Defibrillation Program Implementation Checklist:
An end-of-day soda run turned three members of a Wisconsin electric utility line crew into heroes last December. The Richland Center Electric Utility crew had pulled into a local Mobil-Mart, where Line Foreman Dale Bender was waiting in line when he witnessed a man a couple of places in front of him slump to the floor, grabbing his chest. As bystanders rushed to aid the man, Bender ran to the bucket truck and grabbed the defibrillator it carried. He alerted his fellow crewmembers, Journeyman Chris Chitwood and third-year Apprentice Rod Klossowski, who responded with him.
Upon reaching the victim, Chitwood began CPR as Klossowski applied the defibrillator pads. Following patient analysis and Bender’s “All Clear!,” the device immediately advised a shock. After receiving a single shock, the victim began breathing and exhibited signs of a pulse. EMTs arrived almost simultaneously, and according to Bender, “They simply unplugged the leads from our machine and hooked it to theirs, which was the same model.”
The close proximity of an automated external defibrillator, available within moments following the sudden cardiac arrest (SCA) and followed by a rapid EMS response, helped save the victim’s life, proving once again that early defibrillation programs pay off for both utilities and communities.
Following the rescue, Dick Dosch, electric superintendent for Richland Center Electric Utility, released a statement saying, “Words are hard to find to describe how proud I am of these electric utility employees for their actions. I am also proud of the Richland Center Utility Commission for having the foresight to see that this equipment is needed not only by employees, but also in the community.”
Dosch credits Municipal Electric Utilities of Wisconsin (MEUW) President Richard Kirchoff, of Hutisford Utilities, for bringing attention to the need for defibrillators on utility trucks several years earlier.
Defibrillation programs protect both employees and community
For utility industry employees, quick access to defibrillation following SCA is a good idea already proving its worth with real-life results. In the two years since the inception of early defibrillation programs at both Cobb Energy and XCEL Energy, two lives have been saved, thanks to the availability of automated external defibrillators put in place by company teams who designed programs specifically tailored for their workforce and communities.
At Cobb Energy, one of the company’s 75 defibrillators was used to treat a member of the public who collapsed in March 2002. A Cobb Energy service crew driving by a local restaurant noticed police cars, and became concerned. Crew members Ken Bryant, Brian Mathison and Adam Moody turned into the parking lot and discovered a 70-year old man being given CPR. The crew offered their assistance and use of the defibrillator in the truck until an ambulance arrived. Cobb Energy, which has made a commitment to serve the communities in which employees live and work, recognized the three for their bravery in offering their assistance to a private citizen. The Cobb Energy line crew that stopped to see if they could assist embodied the commitment to community for which the industry is known.
At Xcel Energy’s Black Dog Plant in Minnesota, a 47-year old contractor is alive today because of the close proximity of a defibrillator and the quick response of co-workers. In April 2002, coworkers discovered Mike Rogers of Duluth, MN, collapsed on a second floor stairway landing. He wasn’t breathing. The plant’s control room immediately called 9-1-1 while three operator repairmen rushed to his aid with one of the plant’s defibrillators. After one shock, the victim regained a stable heart rhythm. The Burnsville Fire Department then arrived and transported the victim to a local hospital.
The three responders—Greg Fischer and Scott Helgeson, operator repairmen, and Gary Strom, lead operator repairman—each received Life Sustaining Awards from the company. Carl Sannes, plant director at Xcel's Black Dog facility, underscored the importance of having a defibrillator readily accessible by trained employees, saying, “We are very proud of how our entire operating shift responded to this emergency, and are all grateful that we had a defibrillator and trained plant personnel available.”
Utility industry starts on and stays on the leading edge
Today, safe, easy-to-use and technologically advanced defibrillators are increasingly being deployed throughout the industry, where it is well-known that accidental contact with high voltages can result in sudden cardiac arrest. SCA is most often caused by ventricular fibrillation (VF), a condition in which the heart’s electrical impulses suddenly become chaotic. The only effective treatment for SCA is rapid defibrillation. While CPR can buy a victim time by delivering oxygen to the brain, it cannot restore a normal heart rhythm. Automated defibrillators rapidly and automatically assess a victim’s heart rhythm and safely make the appropriate therapy decisions, using an electrocardiogram (ECG) analysis system. As a result, equipping and training employees such as linemen to use automated external defibrillators immediately following a cardiac event can measurably improve SCA survival rates.
Industry committed early to fighting SCA
The utility industry has demonstrated a longstanding commitment to protecting the lives of employees and community members from SCA. It has long been recognized that a shock of 50-100mA can result in VF, severe burns and muscular contractions1. As a result, utilities, along with airlines and casinos, were among the first industries to implement wide-scale early defibrillation programs to protect employees and the public. Long before that, utilities were among the first to invest in research and technology to treat for this deadly condition. Notably, the utility industry was a catalyst in the development of the first bulky, “portable” defibrillator, more than half a century ago.
In 1925, Consolidated Edison of New York consulted the Rockefeller Institute on how to improve survival from electrical accidents resulting in SCA. The Institute funded research at several universities including Johns Hopkins to study the effects of electric shock, in hopes of protecting employees. At that time, there was no remedy for VF. Investigator William Kouwenhoven, a professor of electric engineering at Johns Hopkins, noted that low-voltage shocks caused VF. In 1933, by administering a countershock of electricity, he and fellow researcher neurologist Orthello Langworth, MD, discovered they were able to restore a normal heart rhythm. Several years later, their discovery would result in the development of the first defibrillator--280-pound contraption mounted on a wheeled cart.2 In 1957, the device saved its first life--a 42-year old Hopkins patient who suffered VF in the operating room. Luckily for the patient, the admitting resident was familiar with the defibrillator locked in the 11th floor laboratory. He was able to persuade a security guard to give him access to the device in time to wheel the huge defibrillator down to the patient. According to Johns Hopkins, the patient lived another 18 years. Kouwenoven’'s research was later used to development a smaller 45-pound model that could operate on either small battery or AC current. The work was funded by Edison Electric specifically for use by utility line crews. Consolidated Edison's early investment had paid off.2, 3
The manufacturer of the devices selected by Cobb Energy, Xcel, and Richland Center has also been on the leading edge in the fight against SCA as it further developed defibrillation technology. The company has the distinction of introducing the first low-energy biphasic defibrillator in 1996. The defibrillation technology selected was designed to be virtually maintenance free and easy to use for all trained responders, with voice and text prompts to guide the user. The company's next generation model was the first defibrillator designed to effectively and safely treat pediatric patients. The most recent addition to a growing collection of “firsts” for the manufacturer is a groundbreaking new defibrillator, the first in a new generation designed for the home.
Program design creates effective response
Both Xcel Energy and Cobb Energy utilized implementation assistance from Amy Dixon, a clinical implementation specialist and EMT. Using recognized guidelines, research and industry practice, Dixon provided site assessment and program consultation to determine the most effective way to deploy defibrillators to protect employees.
“The department of Labor’s Occupational Safety and Health Administration (OSHA) recommends treatment within 3-4 minutes for lifethreatening events, such as severe bleeding, respiratory arrest, or cardiac arrest. Additionally, the American Heart Association recommends defibrillation response times from 3-5 minutes, depending on the environment,” explained Dixon.
She also emphasized that an emergency response plan that identifies how and when lay rescuers will respond to emergencies is essential to a successful early defibrillation plan.
“The plan should be defined in formal policies and procedures that include how defibrillator responders as well as local Emergency Medical Systems are to be notified in the event of an emergency,” she said. Dixon added that it should also include how the defibrillator response protocol is to be used by the response team members and the procedures to be followed after response to an emergency incident. In addition to covering normal business hours, the plan should include special procedures for alternate shifts, and times of reduced or increased occupancy.
Where should defibrillators be placed?
Manufacturers and experts such as the National Center for Early Defibrillation, a nonprofit advocacy organization, recommend that utilities perform a site survey to gather information to help identify where the defibrillators should be located in order to meet the response time goal. Placement should be based on one of two response models: localized or centralized.
In a localized response, such as that used by the Richland Center Electric Utility line trucks, defibrillator placement is made with time factored in for someone to witness to the victim's collapse, retrieve the defibrillator, return, and apply it to the victim within the response time. Companies using this model have often deployed defibrillators on line trucks to provide the close proximity of the defibrillator which is critical in the event that a poletop rescue may need to be performed. Many companies also express a commitment to their communities, and desire to be able to respond to SCA in the general population as needed.
In a centralized response model, the defibrillator is placed in a central location staffed by full-time responders. In this approach, the witness to the victim's collapse notifies the central location and proceeds to provide basic care until the device is brought to the victim's side.
In either case, defibrillators should be located so that the walk to retrieve the nearest one is no greater than 90 seconds. Any barriers, such as stairs or elevators, will increase the time needed. The need to climb stairs or use elevators to access multi-story buildings can significantly slow EMS response time.4
Walk it Out
To determine the best location for a defibrillator, conduct an “SCA response test” for each planned defibrillator location. Whenever possible, your test should mirror real response situations throughout representative locations in your facility or work area. Place a “victim” (either a mannequin or volunteer) at a selected location. Then place a witness to the SCA event at the victim’s side. Using your response model, have the witness initiate the response. Use a stopwatch to measure all of the relevant time intervals. Start with recognition of sudden cardiac arrest by a witness as “time zero” and factor in time for:
Response team training boosts confidence
A quality training program is important to the ultimate success of an early defibrillation program. Advances in defibrillator technology have made the devices much easier to use and maintain, with reduced training requirements. To be confident in using a defibrillator in an emergency situation, rescuers should be trained in the proper skills and understand the basics of responding to sudden cardiac arrest. Since most trained personnel will go for long periods of time without being called on to use an AED, a re-training program will keep responders sharp and their confidence high.
Rugged, lightweight equipment a must for line truck deployment
The defibrillator model chosen by Cobb Energy, Richland Center and Xcel Energy has become the utility industry standard—rugged, effective and reliable, virtually maintenance free, as well as compact and lightweight. The devices are designed to withstand harsh weather conditions and rough treatment, and to perform daily, weekly and monthly self-tests to help ensure that they are always ready to use.
The risk of sudden cardiac arrest--and the need for early defibrillation—will continue to be one that the utility industry must prepare for, given the potential for accidental contact with high voltages. Having a well-planned program, the right equipment and a quality training plan helps these utilities prepare for the unexpected.
For more information
Information on implementing an early defibrillation program specifically tailored to the utility industry is available from Philips by calling 1-800-263-3342, or by visiting the web site at www.medical.philips.com/goto/heartstart. If you have questions regarding training requirements, Good Samaritan laws, or state laws regarding use of defibrillators by trained first responders, contact the American Heart Association at 1-800-242-8721 or your local Red Cross chapter. Or visit the National Center for Early Defibrillation website, at www.early-defib.org.
About the Author
Kathy Hjelmeland is a freelance writer based in Seattle, Washington. Her articles on early defibrillation programs have appeared in CorrectCare, Electric Energy, Occupational Health & Safety, Ski Patrol Magazine, US Cycling, and Utility Safety. Philips Medical Systems offers a complete solution in resuscitation products, helping rescuers treat SCA quickly and effectively whenever it occurs.
References
- Obtain management commitment to and approval of the early defibrillation program, as well as commitment and support for those individuals/departments that will support the program
- Conduct a site survey to identify barriers to response and high-risk areas
- Identify the medical director, program coordinator and defibrillator response team members
- Develop your emergency response plan
- Identify a training program and provider and training plan
- Identify the minimum equipment needed for each location and any maintenance needs.
An end-of-day soda run turned three members of a Wisconsin electric utility line crew into heroes last December. The Richland Center Electric Utility crew had pulled into a local Mobil-Mart, where Line Foreman Dale Bender was waiting in line when he witnessed a man a couple of places in front of him slump to the floor, grabbing his chest. As bystanders rushed to aid the man, Bender ran to the bucket truck and grabbed the defibrillator it carried. He alerted his fellow crewmembers, Journeyman Chris Chitwood and third-year Apprentice Rod Klossowski, who responded with him.
Upon reaching the victim, Chitwood began CPR as Klossowski applied the defibrillator pads. Following patient analysis and Bender’s “All Clear!,” the device immediately advised a shock. After receiving a single shock, the victim began breathing and exhibited signs of a pulse. EMTs arrived almost simultaneously, and according to Bender, “They simply unplugged the leads from our machine and hooked it to theirs, which was the same model.”
The close proximity of an automated external defibrillator, available within moments following the sudden cardiac arrest (SCA) and followed by a rapid EMS response, helped save the victim’s life, proving once again that early defibrillation programs pay off for both utilities and communities.
Following the rescue, Dick Dosch, electric superintendent for Richland Center Electric Utility, released a statement saying, “Words are hard to find to describe how proud I am of these electric utility employees for their actions. I am also proud of the Richland Center Utility Commission for having the foresight to see that this equipment is needed not only by employees, but also in the community.”
Dosch credits Municipal Electric Utilities of Wisconsin (MEUW) President Richard Kirchoff, of Hutisford Utilities, for bringing attention to the need for defibrillators on utility trucks several years earlier.
Defibrillation programs protect both employees and community
For utility industry employees, quick access to defibrillation following SCA is a good idea already proving its worth with real-life results. In the two years since the inception of early defibrillation programs at both Cobb Energy and XCEL Energy, two lives have been saved, thanks to the availability of automated external defibrillators put in place by company teams who designed programs specifically tailored for their workforce and communities.
At Cobb Energy, one of the company’s 75 defibrillators was used to treat a member of the public who collapsed in March 2002. A Cobb Energy service crew driving by a local restaurant noticed police cars, and became concerned. Crew members Ken Bryant, Brian Mathison and Adam Moody turned into the parking lot and discovered a 70-year old man being given CPR. The crew offered their assistance and use of the defibrillator in the truck until an ambulance arrived. Cobb Energy, which has made a commitment to serve the communities in which employees live and work, recognized the three for their bravery in offering their assistance to a private citizen. The Cobb Energy line crew that stopped to see if they could assist embodied the commitment to community for which the industry is known.
At Xcel Energy’s Black Dog Plant in Minnesota, a 47-year old contractor is alive today because of the close proximity of a defibrillator and the quick response of co-workers. In April 2002, coworkers discovered Mike Rogers of Duluth, MN, collapsed on a second floor stairway landing. He wasn’t breathing. The plant’s control room immediately called 9-1-1 while three operator repairmen rushed to his aid with one of the plant’s defibrillators. After one shock, the victim regained a stable heart rhythm. The Burnsville Fire Department then arrived and transported the victim to a local hospital.
The three responders—Greg Fischer and Scott Helgeson, operator repairmen, and Gary Strom, lead operator repairman—each received Life Sustaining Awards from the company. Carl Sannes, plant director at Xcel's Black Dog facility, underscored the importance of having a defibrillator readily accessible by trained employees, saying, “We are very proud of how our entire operating shift responded to this emergency, and are all grateful that we had a defibrillator and trained plant personnel available.”
Utility industry starts on and stays on the leading edge
Today, safe, easy-to-use and technologically advanced defibrillators are increasingly being deployed throughout the industry, where it is well-known that accidental contact with high voltages can result in sudden cardiac arrest. SCA is most often caused by ventricular fibrillation (VF), a condition in which the heart’s electrical impulses suddenly become chaotic. The only effective treatment for SCA is rapid defibrillation. While CPR can buy a victim time by delivering oxygen to the brain, it cannot restore a normal heart rhythm. Automated defibrillators rapidly and automatically assess a victim’s heart rhythm and safely make the appropriate therapy decisions, using an electrocardiogram (ECG) analysis system. As a result, equipping and training employees such as linemen to use automated external defibrillators immediately following a cardiac event can measurably improve SCA survival rates.
Industry committed early to fighting SCA
The utility industry has demonstrated a longstanding commitment to protecting the lives of employees and community members from SCA. It has long been recognized that a shock of 50-100mA can result in VF, severe burns and muscular contractions1. As a result, utilities, along with airlines and casinos, were among the first industries to implement wide-scale early defibrillation programs to protect employees and the public. Long before that, utilities were among the first to invest in research and technology to treat for this deadly condition. Notably, the utility industry was a catalyst in the development of the first bulky, “portable” defibrillator, more than half a century ago.
In 1925, Consolidated Edison of New York consulted the Rockefeller Institute on how to improve survival from electrical accidents resulting in SCA. The Institute funded research at several universities including Johns Hopkins to study the effects of electric shock, in hopes of protecting employees. At that time, there was no remedy for VF. Investigator William Kouwenhoven, a professor of electric engineering at Johns Hopkins, noted that low-voltage shocks caused VF. In 1933, by administering a countershock of electricity, he and fellow researcher neurologist Orthello Langworth, MD, discovered they were able to restore a normal heart rhythm. Several years later, their discovery would result in the development of the first defibrillator--280-pound contraption mounted on a wheeled cart.2 In 1957, the device saved its first life--a 42-year old Hopkins patient who suffered VF in the operating room. Luckily for the patient, the admitting resident was familiar with the defibrillator locked in the 11th floor laboratory. He was able to persuade a security guard to give him access to the device in time to wheel the huge defibrillator down to the patient. According to Johns Hopkins, the patient lived another 18 years. Kouwenoven’'s research was later used to development a smaller 45-pound model that could operate on either small battery or AC current. The work was funded by Edison Electric specifically for use by utility line crews. Consolidated Edison's early investment had paid off.2, 3
The manufacturer of the devices selected by Cobb Energy, Xcel, and Richland Center has also been on the leading edge in the fight against SCA as it further developed defibrillation technology. The company has the distinction of introducing the first low-energy biphasic defibrillator in 1996. The defibrillation technology selected was designed to be virtually maintenance free and easy to use for all trained responders, with voice and text prompts to guide the user. The company's next generation model was the first defibrillator designed to effectively and safely treat pediatric patients. The most recent addition to a growing collection of “firsts” for the manufacturer is a groundbreaking new defibrillator, the first in a new generation designed for the home.
Program design creates effective response
Both Xcel Energy and Cobb Energy utilized implementation assistance from Amy Dixon, a clinical implementation specialist and EMT. Using recognized guidelines, research and industry practice, Dixon provided site assessment and program consultation to determine the most effective way to deploy defibrillators to protect employees.
“The department of Labor’s Occupational Safety and Health Administration (OSHA) recommends treatment within 3-4 minutes for lifethreatening events, such as severe bleeding, respiratory arrest, or cardiac arrest. Additionally, the American Heart Association recommends defibrillation response times from 3-5 minutes, depending on the environment,” explained Dixon.
She also emphasized that an emergency response plan that identifies how and when lay rescuers will respond to emergencies is essential to a successful early defibrillation plan.
“The plan should be defined in formal policies and procedures that include how defibrillator responders as well as local Emergency Medical Systems are to be notified in the event of an emergency,” she said. Dixon added that it should also include how the defibrillator response protocol is to be used by the response team members and the procedures to be followed after response to an emergency incident. In addition to covering normal business hours, the plan should include special procedures for alternate shifts, and times of reduced or increased occupancy.
Where should defibrillators be placed?
Manufacturers and experts such as the National Center for Early Defibrillation, a nonprofit advocacy organization, recommend that utilities perform a site survey to gather information to help identify where the defibrillators should be located in order to meet the response time goal. Placement should be based on one of two response models: localized or centralized.
In a localized response, such as that used by the Richland Center Electric Utility line trucks, defibrillator placement is made with time factored in for someone to witness to the victim's collapse, retrieve the defibrillator, return, and apply it to the victim within the response time. Companies using this model have often deployed defibrillators on line trucks to provide the close proximity of the defibrillator which is critical in the event that a poletop rescue may need to be performed. Many companies also express a commitment to their communities, and desire to be able to respond to SCA in the general population as needed.
In a centralized response model, the defibrillator is placed in a central location staffed by full-time responders. In this approach, the witness to the victim's collapse notifies the central location and proceeds to provide basic care until the device is brought to the victim's side.
In either case, defibrillators should be located so that the walk to retrieve the nearest one is no greater than 90 seconds. Any barriers, such as stairs or elevators, will increase the time needed. The need to climb stairs or use elevators to access multi-story buildings can significantly slow EMS response time.4
Walk it Out
To determine the best location for a defibrillator, conduct an “SCA response test” for each planned defibrillator location. Whenever possible, your test should mirror real response situations throughout representative locations in your facility or work area. Place a “victim” (either a mannequin or volunteer) at a selected location. Then place a witness to the SCA event at the victim’s side. Using your response model, have the witness initiate the response. Use a stopwatch to measure all of the relevant time intervals. Start with recognition of sudden cardiac arrest by a witness as “time zero” and factor in time for:
- Calling 9-1-1 or an in-house emergency response number
- Beginning CPR
- Arrival of the defibrillator
- Application of the defibrillator pads
- Delivery of the first shock
Response team training boosts confidence
A quality training program is important to the ultimate success of an early defibrillation program. Advances in defibrillator technology have made the devices much easier to use and maintain, with reduced training requirements. To be confident in using a defibrillator in an emergency situation, rescuers should be trained in the proper skills and understand the basics of responding to sudden cardiac arrest. Since most trained personnel will go for long periods of time without being called on to use an AED, a re-training program will keep responders sharp and their confidence high.
Rugged, lightweight equipment a must for line truck deployment
The defibrillator model chosen by Cobb Energy, Richland Center and Xcel Energy has become the utility industry standard—rugged, effective and reliable, virtually maintenance free, as well as compact and lightweight. The devices are designed to withstand harsh weather conditions and rough treatment, and to perform daily, weekly and monthly self-tests to help ensure that they are always ready to use.
The risk of sudden cardiac arrest--and the need for early defibrillation—will continue to be one that the utility industry must prepare for, given the potential for accidental contact with high voltages. Having a well-planned program, the right equipment and a quality training plan helps these utilities prepare for the unexpected.
For more information
Information on implementing an early defibrillation program specifically tailored to the utility industry is available from Philips by calling 1-800-263-3342, or by visiting the web site at www.medical.philips.com/goto/heartstart. If you have questions regarding training requirements, Good Samaritan laws, or state laws regarding use of defibrillators by trained first responders, contact the American Heart Association at 1-800-242-8721 or your local Red Cross chapter. Or visit the National Center for Early Defibrillation website, at www.early-defib.org.
About the Author
Kathy Hjelmeland is a freelance writer based in Seattle, Washington. Her articles on early defibrillation programs have appeared in CorrectCare, Electric Energy, Occupational Health & Safety, Ski Patrol Magazine, US Cycling, and Utility Safety. Philips Medical Systems offers a complete solution in resuscitation products, helping rescuers treat SCA quickly and effectively whenever it occurs.
References
- Induced AC creates problems for pipelines in utility corridors, Pipe Line & Gas Industry, June 3 1999 V 82 No. 6.
- Hopkins Medical News Online, Winter 1998
- Eisenburg, MS Life in the Balance: Emergency Medicine and the Quest to Reverse Sudden Death, Oxford University Press, 1997 pp.186-187, 191.
- Lateef F, Anantharaman V. Delays in EMS response to and evacuation of patients in high-rise buildings in Singapore. Prehospital Emergency Care 2000;4:327-332.
