Out-of-hospital cardiac arrest (OHCA) remains a significant medical emergency in Australia, with over 26,000 cases reported annually. Despite advancements in emergency response, survival rates remain critically low at approximately 5%, with fewer than 2% of patients receiving public access defibrillation (PAD).[1] Evidence shows that timely defibrillation via AEDs (Automated External Defibrillators) significantly improves survival outcomes, particularly for those receiving PAD, who demonstrate the highest survival rates among all OHCA cases. [2]
Given this, the strategic placement and accessibility of AEDs within workplaces, alongside staff training in CPR (Cardiopulmonary Resuscitation), are not only medical imperatives but also integral to meeting Workplace Health and Safety (WHS) obligations. However, the availability of PAD can decrease by as much as 50% outside of business hours,[3] highlighting the need for workplace preparedness and continuous compliance with relevant Australian standards and guidelines. This article provides a technical overview of workplace CPR and AED protocols, focusing on medical best practices, regulatory requirements, and key implementation considerations.
Medical Basis for AED Deployment in the Workplace
Cardiac arrest is a medical emergency that occurs when the heart stops beating effectively, leading to an absence of blood flow to the brain and other vital organs. As seen above, the out-of-hospital cardiac arrest survival rates are low, but the timely application of CPR and defibrillation can significantly improve survival chances.
AEDs: A Clinical Overview
An AED is a medical device designed to diagnose life-threatening cardiac arrhythmias, specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). These conditions can result in sudden cardiac arrest (SCA), and defibrillation when delivered within minutes, can restore normal heart rhythm.
In workplace settings, the presence of an AED ensures that the most effective intervention is available to stabilise an individual in the event of SCA. Australian medical guidelines, including the Australian Resuscitation Council (ARC) Guidelines, recommend that workplaces be equipped with AEDs in environments where there is a higher risk of sudden cardiac events.
Compliance with Australian Medical and Safety Standards
Workplace health and safety regulations in Australia, primarily governed by the Work Health and Safety Act 2011 (WHS Act), outline specific obligations for employers regarding workplace injuries and medical emergencies. These obligations include ensuring that workers have access to appropriate emergency medical equipment, including AEDs, in accordance with medical best practices.
Risk Assessment and AED Necessity
Employers must conduct a Workplace Risk Assessment to determine whether an AED is required on-site. This assessment should consider:
- The nature of the work environment, particularly in high-risk areas such as manufacturing, construction, mining, and healthcare facilities.
- The number of employees and the proximity to external medical services (e.g., emergency medical services or ambulances).
The number of employees and the proximity to external medical services (e.g., emergency medical services or ambulances).
Training and Certification for AED Use in the Workplace
In workplaces where AEDs are present, at least one trained individual should be certified in CPR and AED use.
Training should be refreshed at least every 12 months to ensure staff competency. The curriculum should include high-quality chest compressions, correct use of an AED, and post-resuscitation care.
First Aid and CPR Training:
In workplaces where AEDs are present, at least one trained individual should be certified in CPR and AED use.
Training should be refreshed at least every 12 months to ensure staff competency. The curriculum should include high-quality chest compressions, correct use of an AED, and post-resuscitation care.
Medical Protocol for AED Use:
In the event of a cardiac arrest, employees should follow established medical protocols:
- Assessment and Diagnosis: The first responder must assess the individual for signs of cardiac arrest (absence of pulse, unresponsiveness, and abnormal breathing).
- Activate Emergency Services: Call 000 and request an ambulance, providing the exact location and the nature of the emergency.
- AED Application: Once an AED is available, the device will provide voice prompts to guide the user through the process. The pads should be placed on the chest as indicated by the AED, ensuring proper contact for shock delivery.
- Defibrillation: If the AED recommends a shock, the device will deliver it automatically. It is critical that no one is in contact with the patient during shock delivery to avoid injury.
- Resumption of CPR: Aftershock delivery (if advised), CPR should immediately resume. This includes chest compressions at a depth of 5–6 cm and at a rate of 100–120 compressions per minute.
Record-Keeping and Documentation:
It is essential for employers to keep accurate records of:
- AED maintenance (battery changes, pad replacements)
- Training certifications for all staff involved in first aid
- Risk assessments for AED placement and readiness
- AED usage logs (detailing any events where the device was deployed)
These records should be reviewed regularly to ensure ongoing compliance with WHS regulations and medical standards.
Maintenance of AED Equipment: Medical Standards for Operational Readiness
To ensure that AEDs function properly in an emergency, regular maintenance and inspection are required. Non-functional or expired equipment can lead to critical failures in emergency situations, endangering lives.
Key Maintenance Tasks:
- Battery Replacement: AED batteries have a lifespan of 2–5 years, depending on the model. It is essential that batteries are replaced according to the manufacturer’s guidelines to ensure full functionality during use.
- Pad Expiry: Defibrillation pads must be replaced after use or once they reach their expiration date. Pads should be stored at the correct temperature to maintain their effectiveness.
- Monthly Inspections: Regular monthly checks should be carried out to ensure the AED is fully operational. This includes checking the readiness indicators, inspecting the pads for damage, and verifying that all components are in place.
Medical Device Compliance:
AEDs must meet Australian Medical Device Regulations under the Therapeutic Goods Administration (TGA), ensuring they are fit for clinical use. Employers should verify that their AEDs are certified and comply with ISO 13485 (quality management systems for medical devices).
Enhancing Workplace Survival Rates Through Compliance and Readiness
Workplace readiness for cardiac emergencies is crucial in improving outcomes for employees who suffer sudden cardiac arrest. By ensuring compliance with both medical protocols and Work Health and Safety regulations, workplaces can improve survival rates and meet their legal and ethical obligations to employees.
Employers must invest in the appropriate training, ensure the availability of AEDs, and adhere to strict maintenance schedules to maintain the safety and health of all personnel. By integrating medical best practices with WHS standards, Australian workplaces can significantly mitigate the risks associated with cardiac events, ensuring a safer and more compliant working environment.
References
- Bray J, Howell S, Ball S, et al. The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC). Resuscitation 2022;172:74–83.
- Nehme Z, Andrew E, Bernard S, Haskins B, Smith K. Trends in survival from out-of-hospital cardiac arrests defibrillated by paramedics, first responders and bystanders. Resuscitation 2019;143:85–91
- Ball S, Morgan A, Simmonds S, Bray J, Bailey P, Finn J. Strategic placement of automated external defibrillators (AEDs) for cardiac arrests in public locations and private residences. Resusc Plus 2022;10
Disclaimer
The information provided in this article is for general informational purposes only and does not constitute medical, legal, or regulatory advice. While every effort has been made to ensure accuracy, workplaces should consult relevant Australian medical guidelines, Work Health and Safety (WHS) legislation, and qualified professionals to ensure compliance with all applicable requirements. The authors and publishers do not accept any liability for actions taken based on the content of this document.