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The ABCs of AEDs

Installing AEDs in your facility - and providing training for your staff - is no longer a matter of choice. Learn about emerging regulations and requirements, how and where to install AEDs, and what it feels like to save a life.

"The member had already had the heart attack as I was entering the building. As I approached the scene, Susan was there, and two nurses were doing CPR. I brought the AED down to the fitness floor, and Susan and I applied the pads. The AED monitored him and called for two shocks. The second shock saved his life." -Nancy Arnold, personal trainer at Liberty Athletic Club, Ann Arbor, Mich.

Arnold was in the right place at the right time to save a member's life, and she had the right training and the right device: An automated external defibrillator (AED). An AED is a device that analyzes the heart's electrical rhythm and, if necessary, prompts the user to deliver a shock to a person experiencing sudden cardiac arrest. The average cost of an AED is around $2,000, but they're worth much more in terms of risk management, member safety and compliance with the law. "The AED is a really positive thing to have in the club from two perspectives: 1) For the simple fact that if something were to occur, the member's chances of survival are drastically improved by having an AED in the club, and 2) The members feel much more assured that they are in good hands, which is always a positive thing, as well," says Alexander Obe, owner and operator of P.T.S. Health and Fitness, Princeton, N.J.

Know your state laws

Many owners and managers of fitness facilities have entertained fears of being sued for incorrectly or ineffectively using an AED. It was seen as safer, liability-wise, to avoid having an AED at all. But the tide has turned. State lawmakers have taken steps to require many fitness facilities to have AEDs, and people are finding new reasons to sue. "We have noticed, over the past few years, that legal action is being taken against organizations that do not have the devices available - or have them available, but not accessible," says Don Lauritzen, Health and Safety Expert, American Red Cross, Washington, D.C.

Fitness centers are more protected than ever when taking life-saving measures. "From what we have observed, regulations are leaning toward making it easier for the lay rescuer to use an AED with protections under Good Samaritan laws," says Lauritzen. "It seems that the use of AED devices is becoming more common, and legislation is being written and passed that strongly recommends or requires the placement of AED devices in fitness facilities, schools and other public places."

Legislation is, for the most part, left up to individual states. California, Illinois, Massachusetts, Michigan, New Jersey, Rhode Island, New York, Louisiana, Oregon, Arkansas, Indiana and Washington, D.C., have all recently passed legislation requiring fitness facilities to have at least one AED. P.T.S. Health and Fitness installed its AED in February 2007 because of new state laws. "Legislature recently passed that all health clubs in New Jersey have an AED installed, and at least one person on duty at all times who is AED-certified," Obe says.

Some states also require fitness facilities to register their AEDs, or notify a local emergency authority that they have one, to aid the state in creating a registry of the location of all defibrillators.

The Chain of Survival

When you or other witnesses recognize the warning signs of a heart attack, cardiac arrest, stroke or choking, the key to survival is timely initiation of the Chain of Survival. Anyone who is unresponsive should receive emergency care. Heart attack, cardiac arrest, stroke and choking can each cause unresponsiveness.

Link 1: Call 9-1-1 (or the EMS system in your area)

As soon as an emergency is recognized, call 9-1-1. When you or another rescuer calls 9-1-1, let the dispatcher ask you questions. Answer in short, specific replies, giving only the requested information. If you are alone, you must immediately begin performing CPR, the next link in the chain.

Link 2: Begin cardiopulmonary resuscitation (CPR).

CPR is the critical link that buys time between the first link (call 9-1-1) and the third link (use the AED). The earlier you give CPR to a person in cardiac or respiratory arrest, the greater his or her chances of survival. CPR keeps oxygenated blood flowing to the brain and heart until defibrillation or other advanced care can restore normal heart action. In many areas of the country, emergency dispatchers are taught how to help callers give emergency care. With help from the dispatcher, callers can give CPR (and use an AED).

Link 3: Use the AED

Many sudden cardiac arrest victims are in ventricular fibrillation (VF). VF is an abnormal, chaotic heart rhythm that prevents the heart from pumping blood. You must defibrillate a victim immediately to stop VF and allow a normal heart rhythm to resume. The sooner you provide defibrillation with the AED, the better the victim's chances of survival.

Taken from the American Heart Association.

Using an AED

According to Don Lauritzen, Health and Safety Expert, American Red Cross, Washington, D.C., when you identify a cardiac emergency at your facility, you should first activate your facility's emergency action plan. Check the scene for safety and the victim for life-threatening conditions, and have someone call 9-1-1 or the local emergency number. Then, send someone for the AED while you care for the victim. If the victim is in cardiac arrest, start CPR and continue until the AED arrives and is ready to use.

Most AEDs can be operated by following these simple steps:

  • Turn on the AED.
  • Wipe the person's chest dry.
  • Apply pads to bare chest.
  • Plug in the pads connector, if necessary.
  • Make sure no one, including you, is touching the person. Tell everyone to "stand clear."
  • Push the "analyze" button, if necessary. Let the AED analyze heart rhythm.
If the AED advises you to shock the person:
  • Make sure no one, including you, is touching the person. Tell everyone to "stand clear."
  • Push the "shock" button, if necessary.
After shock is delivered and there are no signs of life:
  • Give five cycles or about two minutes of CPR (30 chest compressions, two breaths per cycle).
  • Let the AED reanalyze.
  • If the AED says, "no shock advised," give five cycles (about two minutes) of CPR.
  • Follow AED prompts.

Are You Exempt?

As of 2001, all 50 states had enacted defibrillator laws or adopted regulations. However, under the new AED laws enacted by individual states, not all fitness facilities are created equal.

Many state laws now require health clubs to have at least one AED, but the National Conference of State Legislatures notes that the definition of "health club" in this context "does not include a hotel or motel that provides physical fitness equipment or activities, an organization solely offering training or facilities for an individual sport, or a weight reduction center." Check your state's definition of "health club" to see where your facility falls.

Make AEDs accessible

For many fitness facilities, purchasing an AED is no longer an option; it's a requirement. Now they must decide how many AEDs to purchase, and where to put them. "To determine the appropriate number of AED units needed, and the proper placement of each unit, facilities should conduct a site survey of their location(s)," says Lauritzen. "Restricted access and high-risk areas may warrant additional devices. Work with local EMS personnel to discuss site survey and EMS response times."

AEDs must be easily accessible for use during an emergency. "It is recommended that AED devices be placed where they may be retrieved (roundtrip from anywhere in the facility) and applied to the victim within three or four minutes," says Lauritzen. "Devices should be accessible to responders, and not locked up in a cabinet in the manager's office."

Training and education

"During the event I was very calm. Of course, I could feel my adrenaline pumping; however, my training allowed me to remain calm and steady during the crisis. I didn't think about anything - I just reacted."

"Training and frequent practice are key factors to a successful AED program," says Lauritzen. Superior Athletic Club, Medford, Ore., installed its first AED seven years ago, and "all staff is certified to use [the AED]," says Jim Kusnerik, CEO and owner. "I [also] have a ... certified instructor on staff." There are a few options for finding the right educational opportunities for your staff, but it's important to remember that cardiopulmonary resuscitation (CPR) is still a requirement. "CPR is performed in conjunction with the use of an AED," Lauritzen explains.

One option for training is through the Red Cross. "American Red Cross AED training is available as an add-on to adult CPR and child CPR courses," says Lauritzen. "The training combines lecture, interactive video demonstrations and hands-on practice to teach participants lifesaving skills." Additionally, many companies that sell AEDs offer training. P.T.S. Health and Fitness required all staff members to become certified, and "certification was provided by the company we purchased the AED unit from," says Obe. Thankfully, he adds, the facility has not yet used its AED for any purposes other than testing and training.

Accredited certifying bodies are also recognizing the value of AED training. One example is the International Sports Sciences Association, Carpinteria, Calif., which now requires that all U.S. students who enroll in a certification course submit a copy of their AED certification, in addition to Adult Basic CPR.

Emergency reaction

Before using an AED, the user must first identify the signs of someone who needs the assistance of the device. "A person in cardiac arrest will be unconscious and show no signs of life (breathing or movement)," says Lauritzen. "Any heart attack might lead to cardiac arrest."

Signs of a heart attack include the following:

  • Persistent chest pain or pressure that lasts longer than three to five minutes, or goes away and comes back
  • Chest pain spreading to the shoulders, neck, jaw or arms
  • Shortness of breath or difficulty breathing
  • Nausea, vomiting or dizziness
  • Pale, ashen (grayish) or bluish skin
  • Sweating
  • Complaints of heartburn or indigestion
  • Stomach pain
  • Denial that anything serious is wrong.
When you or your staff recognize some or all of these symptoms, call 9-1-1 or the local emergency number immediately, and then proceed through the Chain of Survival (see The Chain of Survival).

Additional preparations

Purchasing an AED is the first step. There are others you should take to best prepare your staff for emergencies:

Build a team. Identify an AED program coordinator and response team.

Prepare. Develop an Emergency Action Plan for all of your locations.

Spread the news. Make sure your members are aware of your facility's AED program - it is an added benefit, and shows that your fitness center is dedicated to their well-being.

Reach out. Contact your local American Red Cross Chapter (www.redcross.org). They can help facilitate training opportunities.

Research. Determine how having an AED affects your insurance. "Check with your risk-management department and insurance agency, as the answer can differ greatly depending on what type of policy is in effect," Lauritzen advises.

Test it. Maintain and test your AED to manufacturers' standards.

Post-event staff care

"I did deal with post-traumatic stress after the event. I couldn't stop shaking, and was quite emotional. I couldn't believe that I had just experienced saving someone's life. It was overwhelming."

At Superior Athletic Club, "Three staff members have [used AEDs], all with positive, life saving-results," says Kusnerik. No matter what the outcome, however, when the sirens fade and the facility slowly gets back to normal, pay attention to the staff who participated in handling the emergency. They may be feeling many different and confusing emotions, and may even develop post-traumatic stress symptoms. Give them time to recover, and arrange for access to help, if necessary.

Peace of mind

"The member is doing quite well today. He returned to exercise as soon as his doctors would allow."

Having an AED accessible and prominently located in your facility gives members peace of mind, particularly those with heart conditions. "Our trauma bags are visible," says Kusnerik. "Doctors, nurses, etc., were happy to see that we had them." At P.T.S. Health and Fitness, "member feedback has been extremely positive," says Obe. "I believe they feel reassured in the fact that if something were to happen, there's a greater chance for them to survive the incident than if [the AED] were not here."

Preparing for an emergency of any kind is the best way to help prevent harm. With any luck, you'll never have to use the AED in your fitness center. But, maybe someday, like Nancy Arnold, you or someone on your staff may learn what it feels like to save a life.

References
National Conference of State Legislatures: The forum for America's ideas. State laws on heart attacks, cardiac arrest and defibrillators: Encouraging or requiring community access and use. www.ncsl.org/programs/health/aed.htm, updated June 2007, accessed July 17, 2007.
American Heart Association. The links in the chain of survival. www.americanheart.org/ presenter.jhtml?identifier=3012016, accessed July 17, 2007.
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