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What to Consider When Selecting an AED

By Chip Georges

Let’s face it; AEDs are here to stay. Certainly, they are a hot topic right now and have been for a while. If your workplace has not implemented AEDs already, I would bet a lot of money the subject has at least been discussed. And because there is more to an AED program than simply hanging one on the wall and hoping for the best, this article may contribute by helping you understand the difference between buying an AED and investing in a complete and compliant program. So, without further delay, here is a little ‘defibrillation information” to grab your concentration.

I am not going to talk about how successful AEDs are or why you should have them, I’m not going to explain how AEDs protect a company’s reputation. Those facts and reasons have been proven and written in article after article.

           If someone tells you AEDs are not a good thing, then please tell him or her to wake up. If they weren’t, then AEDs sold, month after month, would not be increasing the way they are.

Elements of a Complete Program

Most decision-makers whom I have had the good fortune to meet spend most of their time in one-sided presentations with sales reps from AED providers. All they talk about is the features of their particular AED and why theirs is best. While that is certainly important, I believe the buyer needs to do more than research the AED; he or she needs to understand what goes into a complete and compliant program.

Such a program involves a series of steps that must be addressed so the program is not only compliant, but also carries the greatest chance of being successful. While these steps can seem overwhelming at first, in reality they are simple to achieve if you have the right help and support from a reputable program provider.

The steps involved with a complete and compliant program are included in the following list. Some are required by law; others are simple and effective directives.

1. Site assessment

2. Medical direction and oversight

3. Responder CPR & AED training and certification

4. EMS notification

            5. Maintenance and upkeep of the AEDs and the components of an AED program

6. Choosing the right AED and related accessories

7. Establishing program awareness

8. Complying with any local ordinance(s)

            9. Proper registration of AED/AED program if required by state, county, or city

The requirements don’t end here. Most AEDs require a prescription. AEDs are Class 3 medical devices regulated by the FDA. There are a couple of models that do not require a prescription, but do not be misled by this promoted “convenience”. You still need to satisfy the rest of the list.

Site assessment. A site assessment is a time for you to look at your facility and figure out the best possible location to place your AED(s). A three- to four-minute response time is crucial. Easy accessibility is what you are going for here.

Medical direction and oversight. This entails the direct involvement of a physician (or program director) to help with the development, tracking, and upkeep of written policies, procedures, protocols, certifications, and program upkeep requirements.

Responder certification. This comes from being trained in CPR and AED administration by a nationally accredited association (i.e., the American Heart Association).

EMS notification. EMS notification involves notifying the local EMS district in writing about the location of your AEDs.

Maintenance and upkeep. This part of the program involves the tracking and logging of AED maintenance checks, along with the tracking of responder certifications and monitoring of any regulatory changes that the laws may dictate.

Establishing program awareness and registration. You establish program awareness simply by notifying all possible employees of your AED program and that your facility does indeed have AEDs. Some cities have local ordinances that require a registration process of some type, which may or may not involve a minimal fee.

Many AED providers have the capability of providing an AED management program that takes care of most, if not all, of the requirements discussed above. A nominal fee is required in most cases but can be well worth it, especially if completing the requirements in house is not feasible. Again, if you are working with a reputable sales rep, he or she will be able to point you in the right directions.

Choosing the Right AED

In regard to number 6 above, I wanted to talk about it last. I am surprised that, while you can indeed find out a lot about AEDs on the Internet, nowhere have I found a list of general questions that every buyer should ask when meeting with his AED representative. All AEDs provide some type of shock therapy, but the similarities stop there. The “all AEDs are the same” attitude needs to be thrown out the window, and AEDs must be looked at very closely. Fortunately, the most important differences are right in front of you.

All AEDs differ, from the color to the design, durability, level of support, and cost of ownership. Your sales rep should have quick, honest answers about these features. If he or she spends more time talking about the competition than his or her own products, kindly escort him or her out of your office.

One important question should be at the forefront of your mind: “Who is this program being built around?” The majority of AED programs need to be built around infrequent lay responders. This is important because the chances of the responder’s never having been involved in a Sudden Cardiac Arrest (SCA) emergency are very high. Even if you are so fortunate as to have EMTs, paramedics, or doctors on staff, most of those wonderful, lifesaving people still fall into the infrequent lay responder category when it comes to administering high-quality CPR and defibrilliation.

An SCA event is a scary, unforeseen, frightening, shocking (no pun intended), adrenaline-rushed event. What a person learns through the videos in training is not exactly what happens during a live event: “Leisure Suit Larry” is not going to be lying all nice and pretty on his back, smiling without a bead of sweat on his forehead, with his shirt unbuttoned for you. Maximum support is needed and should be provided by the AED you are using. The less the responder has to quickly recall from training, the better.

Be cautious. Most AEDs provide heart rhythm analysis and shock therapy. Your AED needs to say more than “ATTACH ELECTRODE PADS” and “PRESS SHOCK BUTTON.” Some models do say a little more than that, such as “CALL 911,” but more support is still needed.

The Value of CPR Support

New technology has been out for a while, so do not settle on just any “shock box.” Make sure your AED provides some type of CPR support. Most AEDs do not, but finding one and paying a little extra for it is worth every penny. The chance of an infrequent lay responder performing adequate CPR in a live event is very low. Why? The answer is in the description of the person responding, the infrequent lay responder. This is one of the reasons the American Heart Association comes out with newer guidelines for CPR and AED administration every five to six years. These always stress the “push hard, push fast” principle by increasing the compression recommendation.

Why is having an AED with CPR support so important? Simple answer: Half the time an AED is used, no shock will be advised. However, every victim will need high-quality CPR to survive. In other words, there is about a 50 percent chance that when an AED is put on a victim, that AED will say something to the effect of, “NO SHOCK ADVISED” (or something similar). Thus, if your AED does not provide CPR support, that AED helps you only halfway through that frightening situation. Now, I do not know about you, hut if I need an AED to be used on me, I certainly don’t want it to help my Good Samaritan only halfway.

 Questions to Aid Your Research

I will begin to wrap up this article with a simple list of questions that you can use when researching AEDs. As I said earlier, your sales rep should have quick answers to the following questions:

1. How much is the initial cost of the AED and related accessories?        

2. What is the true cost of ownership of the AED? (That is, how much do replacement pads and batteries cost, and how often do I need to replace them?)

3. Can my AED be upgraded when newer CPR/AED guidelines are implemented? (Trust me, this will happen, and some AED manufacturers took nearly a year and a half to provide upgrade capabilities to their customers.)

4. Can my AED be upgraded on site, or do I have to send it in? What will be the approximate cost to upgrade?

5. What type of batteries does the AED use? (Are they available over the counter, or must they be purchased from the manufacturer?)

6. What type of pads does the AED use— a one-piece pad or two-piece pad?

7. How durable is the AED? What is the IP (ingress protection) rating  of the device? (All AEDs get rated for protection again environmental elements, including water and dust. Some AEDs are classified as light-duty, indoor-use AEDs.)

8. How well does the AED replicate and remind me of what I learned in training?

9. Does the AED provide just audio prompts, or does it also provide clear, visual prompts as well? (Hint: An SCA event is not exactly a quiet situation.)

10. What type of support will the AED provide if no shock is advised?

11. What type of CPR support does the AED provide—none, minimal CPR prompting, or real-time CPR coaching/feedback?

These questions address critical factors that will help you decide which AED is right for you; also, don’t hesitate to perform some background research on the AED manufacturer. The right AED can and, in most cases, will make the difference between a successful rescue and an event full of confusion.

While this information all at once can seem overwhelming, it is imperative to understand the many steps that go into an AED program. A good sales rep will coach you through the different steps so that you feel comfortable and confident that your program is complete and compliant. Enjoy your AED program implementation. It is without a doubt a lifesaving program.

 

Chip Georges is National Sales Manager of St. Louis, Mo. based Marelly Products, a national provider of AED programs. He speaks at all types of safety conferences and conducts monthly webinars about AED programs, as well as being directly involved with client program implementation. He can be reached directly at 888-609-6599, ext. 3, or chipgeorges@marelly.com.

Real CPR Help®

ZOLL’s AED Plus® features Real CPR Help®, a tool that is able to actually see what you are doing and provide feedback to help you do it well. Audio and visual prompts help you rescue with confidence and clarity unmatched by any other automated external defibrillator (AED).

Not pushing hard enough? It will tell you when to push harder.
Pushing hard enough? It will say, “Good compressions.”
Not pushing fast enough? A metronome will lead you to the right rate.
It will even show you the depth of each compression. In real time.
Not yet started? The AED Plus will tell you again to get started.
Compressions stopped? It will tell you to continue.
ZOLL believes an AED should not just deliver a shock. It should also help the rescuer provide high-quality cardiopulmonary resuscitation (CPR). That’s why you need ZOLL’s AED Plus with Real CPR Help.

The AED Plus offers:
Support for the complete Chain of Survival.
Real CPR Help for rate and depth of compressions.
Help to all victims of SCA, even those for which no shock is advised.
A one-piece pad for fast accurate placement of electrodes.
Consumer lithium camera batteries available from retail stores.

Chain of Survival

In cardiovascular emergencies, every second counts.  As emergency responders race to save the life of a cardiac arrest victim, a stroke victim, or someone suffering a heart attack, every moment that passes places that victim at greater risk of permanent disability or death.  Cardiac emergencies often have the highest fatality rates of all emergency events simply because they demand some of the fastest response times.

The Chain of Survival specifies a series of critical steps that can help save lives during cardiovascular emergencies.  The links in the Chain include:

Immediately Call 9-1-1: Recognize the signs of a heart attack, cardiac arrest   or stroke and call 9-1-1.

Perform CPR: If the patient is unconscious and has suffered a cardiac arrest, cardiopulmonary resuscitation (CPR) keeps oxygen rich blood flowing to the brain and heart while waiting for a defibrillator to arrive.

Use an AED: An Automated External Defibrillator (AED) delivers an electrical shock to restore the heart’s normal rhythm in cardiac arrest victims.

Early Advanced Care: An advanced life support ambulance with licensed paramedics should arrive within the time set by local EMS responders.

Courtesy of the American Heart Association.

Sudden Cardiac Arrest

Sudden cardiac arrest (SCA) is a leading cause of death among adults over the age of 40 in the United States and other countries. In the United States alone, approximately 250,000 people die every year from SCA, according to the Centers for Disease Control and Prevention. In fact, more people die each year from SCA than the number who die from colorectal cancer, breast cancer, prostate cancer, auto accidents, AIDS, firearms, and house fires combined.

SCA also affects many young people. Approximately 10 percent of SCA events occur among people less than 40 years of age.

SCA is a life threatening condition that can be treated successfully through early intervention with cardiopulmonary resuscitation (CPR), defibrillation, advanced cardiac life support and hypothermia.
What is SCA?
Sudden cardiac arrest, or SCA, is the sudden unexpected loss of heart function, breathing and consciousness. SCA usually results from an abnormal heart rhythm, often as a result of underlying heart conditions. Unfortunately, many people do not realize they have underlying heart conditions-- until SCA occurs. In fact, about two-thirds of unexpected cardiac deaths occur without prior indication of heart disease.

SCA is not the same as a heart attack, which occurs when blood vessels in the heart get clogged, preventing blood flow to sections of heart muscle. A heart attack, however, can lead to SCA by triggering an abnormal heart rhythm. SCA may be compared to an electrical problem in the heart, in contrast to a heart attack, which is more of a plumbing problem.

Without immediate treatment, SCA is fatal. Effective treatment generally involves cardiopulmonary resuscitation (CPR), use of a defibrillator to shock the heart back to a normal rhythm, and advanced life support including drug therapy and, increasingly, therapeutic hypothermia. The quicker treatment is delivered and circulation is restored, the greater the chances for survival.

Signs and Symptoms
Typically, SCA occurs without warning. Signs of SCA include:
Sudden collapse
Loss of consciousness
Cessation of normal breathing
Loss of pulse and blood pressure.
 
Symptoms of a heart attack, in contrast, include:
Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest, lasting more than a few minutes
Pain spreading to the shoulders, neck, or arms
Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath
Atypical chest pain, stomach, or abdominal pain
Nausea or dizziness
Shortness of breath and difficulty breathing
Unexplained anxiety, weakness, or fatigue
Palpitations, cold sweat, or paleness.

Facts and Figures about SCA
>The precise incidence of SCA is unknown because available epidemiological databases do not record deaths due to sudden cardiac arrests. Therefore estimates are based on surrogate data. Efforts are underway to establish a better way to capture accurate data.
>Each year in the U.S., 400,000 to 460,000 people die of unexpected sudden cardiac death in an emergency department or before reaching a hospital. (Circulation 2001;104:2158-63)
>The age-adjusted sudden cardiac death rate is higher among men than women. (MMWR Feb 15, 2002 51(06):123-6).
>Blacks have the highest age-adjusted rate of sudden cardiac death, followed by whites. (MMWR Feb 15, 2002 51(06):123-6).
>States with a high proportion of sudden cardiac deaths, in descending order, include: Wisconsin, Idaho, Utah, Colorado, Oregon, Connecticut, Rhode Island, South Dakota, Montana and Vermont. Hawaii has the lowest age-adjusted sudden cardiac death rate; Mississippi has the highest. (MMWR Feb 15, 2002 51(06):123-6).
>About two-thirds of unexpected cardiac deaths occur without prior indication of heart disease. (J Am Coll Cardiol 2004;44:1268-3008-13)
>About 60 percent of unexpected cardiac deaths are treated by emergency medical services (EMS). (JAMA 2002;288:3008-13)
EMS treats about 100,000 to 250,000 cardiac arrests in the U.S. annually. (JAMA 2002;288:3008-13; Ann Emerg Med 1999;34:517-25)
>Of the cardiac arrests treated by EMS, 20 to 38 percent are found in ventricular fibrillation (VF) or ventricular tachycardia (VT) (21,000 to 91,000 cases), rhythms that can be treated with defibrillators. (Ann Emerg Med 1999;34:517-25)
>The incidence of VF is decreasing over time. (Ann Emerg Med 1999;34:517-25, Resuscitation 2004:63(1):17-24; Resuscitation 2005;67(1):51-4)
>Fifty-seven percent of adults in the U.S. say they have undergone training in cardiopulmonary resuscitation (CPR), most often due to work or school requirements. Most say they would be willing to use CPR to help a stranger. Most say they would be willing to use an automated external defibrillator (AED). Eleven percent say they have used CPR in an actual emergency. (Resuscitation 2000)
>The incidence of lay responder defibrillation was 2.05 percent in 2002. (American Heart Association)
>The incidence of SCA in children is unknown. Estimates vary widely. Research among high school athletes suggests the incidence ranges from 0.28 to 1.0 death per 100,000 high school athletes nationwide (J Am Coll Cardiol 1998:32:1881-4).
>The average survival SCA survival rate is 6-7%. (Prehosp Emerg Care 1997; 1(1):45-57.)

Courtesy of Sudden Cardiac Arrest Foundation.

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