The Occupational Safety and Health Administration’s (OSHA) requirement for first-aid/CPR responders on-site has not changed; when performing electrical work, it is a recognized fact they are needed. Electrical shock in the workplace is a significant cause of sudden cardiac arrest. Immediate response by trained individuals can save a life. What is new are the changes to the CPR guidelines.
An international body consisting of scientific experts from a variety of countries, cultures and disciplines reviewed the existing data and determined that changes were needed. In the United States alone, more than 300,000 people die annually from sudden cardiac arrest. CPR success rates are not as promising as one might hope. Out-of-hospital success rates range from 2 to 30 percent. Possible causes for the low rates include an inadequate number of compressions and the lack of compression depth. In addition, compressions typically are interrupted frequently, and excessive ventilation is provided. When this occurs, not enough blood is pushed through the heart and to the brain.
However, it was noted in studies reviewed by the international body that success rates were much higher when organized rescue programs were in place. Survival rates ranged from 49 to 74 percent. Key elements of these programs include training of rescuers, rapid recognition and response, and the use of an automated external defibrillation (AED) within five minutes of the incident.
To improve rates universally, the guidelines simplified procedures by focusing on the critical aspects of CPR. The most significant change is the ratio of chest compressions to rescue breaths. The old guidelines called for 15 compressions for every two rescue breaths. The new guidelines are 30 compressions for every two rescue breaths. The same ratio is to be used for adults, children and infants (except newborns). The procedure begins with the two rescue breaths and then goes into the chest compressions. The speed and depth remain the same. In an adult, the speed is 100/minute and compression depth is from 1½ to 2 inches.
The new rules no longer call for lay rescuers to check for signs of circulation before beginning chest compressions. It was determined that a lay person could not reliably detect circulation in a victim. Although a small amount of damage may occur if compressions are given when not needed, more harm occurs if rescuers don’t do chest compressions when needed. Eliminating the need to learn and look for signs of circulation makes training easier and increases the likelihood a lay rescuer will remember their CPR.
The new guidelines also push for AEDs at all locations where a potential need exists. OSHA does not currently require they be a part of your first aid kit. However, OSHA has begun to look more closely at the AED’s potential for saving lives in the workplace. Many factors will need to be reviewed. An interesting aspect of AEDs is that their operating temperatures range from 32º to 122ºF (0º to 50ºC). They may not prove useful for a lineman or outside contractor in the winter months.
When an AED is present, the new CPR guidelines call for it to be applied as soon as available. Once applied, it should deliver a single shock and direct the user to follow up immediately with two minutes of CPR beginning with chest compressions. In contrast, the old guidelines allowed up to three shocks to be given. A shock was delivered, then the AED would reanalyze the heart before providing instruction. The multiple series of shocks and reanalysis created delays up to 37 seconds. Now, with the two minutes of CPR between shocks, oxygen can be delivered, which may improve the effectiveness of the next defibrillation. [NOTE: AEDs assist with ventricular fibrillation, the abnormal heart rhythm responsible for most cardiac arrests. If there are other causes, the AED may not be effective.]
What this means to electricians is that updated training is needed. The new guidelines were released in late 2005. All organizations, such as the National Safety Council, American Heart Association and Red Cross, would have updated their training programs in 2006. Current certifications under the old guidelines still are recognized, but if new AEDs are used, they will be programmed in accordance with the new guidelines.
This brings attention to any companies using pre-2005 AEDs. Updates of the older machines should be coordinated with the training. The AED manufacturers should be contacted to reprogram the machines. Are your AED pads and batteries current or expired? Any workplaces with Public Access Defibrillator programs also must update the program to reflect the new guidelines.
The changes to the CPR protocols also shed light on the general need to keep everything up-to-date. Pay attention to equipment and training. With or without external motivation, employers should take time to review their procedures and look to make improvements. EC
O’CONNOR is with Intec, a safety consulting, training and publishing firm that offers on-site assistance and produces manuals, training videos and software for contractors. Based in Waverly, Pa., he can be reached at 607.624.7159 or by e-mail at firstname.lastname@example.org.