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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.

by Robert S. Ambrose

Heart disease has been America’'s #1 health problem since the turn of the century. Sudden cardiac arrest strikes 350,000 each year, that is, 1,000 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 affect 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.

Effective resuscitation of any victim of SCA is most likely to occur 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:

(1) early recognition and prevention of the symptoms of a heart attack,
(2) prompt activation of the emergency medical services (EMS) system,
(3) bystander cardiopulmonary resuscitation (CPR),
(4) quick defibrillation at the scene, and
(5) 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 workplaces. We want to emphasize the need for the development of an organized system of response. When all of 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 in the early stages of a heart attack will reduce the need to take further action.

Of all patients presenting with 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 a crashing heart attack and cardiac arrest. The emphasis needs to be on employee awareness programs focusing on the beginnings of a 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--greatly increases salvage rates in the 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 Early Access 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 9-1-1. For every minute a rescuer delays, the patient loses 10 percent of his 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 at the time clock. Reminders also can be added to each employee’'s desk top, repetitively reminding every 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 in 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 what is called 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 is the tool used for this purpose, and it is very easy to use. The key factor is time. When the user applies an 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’'s and intravenous medications also are 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 relations 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.

Robert S. Ambrose is a paramedic and President of the Citizen Safety Institute ( ,, Manhattan Beach, Calif. He was assisted in the preparation of this article by Samuel J. Stratton, M.D., Medical Director for Los Angeles County Emergency Medical Services; Marylin Harz, BSN, Ph.D., Director of Education; and cardiologist James Wolfe, M.D.