The Details of AEDs

What you didn’t know about CPR and defibrillation could save a life.

• By Cindy Pauley
• Jun 01, 2023

Automated external defibrillators (AEDs) and cardiopulmonary resuscitation (CPR) are the perfect tools for aiding a cardiac arrest victim while awaiting emergency medical assistance. Quick action using CPR and AEDs can save the lives of the nearly 350,000 cardiac event victims each year outside of a hospital setting. But what does OSHA require employers to do? What you didn’t know about OSHA regulations regarding AEDs may be surprising. 

Understanding the Heart of the Matter

To understand how CPR and defibrillation work, it’s best to understand what is happening inside the body during a cardiac arrest. The cardiovascular system, made up of the heart, blood and blood vessels, transports oxygen and nutrients to body tissues and removes waste that’s eliminated by the lungs. 

The fist-sized heart is located between the sternum and the spine. For an average adult, it beats 60 to 80 times per minute to circulate approximately five to six liters of blood. Divided into four chambers (two atria and two ventricles), the heart is composed of sophisticated muscle tissue that generates its own electrical impulses. These impulses help contract the heart, allowing oxygen-poor blood to leave the heart and oxygen-rich blood to return from the lungs. The heart filling and then pushing blood out is what is felt as the pulse.

All body systems rely on a properly functioning circulatory system. When something disrupts circulation, shock can occur. If multiple cells of an organ die from oxygen deprivation, the organ dies within minutes. When critical organs die, the victim can also die within minutes. The goal of CPR is to circulate oxygenated blood to keep vital organs alive until help arrives.

Signs and Symptoms of Cardiac Compromise

Think of the circulatory system as the body’s blood transportation system and the heart as the engine. Amazingly, the heart generates its own electrical impulses, pumping in a regular, rhythmic manner. As with any engine, the heart requires a certain amount of pressure to function and doesn’t work well when clogged with grease or debris. 

The most common causes of sudden cardiac arrest include a heart attack, electrocution and asphyxiation—all of which could occur in the workplace. Common signs and symptoms of cardiac compromise include:

• Chest pain accompanied by a crushing or squeezing sensation,
• Pain that radiates to the jaw or arm,
• Irregular pulse and/or abnormal blood pressure,
• Shortness of breath, 
• Cool and sweaty skin,
• Nausea and vomiting, and 
• Anxiety or feeling of impending doom.

CPR and early defibrillation are part of the emergency medical services (EMS) chain of survival that significantly improve the chance of cardiac patient survival. However, according to the American Heart Association (AHA), even the best CPR will not provide enough circulation of oxygen to the brain and heart for more than a few minutes. In fact, a patient whose brain is deprived of oxygen for 10 minutes or more seldom recovers. This is where defibrillation with an AED comes into play.

Giving the Heart a Jump Start

For every minute a patient is in cardiac arrest, their chances of survival decrease dramatically. When a patient doesn’t have a pulse and isn’t breathing, CPR should be performed until an AED is available. Though CPR and defibrillation are used in tandem as part of the chain of survival, it’s important to note that CPR alone does not restart the heart. CPR is an oxygen circulation procedure. AEDs, on the other hand, are meant for lifesaving intervention.

AEDs, when “analyzing,” are determining heart rhythms that indicate ventricular fibrillation (V-fib). When indicated, an AED uses an electric shock, called defibrillation, to stop and reorganize a chaotic heart rhythm. The AED delivers a high-voltage current through the patient’s skin that traverses the heart muscle and stops the chaotic electrical pattern. The high voltage is why responders and others are instructed to clear from the patient before shocks are administered. The heart is temporarily paralyzed, allowing its natural pacemaker to kick in again. Essentially, the heart has been given a jump start.

AEDs in the workplace can save precious treatment time and increase the odds of patient survival. These lifesaving tools are light, portable, easy to use and inexpensive. They are best placed near high-hazard areas such as confined spaces, near electrical energy or in remote work areas. Response time to reach AEDs should be kept within three to five minutes.

OSHA Requirements Regarding CPR 

OSHA 1910.151 requires first aid treatment be provided in the absence of an infirmary, clinic or hospital in near proximity to the workplace used to treat injured employees. This may include assisting a victim of cardiac arrest using CPR or defibrillation.

OSHA requirements for CPR and defibrillation differ considerably. Standards requiring CPR include:

• 1910.146 Permit-required Confined Spaces
• 1910.266 Appendix B: Logging Operations – First Aid and CPR Training 
• 1910.269 Electric Power Generation, Transmission, and Distribution
• 1910.410 Qualifications of Dive Team and
• 1926.950 Construction Subpart V, Power Transmission and Distribution

OSHA recommends basic adult CPR refresher training and retesting every year, and first aid training at least once every three years. CPR training includes facilitated discussion along with “hands-on” skills training that uses mannequins and partner practice. 

OSHA recognizes AEDs as important lifesaving technology that plays a role in treating workplace cardiac arrest. However, OSHA doesn’t currently require the use of AEDs in the workplace. OSHA and the AHA formed an alliance in November 2003 for sharing best practices and technical knowledge with the goal of improving safety and saving lives. Both consider worksites viable candidates for the use of AEDs but require employers to assess their own requirements for AEDs as part of their first-aid response.

FDA Oversight

Although OSHA doesn’t address this directly, AEDs are considered Class III medical devices. This means that the Food and Drug Administration (FDA) has some oversight on their use. Almost all AEDs require the purchaser to obtain a prescription from a physician under FDA regulations. The simple prescription process is meant not as a hurdle for employers but as a quality control mechanism. A licensed physician or medical authority ensures AEDs are properly maintained and that all designated responders are properly trained and assists with establishing an emergency response plan for the employer’s AED program.

The AHA requires AED operators to also receive CPR training as an “integral part of providing lifesaving aid to people suffering sudden cardiac arrest.” Though easy to use, each AED is slightly different, so training helps users understand the unique traits and supplies for the individual units at their workplace. Additionally, AED users must be trained to understand the signs of a sudden cardiac arrest, when to activate the EMS system and how to perform CPR.

Many states require or encourage AED users to complete basic CPR and AED courses from a nationally recognized organization. Some states, such as Florida, require everyone who uses an AED to obtain appropriate training, including a course in CPR or a basic first aid course that includes CPR. OSHA doesn’t offer first aid training, nor certify trainers. Training by a nationally recognized organization, such as AHA, the American Red Cross or National Safety Council is recommended.

Key Takeaways

Quick action using CPR and defibrillation with AEDs can save the lives of workers suffering cardiac emergencies. While OSHA doesn’t currently require the use of AEDs in the workplace, the agency considers worksites good candidates for AED use, requiring employers to assess their own AED requirements as part of their first aid response. 

As Class III medical devices, most AEDs require a prescription for purchase as a method of quality assurance. AED training is also required by most states and should include CPR with a hands-on practical component.  

This article originally appeared in the June 1, 2023 issue of Occupational Health & Safety.