Don Youngblood (Master Mr. Olympia) [More Info]
Dead, heart attack
Anthony Clark (Powerlifting Legend) [More Info]
Dead, heart attack and kidney failure
Mike Matarazzo (Pro Bodybuilder) [More Info]
Heart attack, successful bypass surgery
Sudden cardiac arrest, often times called a heart attack, is a leading cause of death in North America. Sudden cardiac arrest is a public health crisis that has touched the lives of many. The weight training community, bodybuilding and powerlifters, are not immune from this crisis, as demonstrated above. However, sudden cardiac arrest is manageable and treatable.
The intent of this article is to provide you with information on a treatment solution that you have probably walked past and never knew was there. The treatment solution is the automated external defibrillator or AED.
The AED has been around for several years but they only recently have become a more accepted, mainstream tool. AEDs, until recently, could only be purchased by prescription.
Now anyone can obtain one. The accompanying photos in this article are of actual AEDs and represent several different manufacturers.
I realize that endorsing specific products is frowned upon, but I endorse the American Red Cross' CardioPulmonary Resuscitation (CPR) program. The Red Cross provides a validated, systematic training program that includes AED use in most locations.
Additionally, knowledge and training on CPR and AEDs should be something every personal trainer should complete.
I work in a facility that has many AEDs on site, and have been trained to use AEDs.
I want to provide you with some background information on these devices, because you may be able to assist in saving a life, all because you know what to do with that box on the wall.
However, knowing that these devices are available and that you can identify them and possibly use one can be very important. It can make the difference between life and death.
The majority of the information for this article came from the National Center for Early Defibrillation. More information can be obtained from their website, http://www.early-defib.org.
What Is An AED?
The AED is a device that both monitors heart rhythms and delivers an electric shock, if required. The electric shock is designed to "restart" the normal heart rhythm and bring an individual "back from the dead."
AEDs are self-contained in small kits that are usually less than a foot squared and 4 inches deep. Many are secured in tamper-proof boxes on walls.
You can find them in federal buildings, airports, arenas, theaters, casinos, toll plazas, gyms and other places where many people gather.
The Common Questions
Are AEDs Safe?
Yes. For the number of years that they have been on the market, there have only been a rare, few cases of inadvertent shock delivery.
Are AEDs Easy To Use?
Yes. AEDs are designed for use by non-medical personnel. Their ease-of-use was demonstrated when a class of 6th graders was instructed to use the device, and the children were able to use AEDs correctly after instruction.
Can You Use An AED Without Being Trained?
Yes. Most every AED made has a self-prompting program that will guide you through its use; However, formal training is still recommended.
Do You Still Need To Call For Help?
Yes. Calling for help should always be the first action once you determine there is a medical emergency.
Can You Be Sued For Using An AED On A Sudden Cardiac Arrest Victim?
No. People may try, but you would be cover under the "Good Samaritan" immunity laws that most every state and the federal government has enacted. So there is very little likelihood of being found at fault.
Are All AEDs The Same?
No. All are designed to defibrillate, however they employ different technologies to recognized heart rhythms, prompting guides, etc.
Does An AED Take The Place Of Cardio Pulmonary Resuscitation (CPR)?
No. An AED is part of CPR; they are used in harmony. Many AEDs will prompt CPR actions be conducted.
Can An AED Be Used On A Wet Or Metal Surface?
Yes. AEDs are self-grounded and can be safely used on settings normally hazardous for electrical operations.
Why Use An AED?
The best reason to use an AED is for the increased survival rate when early defibrillation is administer. After a cardiac arrest occurs, a victim's chance of survival decreases roughly 7-10% a minute. Use of an AED in the first 10 minutes after a cardiac arrest has proven to be a successful lifesaver.
An AED can provide rapid treatment for cardiac arrest in the crucial 10-minute window of opportunity. Many successful AED assisted resuscitations have been documented in both the workplace and in public places.
Many emergency services (police, fire and ambulance) in most large communities now have AEDs. Given their response times to emergencies, they can often get to a victim in less than 10 minutes.
The federal government has, and many state governments have, provided grant money to local governments and schools to purchase AEDs. You're much more likely to live in a community that has AEDs with emergency providers or gathering places than you were just three years ago.
As discussed in the questions earlier, there are "Good Samaritan" laws in most every state. In addition, The Cardiac Arrest Survival Act of 2000 provides complete immunity from civil litigation for users of AEDs.
Conversely, there is more litigation for companies and organizations being negligent in providing AEDs at settings such as on-board airplanes, golf courses and health clubs. So AEDs are accepted, expected and should be available for use.
On the technical side, you should have a basic understanding of what sudden cardiac arrest is. The heart is a muscle that contracts at regular intervals based on chemical-electrical stimulation.
Cardiac arrest is a condition often caused by ventricular fibrillation (VF) that generates an irregular, quivering heart rhythm (an arrhythmia). This irregular rhythm does not allow the heart to pump blood.
The consequences of the arrhythmia are blood and oxygen not being transported to the brain and heart, the pulse stopping, breathing stopping and the victim becoming unconscious.
External defibrillation is used to "reset" the normal electrical stimulation of the heart, enabling the heart to pump blood again. CPR is used in conjunction with an AED to reduce brain damage from the lack of circulating oxygen and prolong electrical activity in the heart.
Abnormal Heart Rhythms
The abnormal heart rhythms, arrhythmia, fall into three categories: shockable, nonshockable, and intermediate. Patients with shockable rhythms benefit most (survival) from defibrillation at essentially no risk. More detailed definitions of these categories are below:
- Shockable Rhythms: lethal rhythms that can result in the patient's death unless defibrillation is deliver very quickly.
These rhythms include coarse ventricular fibrillation (VF) and rapid ventricular tachycardia (VT) and are always (VF) or almost always (rapid VT) associated with a pulseless, unresponsive patient.
- Nonshockable Rhythms: benign (or even normal) rhythms that must not be shocked, especially in patients with a pulse, because no benefit will follow and deterioration in rhythm may result.
Nonshockable rhythms include normal sinus rhythm, supraventricular tachycardias, sinus bradycardia, atrial fibrillation and flutter, heart block, idioventricular rhythms, premature ventricular contractions, and other rhythms accompanied by a palpable pulse and/or occurring in a conscious patient.
To maximize safety in the event of misapplication of the device/electrodes, asystole is included in this group. The AHA discourages shocks for asystole.
- Intermediate Rhythms: Rhythms for which the benefits of defibrillation are limited or uncertain. These include fine VF (associated with pulselessness and low survival rates) and VT that does not meet all criteria for inclusion in the shockable VT rhythm category.
Defibrillation waveforms are a technical, complex issue that deals with the delivery of shocks. Basically, there are two types of waveforms - Monophasic and Biphasic.
he majority of AEDs on the market today are biphasic. The American Heart Association has additional technical literature if you are interested.
You will find some form of instruction with each AED. Some instructions are attached directly to the unit (as depicted in the photo), while others are enclosed in the carrying case. As mentioned previously, an AED is part of CPR.
I have included a flow chart that goes through the basics of Check, Call and Care for evaluating and assisting victims of medical emergencies. During the caring phase, an AED is used if necessitated by the situation.
If you are trained and certified in CPR, you can perform all the actions required by the emergency. If you are not trained, you can still provide assistance.
All AEDs have defibrillation pads. The defibrillation pads sense the electrical signals of the heart and deliver the shock to the victim if recommended. The defibrillation pads must be applied to the victim (one on the upper chest and another on the side). This is a normal prompt during an AED start up.
You can assist by removing the victim's shirt and applying these pads. Most AED kits come with a razor or scissors to improve attachment of these defibrillator pads to the victim. If you have an individual with a significant amount of body hair, the hair will need to be removed to adequately apply the pads.
There are electronic cables that run from the defibrillation pads and plug into the AED. Most AEDs can determine which cable is attached to the upper chest pad and which pad is attached to the pad on the victim's side. Running these electronic cables from the AED to the defibrillation pads is simple and will save time.
When the AED is turned on, it will analyze the victim's heart rhythm and prompt the rescuer for additional action. For an effective analysis to be made, no one can be touching the victim. If a shock is advised, again, no one can be in physical contact with the victim. Everyone will need to move back. The action to administer the shock is to push a button on the AED. This button is unique and visually stands outs on every machine I have seen.
After a shock is deliver, the AED conducts another analysis of the victim and will prompt additional CPR actions based on the analysis. The flow chart provides a summary of those actions. So, as you have read, the AED part of resuscitation is not that difficult.
In Review, The Basic Steps For Using An AED Are:
- Turning the AED on.
- Following the verbal and visual prompts.
- Applying the defibrillation pads.
- Ensuring the defibrillation pad cables are connected.
- Ensuring nobody is in physical contact with the victim.
- Hitting the button to deliver the shock.
Have A Heart
This article was written to provide awareness. Many of us in our employment or in our comings and goings have seen an AED. The AED is a proven lifesaver and was designed for use by non-medical folks.
I wanted to share with you a little information on what these devices are, how they operate and how simple they are to use. If you have never seen one, I am sure you will in the future, as they become more and more prevalent. Look around the next time you are in an airport, casino or high school gym. You may be surprised.
If you are a personal trainer or work in the fitness industry, I recommend that you take a course in CPR (with AED training included) to best serve your clients. If you own a gym or work at one, I recommend that purchasing an AED be brought to management's attention.
I hope you are never in a situation where you must use an AED. However, I hope this article gave you enough background where you can assist in using an AED on a victim of sudden cardiac arrest. Time is a critical element after cardiac arrest, and anything you do to provide assistance and hasten treatment will help. Then this really would be the most important training article you ever read.