More people can survive SCA if bystanders act quickly to start the Chain of Survival. The Chain of Survival consists of the actions needed to treat a life-threatening emergency. The adult Chain of Survival has 4 vital links:

1. Early Access—Recognizing that an emergency exists and quickly phoning EMS (emergency medical services). In most communities, 911 is the EMS number.

2. Early CPR—Starting CPR immediately after cardiac arrest. CPR circulates gen-rich blood to the brain and heart. It buys time for the victim until defibrillation can be performed.

3. Early Defibrillation—Defibrillating the victim as soon as the AED arrives. This is most effective within three to five minutes.

4. Early Advanced Care—Trained healthcare providers arriving quickly to give advanced care.

Several AEDs on the market are suitable for workplace and community AED programs. The American Heart Association does not recommend one device over another. Selection of an AED will be influenced by the needs of the program site.

You can find a current list of FDA cleared AEDs at www.americanheart.org/cpr.  Click on Corporate Training, AED programs, FDA Cleared AEDs.

Effective AED programs are designed to deliver a shock to a victim within three to five minutes of collapse. When deciding where to place AEDs, use a three-minute response time as a guideline to help you determine how many AEDs you need and where to place them.

Companies should determine if there are places on-site where the incidence of sudden cardiac arrest may be higher, such as corporate health clubs, or that are hard to reach quickly. Also consider areas where many people gather, such as cafeterias.

Should the AED be secured or unsecured?

A secured AED is one that is locked in an office, a wall-mounted cabinet, or other enclosed space. An unsecured device typically is placed in a public area and is not locked.

Will the AED have a notification system?

Automatic Notification System: This type of system automatically notifies trained responders when the AED is removed or its cabinet is opened. This notification may be sent directly to local EMS or to an in-house security system that will then notify EMS.

Audiovisual Alarm: This type of alarm activates lights or an audio alarm when the AED is removed or its cabinet is opened.

Conduct scheduled and preventive maintenance checks according to the manufacturer’s recommendations. The program coordinator or another designated person can do the maintenance checks. This person develops a written checklist to assess the readiness of AEDs and their supplies. This checklist supplements regularly scheduled, more detailed maintenance checks recommended by the manufacturer. At a minimum, the checklist should include the following:

• Verify placement of AEDs (are they where they are supposed to be?);

• Verify battery installation and expiration;

• Check the status/service indicator light;

• Inspect exterior components and sockets for cracks or other damage;

• Check supplies (razor, towel, barrier device, scissors, extra battery, disposable gloves, and an extra set of electrode pads).

After a cardiac arrest occurs, it is critical to get the AED back into service as soon as possible. The written procedure for maintaining the AED should contain a section on this process. Here is a list of activities that should be included:

• Check and replenish supplies as appropriate (includes electrode pads, towel, razor, barrier device, and disposable gloves). Make sure that someone is designated to order and replenish supplies and does so;

• Clean and disinfect the device;

• Check the battery and replace it if needed;

• Check the device and housing for cracks or other damage;

• Return the AED to its designated place with appropriate supplies.

The American Heart Association recommends that as many trained responders as possible have access to defibrillators.

When identifying responders, consider people who typically are on the premises and already respond to emergencies as part of their jobs. Security guards and members of safety response teams are excellent candidates for becoming trained responders.

Once you identify appropriate responders, make sure to obtain approval from their department heads. If these department heads are not already identified as decision makers, begin including them in program updates. This is important. Also make sure that there are appropriate budget allocations for proper training.

To determine how to train your responders, review your state and local requirements for AED programs. These requirements will outline acceptable curriculums, training organizations, and renewal intervals. From there you can plot your training program schedule. Initial training should teach responders:

• How to recognize the warning signs of a heart attack;

• How to respond to an emergency;

• Why and how to activate local EMS;

• How to buy time for the victim by performing one-rescuer CPR until the AED arrives;

• How to assess the patient and determine if you should use an AED;

• How to attach AED pads and ensure that the device is used properly;

• How to follow safety protocols to protect the user and bystanders;

• How to deal with unusual situations (such as a victim with an implanted defibrillator or a victim lying in water);

• How to use all emergency response skills in an emergency.

Responders also need to be trained in the internal Medical Emergency Response Plan (MERP). Typically the oversight physician or medical professional creates the MERP. The MERP should include how responders will be notified of an emergency and the location of the victim, who will call 911, and where the AED is located.

The responders also must be informed of the policy and procedure for transferring patient care to local EMS upon their arrival. Conducting skills reviews is critical to ensure that responders are prepared to perform the necessary skills during an emergency. Examples of how to review skills include performing mock drills, scenario practice, and demonstrations of CPR and AED skills.

The goal is to have trained responders practice activating the emergency response system, getting an AED to the victim within three to five minutes of collapse, and using their CPR and AED training. FSM