics of the work site."

In other words, he points out, with an older population, a few workers may have had bypass surgery, in which case you want the AEDs to be closer to the area in which they work. On the other hand, if there are a number of 20-year-olds, that would not be necessary. "An on-site nurse, if there is one, would be very valuable [in obtaining such information]," says Zoch. "The key issue is to have a champion there who really takes responsibility — they would be my key contact."

The champion also is critically important in developing an internal response system. "It’s easy to say, Please activate 911,’ but since the plant is now assuming first response status, you need an internal response system," says Zoch. "Some plants use overhead paging; others use beepers, phones with dedicated lines, or internal radio dispatch to save those precious seconds."

This process helps get businesses to think outside the box, he adds, while getting everyone on the same page.

No events to date

With a program as new as this one, it is too early to have sufficient data to measure success. And of course, when it comes to workers and cardiac arrest, no news is truly good news. "Thank goodness, we have not yet heard back from any businesses that they had an event," says Zoch.

Nevertheless, he believes his program stands out, both in terms of the key components enumerated above, and other strategies it has adopted. "When an event does occur, afterwards we will offer critical review and critical incident stress debriefing for the staff," Zoch notes. "It is catastrophic to have a fellow employee just fall over, and it is very important for employee morale to have this follow-up."

The program also has devised a creative way for dealing with multisite situations. "One company has 10 plants in this country and in Canada," he notes. "The way we handled that issue was that we worked with the AHA, contacted this business, and found a champion in each city to act as medical director."

Speaking of locations, different states have different regulations regarding emergency services, so it’s critical, notes Zoch, to know the legislative laws that oversee your area. The bottom line, he says, is that "this is an area within our field that can have a tremendous impact on survivability," he asserts. "If it saves just one life, it is well worth all of the hard work and time it took to develop the program. If we approach it that way, it will lead to huge success, and we can make a dramatic impact."

[For more information, contact:

• Thomas W. Zoch, MD, Thedacare at Work, 2009 S. Memorial Drive, Appleton, WI 54915. Telephone: (920) 237-5600.]