Automated external defibrillators (AEDs) are an important lifesaving technology and may have a role to play in treating workplace cardiac arrest. Most sudden cardiac deaths occur outside of the hospital, and many patients visiting doctors’ practices are already at risk for cardiovascular events, many going there because they are already feeling unwell as a precursor to a cardiac arrest.
It is estimated that 5% or less of victims of sudden cardiac deaths are successfully resuscitated and discharged alive from the hospital.
In a study on public access defibrillation (PAD), communities with volunteers trained in CPR and the use of AEDs had twice as many victims survive compared to communities with volunteers trained only in CPR.
There are potential risks that come with the improper use of these devices. It is therefore essential to do thorough research before purchasing a specific product.
Why install an AED in my practice?
The primary purpose of an AED is to assist in the detection of heart arrhythmias. When an arrhythmia is identified with the use of an AED, a shock can be delivered to the heart to help normalise the function and rhythm of the patient’s heart.
In addition to being a tool used in the treatment of heart arrhythmia, another critical purpose that an AED device serves is to help restore a heartbeat in cases where a patient had suffered a sudden cardiac arrest (SCA), where patients may be saved if a shock is delivered inside a three minute window.
A 2021 study of out-of-hospital cardiac arrests in Cape Town found a rate of 23.2 per 100 000 population – likely an underestimate. Less than one in 10 cases had resuscitation attempts, and the average time for arrival of emergency services was 26 minutes. Thus, placing automated external defibrillators (AEDs) in the workplace can mean the difference between life and death.
AED use within the first three minutes after a patient experiences a cardiac arrest has an efficacy rate of about 80%. Performing CPR together with an AED is proven to be a significant improvement of efficacy rate compared to the CPR method alone. Therefore, it is necessary to install AEDs in the workplace, which will likely be granted the highest level of protection and make employees rest assured.
When does an AED shock?
The most common abnormal rhythm that causes cardiac arrest is ventricular fibrillation (VF). Electric shock can prevent ventricular fibrillation and restore the heart to its natural rhythm. An AED is applied to the casualty using two chest pads. The machine delivers electrical shocks to the heart muscle through the chest pad, which double as sensors to detect electrical activity. If the machine senses electrical activity with a heartbeat, it will not give an electric shock. Therefore, AEDs are very safe because they do not produce shock unless required. Products such as the AED7000 also feature locks preventing unintentional defibrillation.
Is it safe to use an AED?
Many associate AEDs with their specialised in-hospital equivalents, which require specialist training for safe use. Use of an AED device is usually considered exceptionally safe: the mechanism underlying the procedure is designed to ensure the patient will not be harmed when the device is use appropriately. Many newer models, such as the AED7000 series or the i-PAD NF1200, come with a smart system, which guides the rescuers through the procedure, ensuring the safety of both the patient and the person conducting the defibrillation.
Is it legal to use an AED on a patient?
There have been some concerns about the use of an AED device on patients of cardiac arrest. The concerns are primarily related to the fear of being sued by the patient when these devices are used. While South Africa lacks a Good Samaritan law to protect bystanders when assisting a patient, there is also no legal obligation for a member of the public to assist. However, doctors are legally required to render assistance in an emergency if they are able to do so.
Generally speaking, an AED is considered a safe device. Nevertheless, there are cases where the use of these devices could be considered inappropriate, for example, when the patient’s heart stops due to problems other than ventricular fibrillation, and thus cannot be saved by defibrillation. In these cases, there may be certain legalities involved when someone does decide to use an AED on such a patient.
The good news is that most AEDs will tell you whether or when it is appropriate to give a shock when you apply the pads on the patient’s chest. However, it’s always best to provide non-medically trained staff with AED knowledge and CPR training.
