Five Steps To Reduce Cardiac Arrest In Your
Workplace
When all of the links of the chain are acted upon, at least 40 percent of sudden
cardiac arrest victims can be saved.
Heart disease has been America's #1 health problem that has not changed in position
since the turn of the century. Sudden cardiac arrest (SCA) strikes 350,000 each year, that
is 1000 people a day. To be more specific, a life is lost to SCA every two minutes. The
existing emergency system used to deal with this immense problem is able to save only 5
percent, nationally. When Americans spend most of their waking hours at work, this type of
emergency is bound to effect all of us.
This old problem has a solution that human resources and employee benefit managers
easily can implement. Apply the following five steps to your business, and you will reduce
cardiac arrest.
The Steps To Reduce Cardiac Arrest:
Effective resuscitation of any victim of SCA is most likely to if the steps to save a
life are promptly provided by trained personnel. In the workplace, this system of response
has been labeled the "Chain of Survival" by the American Heart Association. The
system includes:
- early recognition and prevention of a heart attack,
- prompt activation of the emergency medical services (EMS) system,
- bystanders cardiopulmonary resuscitation (CPR),
- quick defibrillation at the scene, and
- an expeditious connection to advanced care such as paramedics.
This article presents the application of these concepts in easily applied steps.
Business leaders can take these steps to respond to heart attacks and sudden cardiac
arrest in their workplace. We want to emphasize the need for development of an organized
system of response. When all the links of the Chain are acted upon, studies show that 40
percent of the individuals or more can be saved.
Step 1; The Early Recognition Link
One of the most important steps in the chain of survival is Early Recognition.
Recognizing and taking action on the early stages of a heart attack will reduce the need
to take action
Of all patients presenting with a heart attack symptoms, 50 percent begin with mild
stuttering chest symptoms not perceived as pain and not urgent enough to seek out a
doctor. To reach out to these individuals it is important to emphasize the Early
Recognition link in the chain. This preventative measure will interrupt the cascade of
events leading to the crashing heart attack and cardiac arrest. The emphasis needs to be
on employee awareness programs focusing on the beginnings of heart attack. This in itself
will shift the paradigm away from the crashing crisis of events to preventative measures.
Identifying the risk factors - cholesterol, blood pressure, and stress would greatly
increase salvage rates in that usually high mortality seen with cardiac arrest. Programs
are available on these topics in a one-hour format that can be offered at an employee
Lunch-N-Learn.
STEP 2; The Early Access Link
The purpose of this link is to get trained help to the victim as quickly as possible.
When an individual collapses, someone must recognize the emergency (Step 1) and
activate 911. For every minute a rescuer delays, the patient looses 10 percent chance of
survival. Calling 9-1-1 is commonly known, but reducing the delay saves lives.
"Silent Reminders" have been developed to improve this response time. These
reminders can be hung in public places around your company, such as the lunchroom and the
time clock. Reminders also can be added to each employees desk top, repetitively reminding
each employee to call 9-1-1 and your company's internal emergency number.
Step 3; The Early CPR Link
Immediate bystander/employee CPR should begin as soon as a cardiac arrest is identified
and the EMS system has been activated.
CPR buys vital time for the cardiac arrest patient by producing and maintaining
sufficient blood flow to vital organs. When CPR is started early, defibrillation (Step 4)
is more effective in reversing cardiac arrest.
Basic CPR can be learned on a one-hour Lunch-N-Learn program. Because of this short
course all employees can learn the basics, while the emergency response team or managers
can learn the American Heart Association's more advanced CPR course.
Step 4; The Early Defibrillation Link
Rapid defibrillation is the most important single factor in determining survival.
Most cardiac arrest victims are in ventricular fibrillation (VF). Simply stated, the
heartbeat is chaotic and ineffective - more like quivering than pumping. The only
treatment for VF is defibrillation, shocking the heart into a regular rhythm.
The Automated External Defibrillator (AED) is the tool used for this purpose, they are
automated and very easy to use. The key factor is time. When the user applies the AED,
this increases survival dramatically, up to 90 percent in some studies.
Forty states in the United States have adopted advanced legislation that allows for
AEDs to be used by non medical, CPR trained people. These laws protect the rescuer with
special immunity provisions.
Step 5; The Early Advanced Care Link
Although early defibrillation, produces a considerable proportion of all survivors of
cardiac arrest, advanced care such as intubation and intravenous medications are also
important. These interventions not only promote the return of a spontaneous heart rhythm
and circulation, but also stabilize and maintain patients during the post defibrillation
period.
Notification and designing a plan of action with your local EMS provider will speed up
the delivery of proper timely advanced care, benefiting the patient.
Liability and Good Practice
No discussion on reducing cardiac arrest would be complete without consideration of
liability. In brief, manufacturers of AEDs assume product liability and indemnify users
and institutions. Good Samaritan laws and state legislation offer a great deal of
additional protection. Contact the author for a copy of your state's law and a corporate
liability position discussing how you may be at more risk if you do nothing.
Innovations in technology are driving common corporate practice. The "standard of
care" in the community is demanding corporate participation in the Chain of Survival.
OSHA's health and safety practices already dictate some of the Chain, but recent
discussions suggest hanging an AED next to every fire extinguisher.
This is an interesting area of human resources and employee benefits where you can be
proactive. Develop a systematic plan for cardiac emergencies in your business, develop the
Chain of Survival, and maybe your company can increase the chance of survival at your
place of work.
Authors: Robert S. Ambrose is a paramedic and Executive Director of the Citizen Safety
Institute (www.citizensafety.org, www.citizensafety.com) Manhattan Beach, Calif. He was
assisted in the preparation of this article by Samuel J. Stratton, MD., Medical Director
for Los Angeles County Emergency Services; Marylin Harz, BSN, Ph.D., Director of Education
and cardiologist James Wolfe, MD.
