Cardiovascular disease is the single greatest cause of death in the United States. Every year more than 480,000 adult Americans die from sudden cardiac arrest or ventricular fibrillation resulting from myocardial infarction when not hospitalized. Survival rates for out-of-hospital cardiac arrest are only 1 to 5 percent however, shortening the time to defibrillation greatly improves survival from cardiac arrest. Each minute that defibrillation is delayed reduces the likelihood of survival, and after 10 minutes, the odds of survival are limited. In 1999 and 2000, 13 percent of workplace fatalities reported to OSHA were a result of sudden cardiac arrest. In November 2005, the American Heart Association and Emergency Cardiovascular Care Orga- nization developed new CPR guidelines (see Guideline 90, Cardiopulmonary Arrest, page 183) including the use of automated external defibrillators (AEDs). An AED is a computerized device that evaluates a victim’s heart rhythm, generates and delivers an electric current to attempt to restore normal sinus rhythm, and re-evaluates the heart rhythm. AEDs provide voice and visual prompts to guide the user through important rescue steps. AEDs are accurate and easy to operate and can be used effectively with minimal training. OSHA recommends that employers consider use of AEDs at their worksites to reduce time to defibrillation. Use of the AED is an essential element in the “Chain of Survival” of the American Heart Association, which outlines the critical actions required to treat any life-threatening emergency. The Chain of Survival includes essential “links” for reducing the number of deaths from sudden cardiac arrest, namely early access to emergency medical care, early CPR, early defibrillation, and early advanced care. The goal is to increase the number of individuals trained in Chain of Survival and to provide early access to AEDs. Three levels of public AED access are targets: public safety (police, firefighters, security personnel, ski patrol, airline crews), populated facilities (companies, corporations, public facilities, medical offices), and family members or friends of high-risk persons. The current American Heart Association guidelines should be followed for use of AEDs, includ- ing adequate training. Although there are different manufacturers and models of AEDs on the market, there are 5 universal steps of AED operation: 1. Turn on power (by button, switch, or opening the unit). 2. Attach the AED to the chest with electrode pads. 3. Analyze the rhythm. 4. Follow the automated instructions. 5. Deliver the electrical shock if indicated. Protocols and procedures must be established to manage the use of the devices, including appropriate emergency response, proper use and maintenance, and adequate training. AED program elements include: ● Establish a program to manage the devices, including adequate maintenance based on the manufacturer’s recommendations, procedures to ensure accessibility, and availability of ade- quately trained personnel on all shifts. ● Consider AED storage location(s) with maximum accessibility, such as within the occupa- tional health unit and other strategic locations within the company to ensure a quick (≤3-minute) response time. 233 Definition and Purpose Program Objectives and Elements Automated External Defibrillator (AED)