Introducing AEDs requires education, forethought
Once you make the decision to use automatic external defibrillators (AEDs) in your workplace, you need to seek formal training in defibrillation for your first responders and pay careful attention to how the units are actually placed in the building.
Those were some of the main concerns when Paula Smith, RN, BSN, COHN-S, manager of occupational health services at the Hewlett-Packard site in Andover, MA, and Dirk Wellbrock, RN, an occupational health nurse at the Hewlett-Packard plant in Vancouver, WA, introduced AEDs to their work sites. They offer this advice based on their own use of AEDs:
1. Train your first responders in defibrillation, not just how to use the AEDs.
When Smith was working with state emergency services officials to learn how to incorporate AEDs, they indicated that the user should have a working knowledge of defibrillation and advanced CPR. Even though the devices are very simple to use, Smith agreed that it would be important for the first responders to understand how the AEDs fit into an overall emergency response.
The Hewlett-Packard first responders upgraded their training to professional level CPR. That required a four-hour course including the use of ambu bags and pocket masks. Afterward, they were trained on the AEDs themselves for four hours, including hands-on use of the devices.
"It is key that they understand when to use the AED and when to use CPR," Smith says.
2. Don't overtrain the AED users.
Though some advanced training is necessary, Wellbrock suggests that much of it should consist of merely making first responders familiar with some aspects of coronary care.
They don't actually need to know a lot about heart rhythms and so forth. Trying to teach them too much will only confuse and distract them. If they don't understand it well, their confusion can make them less confident about using the AED.
Wellbrock recalls that one of his first responders was once asked by a friend about what type of heart rhythms require a shock and how the machine determines that a shock is needed.
"He responded that he didn't know and he didn't need to know," Wellbrock says. "That's the beauty of the machine. The machine does all of that for you. That's a perfect description of how we train."
3. Determine how many AEDs you need.
Remember that the premise behind an AED is to get defibrillation to the patient quickly. If you have one unit in the medical department and it takes several minutes to notify the nurse and then run it across the factory, you haven't cut much time off the paramedic response. At Hewlett-Packard, corporate policy requires that first responders be able to get to the victim within two minutes, so Smith decided to incorporate the AEDs into that requirement.
What is the geographic area to cover?
Smith and her colleagues studied the work site and determined that it would take 12 AEDs to adequately cover the huge work area. Each unit is placed strategically so that it covers as much area as possible while still within two minutes from any possible victim in that area.
The only areas that still are problematic are a few outside exercise areas, including a tennis court and running track. Rather than placing AED units outside, which is difficult because they can't be exposed to weather, Smith placed units near exterior doors of nearby buildings so that the unit could be taken outside quickly. She says she is considering placing additional units in the outside recreation areas to improve the response time.
"We did fast-walking trials with a stopwatch one day to see if we could get an AED within two minutes to anywhere someone might go down," she says. "It can take a lot of units to cover your area adequately." (See story on first responders and AEDs, below.)
Wellbrock also notes that he keeps an AED stationed in his clinic so that the response time is zero if someone comes in with chest pains and goes into cardiac arrest.
4. Check the units for proper functioning on a regular basis.
The AEDs have self-testing systems that can be programmed to activate at any particular hour of the day. Once the unit tests itself, it will indicate on the status screen that everything is OK. If not, an error message will appear, and the unit will beep frequently until someone attends to it.
To make sure the units are always ready for use, both Hewlett-Packard sites require security officers to check the units' status screens and the breakaway locks on their normal rounds. At the Vancouver site, the units also have a sign nearby asking that passersby call a particular phone number if they hear the unit beeping.
5. Educate all employees, not just first responders, about how AEDs are used.
Smith says it is important that everyone in the workplace understand how AEDs work, even those not trained and authorized to use them. She has included several articles in workplace publications to explain the AED introduction, and she has given demonstrations during lunch time.
"We want people to understand what they are and what they might see if they're ever used," Smith says. "We want people to be aware that if you see people sitting around and waiting for the machine to analyze, that's OK. People don't understand why the first responders aren't doing something and why they can't touch the patient while this is going on." n
· Paula Smith, Occupational Health Clinic, Hewlett-Packard, 3000 Minuteman Road, Andover, MA 01810. Telephone: (978) 659-2435.
· Dirk Wellbrock, Occupational Health Clinic, Hewlett-Packard, P.O. Box 8906, Vancouver, WA 98668-8906. Telephone: (360) 212-3480.
· William Patterson, Occupational Health and Rehabilitation, 66B Concorde St., Wilmington, MA 01887. Telephone: (978) 657-3826.
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