AED’s Are Not a Panacea!

April 07, 2011

Wallace Eddy and Carrie Tupper
Campus Recreation Services
University of Maryland (College Park)

Experience becomes learning when it is reflected upon, considered in light of prior learning, and actively applied to future experiences (Kolb, 1984). At the University of Maryland we have had several experiences involving cardiac arrest. What has been disheartening to staff who are responsible for teaching CPR/AED skills to our professional and student staff is that none of the victims were able to be revived. A careful process of incident review was conducted after each incident, including discussion of CPR/AED protocol followed and immediate documentation of activity.

The staff involved in the attempted lifesaving activity followed protocol exactly as they were trained to do. So why didn’t any of the victims survive? That is the question that staff mentioned repeatedly during post-incident review. During our training we explain the importance of immediately beginning the “chain of survival” in cases of cardiac arrest. It is clear that having AEDs readily available and trained staff to use them is critical for recreation facilities. However, do we do a disservice in our training when we don’t provide the “other side” of information? Information that indicates that although we greatly increase the likelihood of survival with the use of AEDs, they are not a panacea for cardiac arrest; the factors related to survival are complex.

Not all cardiac victims have “shockable rhythms,” meaning that some types of cardiac arrest are not the result of forms of arrhythmia that may be corrected through defibrillation – the application of electrical shock to correct the heart’s rhythm. Regardless of degree of training, if the victim’s heart is not in a shockable rhythm, use of an AED will not result in revival.

Time is another factor. According to the American Heart Association (www.americanheart.org — Cardiopulmonary Resuscitation (CPR) Statistics section, Automated external defibrillators (AEDs) subsection), “In cities such as Seattle, Washington, where CPR training is widespread and EMS response and time to defibrillation is short, the survival rate for witnessed VF cardiac arrest is about 30 percent”, and “In cities such as New York City, where few victims receive bystander CPR and time to EMS response and defibrillation is longer, survival from sudden VF cardiac arrest averages 1-2 percent”. These facts make it clear that “sooner is better” in terms of increasing a victims chance of survival. However, the more positive of the two statistics is 30 percent survival; which conversely means 70 percent non-survival. So what do we tell our staff members? It is important that we reiterate constantly how critical immediate care and attention are to increasing the chance of survival, but we must also make clear that the statistics are not necessarily in favor of survival – – we must offer a balanced perspective that results in best efforts being given, but with a realistic understanding of potential outcomes.

In addition to training, incident follow up should include some of these statistics. It may be difficult for the first responders in a cardiac incident to be rational in their self-assessment of care provided; the provision of these statistics may assist in coping. At Maryland, we are fortunate that many of our full-time, professional staff have training in the “helping fields” and have made connections across campus with mental health professionals upon whom we call upon to assist in incident follow-up. Through post-incident reviews and discussions with front-line staff who provide first response to cardiac incidents, we have turned our experiences into learning.

Some lessons learned:

• Immediate and subsequent follow-up care by qualified professionals (debriefing, group discussions, counseling, etc.) is essential – – especially since staff members will react to the incident in myriad ways.

• Documentation of the incident and protocols followed are necessary aspects for responsible risk management, even though it may feel callous to ask staff who have just gone through the incident to re-live it through documentation; experience and research teaches us that forgetting begins quickly.

• Finding ways to use the incident to increase learning in the department such as enhancing training through “testimonials” of staff who have been through an incident (either first-person shared stories, or stories from collective memory of dealing with an incident) not only has the potential to improve a department’s response in the future, but allows those staff involved in an incident to know their difficult experience is being applied.

• No matter what, you can never be fully prepared to deal with the potential emotional aspects of dealing with a cardiac incident. You can be well-trained, practiced, and tested, but until you are face-to-face with a human victim, you cannot be sure of your reactions. Planning for post-incident care should be part of the risk management process.

As recreation professionals, we work hard to make our programs and facilities as safe as possible; having AEDs available is a critical part of that endeavor. However, we must be prepared for the reality that every incident may not be a “success story;” our success is in the recognition of the importance of an AED program and implementing one with due diligence.

Kolb, D. A. (1984) Experiential Learning, Englewood Cliffs, NJ: Prentice Hall