Cardiac events inevitable as workers get older

Any consideration of automatic external defibrillators (AEDs) in the workplace should include the age of your workers, says Paula Smith, RN, BSN, COHN-S, manager of occupational health services at Hewlett-Packard in Andover, MA.

When Smith studied the addition of AEDs to her work site, she looked at the demographics of the Hewlett-Packard work force. She found that, like the American population in general, the work force was getting older and thereby increasing the chance of a cardiac event at the workplace. As of October 1996, 53% of the Hewlett-Packard work force was 40 years or older, but that figure climbed to 63% by October 1997.

There has been no cardiac arrest at the workplace in the past, but Smith's decision was influenced by the experience of another Hewlett-Packard workplace in Vancouver where there have been four cardiac arrests in recent years. Smith says it is inevitable that her workplace will have a cardiac event at some point.

"We used research on cardiac events and our own demographics to establish that our risk for having a cardiac event on site was 0.8 per year," Smith says. "We have a relatively high potential for an event, and that will only go up as our work force ages."

Skeptic becomes an advocate

The aging work force will dramatically increase the need for AEDs in the workplace, says William Patterson, MD, MPH, medical director of Massachusetts for Occupational Health and Rehabilitation in Wilmington, MA. Patterson tells Occupational Health Medicine that he used to be skeptical about AEDs in the workplace but recently has become a strong advocate.

"One of the critical issues for employers in the next 10 to 15 years is the aging work force," he says. "As the baby boom generation makes its way into their 50s and 60s, the likelihood of a sudden cardiac arrest in the workplace increases. That means the need for AEDs and the cost effectiveness of AEDs in the workplace improves."

Patterson says his attitude toward AEDs altered once he saw how easy they are to use. People will find it easier to use the AED than it is to administer CPR, Patterson says, although they are not interchangeable treatments. Rather, AEDs should be incorporated as part of an overall emergency response plan.

"Companies considering an AED program should first make sure they have all the basics of a good emergency response plan in place, and then you can introduce AEDs as an addition to the whole program," Patterson says. "Not every workplace is going to need AEDs, but the larger and more sophisticated workplaces should seriously consider AEDs now."

Patterson predicts that the standard of care will evolve to require AEDs in large workplaces within five years, and he also predicts that within that time, AEDs will become a routine part of basic life support training for first responders. He notes that the cost of an AED unit, approximately $4,000, is reasonable when you consider that there is almost no ongoing expense for maintenance and training. Once you've bought the unit, you've incurred essentially the entire cost of the program for many years, so the $4,000 should be amortized when considering the cost-effectiveness.