How to Do a Site Assessment
Outlined below is a rational process for determining the optimal quantity and placement locations of your AEDs. We also provide below downloadable worksheets for your team's added assistance in enhancing existing policies, communication systems and training.
Health Risk Assessment
When performing an AED site assessment, you should consider all the steps that need to take place within a 3-minute window of survivability. These steps include:
- Recognizing the event as a cardiac emergency
- Communicating the emergency
- Activating the internal responders
- Retrieving the AED
- Arriving at the victim’s location
- Attaching the AED and delivering the shock
Basic Life Support
Communication systems within a facility will greatly affect the time to respond. Precious time can be saved with automatic notification systems. Ideally, AEDs should be stored in a monitored wall cabinet that automatically notifies building security or other designated responders when the cabinet is opened.
Secured areas can present special problems in terms of sudden cardiac arrest emergency response times. You should consider locating AED units outside secured areas unless the likely responders can easily and quickly move through security checkpoints. Alternatively, having the security checkpoint personnel trained in CPR and SCA medical emergency procedures (so they can serve as members of the ERT (Emergency Response Team)) may be a better option. When security personnel are members of the ERT, internal policies must address whether security personnel can leave their posts to respond to medical emergencies. If these alternative strategies are not feasible, you should make sure time measurements include a worst-case scenario that the ERT may encounter when required to pass through a security checkpoint.
- Areas which are more difficult for emergency medical teams to reach (such as deep inside a facility, upper floors in a tall building, inside secured areas or remote locations, like golf courses).
- Areas where people are engaged in strenuous activities, including exercise.
- Areas with a high percentage of elderly people, who are at higher risk for sudden cardiac arrest.
- AED and wall cabinet placement should meet the Americans with Disabilities Act (ADA) guidelines.
Where Should You Place Your AED?
Once it is decided who the emergency response team is, what communications will be relied upon, and which areas to protect, you can determine the number of AEDs needed and what their specific locations will be. Unfortunately, one simple formula does not apply to all facilities. Therefore, taking a walk through the facility, timing yourself with a stopwatch, and consulting a building diagram, may be the best way to determine the optimal number of AEDs needed and what their placement should be. Keep in mind that the ideal “drop to shock” time is no longer than 3 minutes.
- Highly visible and in wall mount brackets or glass cabinets on building walls in general view, similar to fire extinguishers.
- Near expected SCA emergency medical responders, such as a security or first aid station.
- Close to where the largest numbers of people spend their time.
- Protected from tampering, theft or damage (wall cabinets are alarmed).
- Easily accessed during the facilities’ hours of operation.
First Responder Training
The availability of trained SCA medical personnel greatly affects the effectiveness of an AED program. Security, safety, fire and medical personnel are usually the primary source of responders. Other “natural” responders include “Hall Monitors,” “Floor Captains” or other personnel designated to assist or respond to various medical and non-medical emergencies. Finally, offering training for volunteer responders should be required. The more personnel trained in a facility increases the likelihood of a timely and effective sudden cardiac arrest response. The goal of an AED program is to have multiple responders and multiple AEDs arrive at the scene of an SCA medical emergency in the least amount of time.
The American Heart Association recommends defibrillation in 3 to 5 minutes - ideally in less than three minutes. Each additional minute without defibrillation lowers the rate of successful resuscitation from an SCA by 7 to 10 percent. In order to achieve a good response time, and improve the chances of a successful SCA resuscitation, there must be enough AEDs in the right places, a clear communications pipeline, and enough people trained to respond quickly.