200711cover
Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity.
– George S. Patton
THE
BULLETIN
Volume 75 | Issue 6
November 2007

In Case of Emergency: Unions purchase AEDs as safety precaution

Elizabeth Stringer

Each year, an estimated 200,000 individuals die of sudden cardiacarrest (Defibrillation overview, n.d., ¶ 1). According to the American Red Cross, up to 50,000 could have been saved with the immediate access to an automated external defibrillator (Defibrillation overview, n.d., ¶ 1). As the "community center of the college, serving students, faculty, staff, alumni, and guests" (Role of the college union, 1996, ¶ 1), many college unions have purchased AEDs to be better prepared in case of emergency.

AEDs

According to the American Red Cross:

An AED is a device about the size of a laptop computer that analyzes the heart’s rhythm for any abnormalities and, if necessary, directs the rescuer to deliver an electrical shock to the victim. This shock, called defibrillation, may help the heart to reestablish an effective rhythm of its own. (Defibrillation overview, n.d., ¶ 16)

Once turned on, the AED prompts the user through the steps, so the rescuer simply needs to listen to the commands.

The rescuer will be prompted to apply two electrodes provided with the AED to the victim’s chest. Once applied, the AED will begin to monitor the victim’s heart rhythm. If a "shockable" rhythm is detected, the machine will charge itself and instruct the rescuer to stand clear of the victim and to press the shock button. (Defibrillation overview, n.d., ¶ 17)

Although the AED is possible for even a novice to use, training is still important for those who would most likely be using the machine. According to the American Red Cross, this training is essential for understanding the role of the AED in the overall process, not to mention the additional CPR skills that will also increase chance of survival (Defibrillation overview, n.d., ¶ 18).

Sudden cardiac arrest

Sudden cardiac arrest is not the same as a heart attack. A heart attack occurs when a blood vessel blocks the blood from flowing into the heart properly, causing the muscle to die; whereas, sudden cardiac arrest happens when the heart abruptly stops functioning (Learn about SCA, n.d.). Sudden cardiac arrest is considered a malfunction of the heart’s "electric system," and it can happen to anyone, not just those with prior heart conditions (Learn about SCA, n.d., ¶ 2).

Of those who experience sudden cardiac arrest, the Sudden Cardiac Arrest Association reports that 95 percent die (SCA crisis, n.d.). To increase the survival rate, the Sudden Cardiac Arrest Association encourages the immediate use of an AED, as it plays a critical role in the Chain of Survival (AEDs, n.d., ¶ 1). The Chain of Survival is a four-step process that will increase the likelihood of survival in the case of sudden cardiac arrest (Defibrillation overview, n.d., ¶ 15):

Step 1: Early access to care, such as calling 911

Step 2: Early cardiopulmonary resuscitation (CPR)

Step 3: Early defibrillation (with an AED)

Step 4: Early advanced cardiac life support, as needed

The American Red Cross recognizes the third step as the most important in the Chain of Survival because as it delivers an electric shock to the heart, it can restore cardiac rhythm (Defibrillation overview, n.d.).

AED laws

Although most laws governing the use and placement of AEDs are on the state level, a few federal responses have been signed into law. The Aviation Medical Assistance Act, signed in 1998, provides protection from civil suits to air carriers and individuals who attempt to use AEDs on airplanes and in airports (State laws on cardiac arrest, n.d.). Similarly, the Cardiac Arrest Survival Act of 2000 provides civil immunity for authorized users of AEDs in federal buildings as well as provided local grants to purchase AEDs from 2001–03 (State laws on cardiac arrest n.d.). Most recently, in 2002, the Community Access to Emergency Devices Act provided money for state and local grants for the purchase and placement of AEDs in public places where cardiac arrest is likely to occur (State laws on cardiac arrest, n.d.).

Many states have enacted laws concerning AEDs over the past 10 years, often dealing with protection of users and registration of the machines. According to the National Conference of State Legislatures, most state laws passed between 1997 and 2001 included at least one of the following provisions (State laws on cardiac arrest, n.d.):

  • Establish legislative intent that an "automatic external defibrillator may be used by any person for the purpose of saving the life of another person in cardiac arrest."
  • Encourage or require training in the use of AED devices by potential users.
  • Require AED devices to be maintained and tested to manufacturer’s standards.
  • Create a registry of the location of all such defibrillators, or notification of a local emergency medical authority.
  • Allow a "Good Samaritan" exemption from liability for any individual who renders emergency treatment with a defibrillator.
  • Authorize a state agency to establish more detailed requirements for training and registration.

And over recent years, states have passed laws that require certain places to have AEDs on the premise as well as a trained user. According to the National Conference of State Legislatures Web site: California, Illinois, Maine, Michigan, New Jersey, and New York require health facilities to have AEDs on their premise with varying expectations; Florida, Maryland, Nevada, New York, and Ohio require AEDs to be in schools; and New York also requires AEDs to be maintained in places of public assembly (State laws on cardiac arrest, n.d.).

Colleges and AEDs

AEDs are making their way onto college campuses as well. Ithaca College, in accordance with the New York State Department of Health, has implemented a Public Access Defibrillator program. While several hundred employees—from public safety offices to health center employees—are trained to use the machine, anyone on campus can use the AED to help those in need. To allow for this accessibility, AEDs are placed unsecured in glass cabinets, but an alarm sounds whenever the cabinet is open to prevent vandalism (Public access defibrillator program, n.d.). Also, the cabinet is wired so that a message is sent to public safety dispatches immediately when opened.

Calvin College in Michigan currently has 11 AEDs in various buildings around campus, including the library and health services buildings (Emergency response plan, n.d.). Also, Calvin College, like many institutions, has AEDs in all university emergency vehicles, including campus police patrol cars (Emergency response plan, n.d.).

Just recently, the University of Virginia installed 20 AEDs around campus. The AEDs were placed in the library, theater, and other areas on campus determined to have a "frequent presence of high-risk demographics, such as older people," according to the Cavalier Daily (Gopalakrishnan, August, 29, 2007, ¶ 4).

AEDs in the college union

As places where students, faculty, staff, and visitors all gather, college unions provide the type of high-traffic area that the American Red Cross considers important when considering AED placement (Defibrillation overview, n.d.).

This was exactly the reasoning behind placing an AED in Benson Memorial Center at Santa Clara University. According to Assistant Vice Provost for Student Life Matt Cameron, the AED was donated by the local Red Cross to the Health Center which deemed the union to be an appropriate home (personal communication, May 10, 2007).

The AED in Benson Memorial Union has not been used in the two years since its installation. But 10 to 15 people are trained to use it if needed.

"I believe [the training] was four-plus hours," said Cameron (personal communication, May 10, 2007). "It included CPR and training on the AED machine."

And the campus recreation program has added an AED training course that anyone is allowed to take.

The Skyes Union at West Chester University has two AEDs, one on the first floor and one in the fitness center. With a staff trained in basic first aid and CPR, adding the AED training to their repertoire just furthers the union’s ability to be prepared in case of emergency, said Director Dave Timmann (personal communication, May 10, 2007). He added that the AEDs have "thankfully" never been used.

Valparaiso University has 12 AEDs installed around the campus, with one being in the union.

"Our AED is located at our information desk. Since that is the most central and visible location in our building, we believe that it can increase awareness and response time which can be critical in the event of cardiac emergency," said Jon Burk, assistant union director (personal communication, April 30, 2007).

Eight building managers along with Burk are trained on how to use the AED as well as first aid and CPR.

In September 2001, the State of Delaware Health and Social Services provided 10 AEDs to the University of Delaware campus, two of which were placed in each of the union buildings—the Trabant University Center and Perkins Student Center.

According to Building Supervisor Chris Goering, the Occupational Health department at the university trains all full-time staff members and student building supervisors, so "whenever the facility is open, there is at least one person in the building that is trained in the use of the unit" (Goering, 2004).

Also, AED training is a component of all first aid and CPR classes given at the university (AED program, n.d.).

Starting an AED program

When considering starting an AED program, the American Red Cross recommends considering assessment, funding, legislation, and implementation (Defibrillation overview, n.d.).

First, assess the needs of the environment. Consider the size of the campus community and the union when deciding how many AEDs are needed. The American Red Cross also advises thinking about how long it will take EMS to respond (Defibrillation overview, n.d., ¶ 3).

Next, consider funding. The current price for an AED is about $2,300, plus the cost of training employees and volunteers (Defibrillation overview, n.d., ¶ 21). Some institutions may be able to receive grants or work with the local Red Cross to assist with funding; although it should be noted that AEDs cannot be purchased directly from the Red Cross. Also, a physician’s note is most often needed when purchasing an AED. The American Heart Association said that "This is a quality control mechanism. The licensed physician or medical authority will ensure that all designated responders are properly trained and that the AED is properly maintained" (AED programs Q&A, n.d., ¶ 7).

As previously reported, many states have legislation concerning AED placement and use. The American Red Cross recommends consulting with the institution’s legal advisor before purchasing an AED (Defibrillation overview, n.d., ¶ 4).

Finally, an implementation program is needed, including "point of contact, medical direction, program maintenance, data management, development of protocols, and response plans" (Defibrillation overview, n.d., ¶ 5).

In case of emergency

According to the American Heart Association, 890 Americans die each day from coronary heart disease, a common cause of sudden cardiac arrest, without having any signs or being hospitalized (Sudden cardiac death, n.d.). For every minute without CPR or defibrillation, a person suffering from sudden cardiac arrest chance of survival decreases by 7 to 10 percent (Sudden cardiac death, n.d.). Having an AED on site, especially in high-traffic areas such as college unions, can increase a victim’s chance of survival.

References

AEDs. (n.d.). Retrieved October 19, 2007, from the Sudden Cardiac Arrest Association Web site: http://www.early-defib.org/learnsub.asp?ID=53.

AED program. (n.d.). Retrieved October 19, 2007, from the University of Delaware Web site: http://www.udel.edu/OHS/AED.html.

AED programs Q&A. Retrieved October 23, 2007, from the American Heart Association Web site: http://www.americanheart.org/presenter.jhtml?identifier=3011859.

Defibrillator overview. (n.d.). Retrieved October 19, 2007, from the American Red Cross Web site: http://www.redcross.org/services/hss/courses/aed.html#common.

Emergency response plan. (n.d.) Retrieved October 19, 2007, from the Calvin College Web site: http://www.calvin.edu/admin/campus-safety/emergencyreponseplan/#medical.

Goering, C. (2004, March 3). AEDs in union facilities? Message posted to ACUI_NET electronic mailing list.

Gopalakrishnan, P. (2007). "U. Virginia campus installs new heart defibrillators." Retrieved October 19, 2007, from the Lexis-Nexis Database.

Learn about SCA. (n.d.). Retrieved October 19, 2007, from the Sudden Cardiac Arrest Association Web site: http://www.early-defib.org/learn.asp.

Public access defibrillator program. (n.d.). Retrieved October 19, 2007, from the Ithaca College Web site: http://www.ithaca.edu/sacl/cpr-aed.

Role of the college union. (1996). Retrieved October 23, 2007, from the ACUI Web site: http://www.acui.org/content.aspx?menu_id=92&id=296.

SCA Crises. (n.d). Retrieved October 19, 2007, from the Sudden Cardiac Arrest Association Web site: http://www.early-defib.org/learnsub.asp?ID=71.

State laws on cardiac arrest. (n.d.). Retrieved October 19, 2007, from the National Conference of State Legislatures Web site: http://www.ncsl.org/programs/health/aed.htm.

Sudden cardiac death. (n.d.) Retrieved October 23, 2007, from the American Heart Association Web site: http://www.americanheart.org/presenter.jhtml?identifier=4741.