July2010cover
THE
BULLETIN
Volume 78 | Issue 4
July 2010

Preparing for the Unexpected: Successful outcomes through training and use of AEDs

Megan German

It was late in the day Feb. 15 on The University of Southern Mississippi campus. Michael Ibos, a third-year student at the university, was on duty as an operations manager in the Thad Cochran Center, located in the Union Complex. He was looking forward to a stress-free evening. This was not to be.

“About 5:45 p.m., I was sitting at the Event Services desk when a man approached me and said there was a man having a seizure in the Ball Rooms,” Ibos said.

He was now faced with the very situation for which he had trained during the past three years: rendering the special aid required to save a life. When Ibos arrived on the scene, he encountered an unconscious 71-year-old man receiving cardiopulmonary resuscitation (CPR) from a nurse who happened to be attending the event. Ibos observed that the victim was unresponsive and ascertained there was no pulse. With CPR in progress and 911 called, Ibos knew what to do next: “I immediately ran downstairs to grab the automated external defibrillator (AED),” he said.

An AED, as described in Daniel Moon’s 2002 article for American School and University Magazine, is a laptop sized device that can save the life of a sudden cardiac arrest victim by delivering an electrical shock, restoring their heartbeat to normal. The AED uses voice prompts, lights, and text to tell the rescuer which steps to take. AEDs are accurate and easy to use; with a few hours of training, anyone can learn to operate one safely.

Immediately upon his return, Ibos prepared and placed the AED pads on the victim, while CPR continued. Once the device was prepared, he observed the indications while the machine analyzed the victim and followed the audible directions.

“It advised shock, so I shocked him once,” Ibos said. “After I shocked him, it apparently started his heart again and he had a faint pulse.” Shortly after reestablishing the victim’s pulse, the paramedics arrived and continued treatment until the man was stabilized and could be transported to a local hospital.

The proximity of an AED and properly trained student staff helped save a man’s life. Given the troubling statistics about the prevalence of sudden cardiac arrest incidents, more college unions might benefit from installing AED devices and emphasizing emergency response training for student employees.

Equipment
Dave Bingham, in his 2009 American School and University article “Shocking Statistics,” offered some compelling reasons for increasing AED availability training. Sudden cardiac arrest is known to be the second-leading cause of death in the United States, causing an estimated 400,000 out-of-hospital deaths every year. According to the Sudden Cardiac Arrest Association, fewer than 10 percent of sudden cardiac arrest victims typically survive, but 30–50 percent would likely survive if CPR and AEDs were used within five minutes of collapse. Communities are responding to such statistics by enacting AED legislation and public access defibrillation programs, which require AED purchase, access, and training for public places. These programs are a means of making AEDs available in public or private places where large numbers of people gather.

When someone experiences sudden cardiac arrest, the time for response is short. The American Heart Association advises the optimum time for reviving individuals suffering from sudden cardiac arrest is within three minutes of the incident. When a person has immediate access to AEDs, survival rates increase by as much as 80 percent. This rate drops to 2 percent for individuals left untreated after 10 minutes. Dr. Douglas Zipes, president of the American College of Cardiology, said in a 2002 Centers of Disease Control press release: “Because almost one of every two Americans will die of cardiovascular disease, and because about half of those deaths will be sudden, we need to train people in cardiopulmonary resuscitation and in use of the automated external defibrillator, and make that equipment widely available.”

Emergency response training
Having the equipment is only one factor in being prepared for emergency events. Equally critical is having a well-trained, on-site staff fully capable to respond to an emergency.
Training is the key in the use of all life-saving devices and techniques. Combined CPR and AED application is critical to be effective. Early CPR is an integral part of providing lifesaving aid to people suffering from sudden cardiac arrest. CPR helps to circulate oxygen-rich blood to the brain. After the AED is attached and delivers a shock, the typical AED will prompt the operator to continue CPR while the device continues to analyze the victim.

The U.S. Department of Labor Occupational Safety and Health Administration reported that 7,000–10,000 of the more than 460,000 deaths due to sudden cardiac arrest are attributed to young people, albeit usually in the context of athletic events. Additionally, as Moon recognized in his article, school campuses are community centers. Special events and community meetings are regularly held in college unions, and the commonality of older adults in any facility raises the risk of someone suffering sudden cardiac arrest while on school property. Thus, the importance of having an AED on site is crucial.

The student staff at Southern Miss’s Union Complex consists of approximately 30 students each semester. This includes managers, crew leaders, crew members, and desk assistants. All student employees in the Union and Programs Department progress through a training system called the Staff Training for Excellence Program (S.T.E.P.). This systematic training concept is meant to be progressive in nature and begins by broadly covering all areas of union programs and responsibilities, and then focuses more intently on specifics as employees move through the system to their particular department position. This training system allows students to become familiar with the department’s policies, procedures, and expectations; outlines the student process and leadership development; and teaches student employees that they are an essential part of the center of the Southern Miss community.

Topics covered in S.T.E.P. include facility-specific operations, such as fire alarm and tornado evacuation plans, as well as active shooter and severe weather policies and procedures. Each employee is required to attend training sessions on all of these areas, regardless of the position they hold. A key component of S.T.E.P. is CPR/AED training. Operations staff, graduate assistants, and student managers are required to attend the CPR/AED training annually. Additionally, all managers view monthly refresher videos on various issues (Heimlich, CPR, AED, seizure, severe bleeding, etc.) and discuss topics such as how to manage emergency situations, what resources are available and should be utilized, and who to contact and how to report incidents to the appropriate authorities.

“I’m glad to know our [training] efforts have been effective,” said Ibos’ supervisor Megan Wilkinson, operations manager, reflecting on the February incident in the Union Complex. “When I ran up to the ballroom, I saw Ibos already down there on his knees with the AED in-hand and ready to apply the pads to the man. All I did was put my hand on his back and say, ‘Are you OK?’ There was no question in my mind that he could handle it.”
 
Establishing an AED program
If you are considering implementing a program like the one at Southern Miss, there are several steps to take, as Moon recommended in American School and University. One problem in pursuing AED programs is that administrators are receiving conflicting information on how to establish a program. Local fire departments, nurses, and parents are offering help, but there is not a universal plan for schools. Schools operating on tight budgets will need to plan months in advance, but every organization has to start somewhere.

An AED program can be broken down into eight steps. These steps coincide with those procedures promoted by the Government Services Administration and most other industry and professional organizations that have opinions on this issue.

  1. Form a planning committee that includes administrators, staff, supervisors, and campus health and safety officials who may have expressed interest in creating an AED program.
  2. Have the committee write a vision statement and identify a timeframe for initiating an AED program. Have the planning committee create a prioritized list of locations to best serve the needs of the campus’ high-volume facilities. To have the greatest impact, such schemes should be introduced where the risk of cardiac arrest is highest. According to D. E. Becker, in Anesthesia Progress, it has been suggested that for public access schemes to be cost effective, the probability of cardiac arrest occurring in the location should be at least once every two years.
  3. It is important to remember to locate AEDs where they can be easily accessed and transported to any victim on-site within three minutes.
  4. Designate “trained responders,” and include AED training as part of their job description or responsibilities. There is no age limitation in the training and use of an AED. In the United States, the Federal Cardiac Arrest Survival Act of 2000 protects Good Samaritans administering AEDs, but even so, it is a good idea to ascertain what liability may be applied to exercising life-saving techniques and procedures.
  5. Seek medical direction and a prescription. AEDs are devices controlled by the Federal Drug Administration and require a prescription. Make sure the physician who signs a prescription understands AED protocols and government regulations as they relate to training, equipment maintenance, reporting incidents, and downloading data.
  6. Determine who will be responsible for keeping track of all the data related to the upkeep of the equipment and the educational training. It is best to have one place where all training and maintenance information for the program is kept.
  7. Notify the public about the plan. Provide local media the information in advance so they have the opportunity to report the plan to the community.
  8. The most effective AED programs combine AEDs with CPR and emergency oxygen, so broad emergency medical training may be required. Some states even require both. Training guidelines and protocols may differ from state to state, so be sure to research what is required in your state. There are several good websites (such as http://www.zoll.com) for obtaining this information that also serve as excellent sources for areas outside the United States, including the United Kingdom and Canada.

Once a plan is in place, buying AEDs is only the first step to developing an AED program. AEDs must be accompanied by a comprehensive training and maintenance program to ensure the unit is always ready for use. Some considerations, as Bingham outlined, include:

  • The unit: Most AED systems can be purchased at a cost of $1,500–2,000 depending on manufacturer and model. It is a gift that can by donated by health care organizations/individuals or acquired by institutional funding. The AED in Southern Miss’s Union Complex was obtained through the Red Cross.
  • Maintenance: To ensure units are kept in working order, many institutions use AED suppliers that offer online maintenance programs. After an AED is purchased, representatives from the company work directly with the institution and develop effective maintenance programs.
  • Training: Key personnel such as security staff, administrators, coaches, and trainers generally are the first to be alerted when a sudden cardiac arrest incident occurs, so they should be trained to use AEDs properly. This training should be part of a comprehensive AED program that specifies how personnel should respond and how the AEDs should be maintained. Some of the best sources of training for university staff and organizations are through the American Heart Association and the American Red Cross. Part of the mission of the American Heart Association is to provide first aid, CPR, AED, and blood borne pathogens training for employees in colleges and universities. The American Red Cross has a similarly focused mission statement. Both organizations offer online, classroom, and multilingual instruction to meet the demands of a diverse workforce.


Once key personnel are trained, all employees should be made aware of the new program and the steps that should be taken if a sudden cardiac arrest occurs. This communication also should include the chain of survival: early access (calling for help and providing emergency medical services), early CPR, early defibrillation, and early advanced care.

“The adult CPR training class that our staff has attended for the past few years has now paid off,” Jones said.

Within the Planning core competency for college union professionals is the skill set Preparing for the Unexpected. It is perhaps unfortunate that this learning outcome achieved through S.T.E.P. at Southern Miss was tested in a real instead of hypothetical environment. However, the end result—saving a life—proved well worth the educational and material investment.