Bad Managers cause heart disease .....?

Here's an interesting thought for you..... maybe you should seriously consider getting an AED for your office if you have a tyrannical manager.

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A recent study traces a link between poor management and heart disease among employees. It has been proven that employers should reconsider their managing styles if they are to ensure that workers’ health isn’t endangered. 3 000 workers were interviewed on issues regarding adequate communication between management and staff, senior managers’ attitude towards their juniors, as well as clearly set goals and overwork. Results show that mutual respect accounts for healthier employees and healthier businesses as a whole.

While it is a fact that some people work better under pressure, excessive pressure in the work place, causes the majority to act inadequately and produce less. Experts concluded that taking precautions to ward off work-related stress will also save a business time and money. The negative effects can result in absenteeism, low productivity, employee tardiness and increased customer complaints. Therefore, companies are advised to re-train bosses in order to improve employees’ health and ensure thriving businesses.

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Defibrillators and Hong Kong

The Hong Kong government takes one step closer to full implementation of defibrillators (AEDs) across society.

Good news!

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HK GOVERNMENT PRESS RELEASE CONCERNING AEDs

LCQ4: First aid treatment for heart attack

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Following is a question by the Professor Hon Patrick Lau and an oral reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (March 4):

Question:

Heart disease is the number two killer-disease in Hong Kong, claiming about 17 lives on average every day. According to some scientific researches, every one-minute delay in administering electric shock to patients suffering from a heart attack (sudden cardiac arrest) will reduce their survival rate by 7% to 10%. On the other hand, if automatic external defibrillators (AEDs) are installed at public places so that electric shock can be administered to such patients immediately, the number of persons rescued can be increased by more than one half. Hence, it is common that public places (such as government buildings, schools, shopping arcades and underground railway stations, etc.) in countries such as the United Kingdom, the United States and Japan have AEDs installed, and at the airports of such countries, AEDs are installed at intervals of 50 metres to 100 metres. Although a few places in Hong Kong have AEDs installed at present, the usage rate is on the low side due to insufficient publicity and inconvenient locations. In this connection, will the Government inform this Council:

(a) given the small size and affordable prices (around $10,000-odd each) of AEDs, whether the Government will make reference to overseas practices and install AEDs at locations in the vicinity of fire hoses, public lavatories or lifts at various public places (including the Legislative Council Building and all government buildings), and encourage private organisations to follow suit; if it will, of the details; if not, the reasons for that; and

(b) given that it is easy and simple to operate an AED, which can automatically assess the patient's heart rate and then administer the electric shock as appropriate, and that in Seattle of the United States, upon enhancement of citizens' first-aid knowledge and installation of AEDs at a number of places across the city, the survival rate of persons suffering from sudden cardiac arrest has increased tremendously from 1% to 3% to 16% to 25%, whether the authorities will launch campaigns to teach the public how to use AEDs, with a view to enabling people nearby to give first aid to a person suffering from sudden cardiac arrest within the critical five-minute period, thereby reducing the rate of sudden death of persons suffering from sudden cardiac arrest; if so, of the details; if not, the reasons for that?

Reply:

President,

Automatic external defibrillators (AEDs) are devices used to perform cardiac resuscitation on patients. Overseas research has shown that with the simultaneous use of an AED in the course of performing cardiopulmonary resuscitation (CPR) on a patient suffering from heart attack, the survival rate of the patient could be increased. At present, all ambulances of the Fire Services Department (FSD) are equipped with AEDs. AEDs are also used by public hospitals to perform cardiac resuscitation on patients. While AEDs are simple to operate, consideration must be given to the patients' prevailing circumstances and attention must be paid to the operation procedures before using them on patients. In this connection, AED users must first receive training on first aid and operation of the device. In addition, they must clearly understand that the use of AED is only part of the first aid procedures and the patients still need to be sent to hospitals for medical treatment as quickly as possible.

My reply to the two parts of the question is as follows -

(a) & (b) With the increase in wealth in society, the change in eating habits and the lack of exercise, there is an increasing prevalence of heart disease with signs of early occurrence among the public. The Government therefore encourages people to receive first aid training so that they can perform first aid on patients suffering from heart attack. The first aid training includes CPR and automated external defibrillation.

In fact, the FSD has implemented a Community Cardiopulmonary Resuscitation Training Scheme since 1999 to provide free CPR training to the community and encourage the trained members of the public to perform CPR on people suffering from heart attack before the arrival of ambulance personnel. So far, over 20,000 people have participated in the Scheme.

The FSD has also implemented a Public Access Defibrillation Scheme since 2006. Under the Scheme, free CPR and automated defibrillation training is provided with the aim of encouraging institutions to install AEDs in public places, and enabling those who have been trained to perform first aid on people suffering from heart attack. So far, more than 2,000 people have received training and acquired the basic theories of the two first aid skills and knowledge on the use of relevant device. The people who have received training include staff of property management companies, airport security personnel, staff of residential care homes for the elderly, government staff, staff in the hotel industry, MTR staff, fire safety ambassadors, civilian staff of the FSD, etc.

In addition, the Hong Kong College of Cardiology, Hong Kong Red Cross and Hong Kong St. John Ambulance also offer similar training courses. About 15,000 people have been trained so far.

At present, AEDs have been installed at a number of places in the territory, including office buildings, theme parks, schools, large shopping malls, private housing estates, private clubhouses, commercial buildings, nursing homes, etc. We welcome the increasing popularity of the device. To facilitate wider use of AEDs and to further promote first aid treatment for heart attack in the community, we will enhance our communication and collaboration with the institutions concerned and work together with them. The ultimate goal is to enable more members of the public to offer assistance to people in need by giving first aid treatment. Prior to formulating the long-term specific policy on the promotion of AEDs, the Government will carefully examine all relevant factors, including safety of the device, usage of the device in the territory, the number of people who have received training on the operation of the device, overseas experience, etc.

Ends/Wednesday, March 4, 2009
Issued at HKT 15:54

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Automated external defibrillator, AED Legislation and the case for-and-against ACTIVE ABSTINENCE

In Hong Kong, there is currently no restriction on the usage, ownership and sales of AEDs.

Being a leading international financial centre and world city, many overseas visitors do expect similar "heart safe" environments like they are used to in their home country.

Liability is placed on whether places such as leading businesses, hotels, convention centres and places of high human traffic, are equipped with such AED devices, more than the responsibility of a failed resuscitation attempt. Family members of visitors with SCA incidents will ask the question, "was an AED deployed during the resuscitation attempts?" If it wasn't your will be found liable.

In plain speak, if you have a failed resuscitation attempt on your premises, then there is a small chance that your emergency response procedures could be picked apart and any failings will be highlighted and this could lead to legal action. YOUR WHOLE EMERGENCY PROCEDURE WILL BE SCRUTINIZED, NOT JUST THE AED.

On the other hand, if you have a failed resuscitation attempt, and you do not have an AED on site, you will almost definitely be sued and face significant payouts. Take for example Caritas hospital, which is now in the process of being sued for millions of dollars for the death of a man outside its premises. A significant factor in this case is that an AED could not reach the person in time - because the hospital didn't have any! We will see if this case goes to court, I doubt that it will and the H.A will probably settle. Without an AED onsite, this is what you can expect as the most likely course of any failed resuscitation attempt.

Often businesses are worried that if they stock an AED, and it doesn't get there on time then they will be sued.

The answer to this problem is quiet simple - If your emergency procedures are that weak that you can't guarantee getting an AED to a victim quickly, then it's your procedure that is lacking, and not the AED. After all an AED is just an inanimate object and can't get to an emergency by itself. It needs human interaction to save a life. The only difference in the outcome will be that if you have an AED and it doesn't get to the emergency on time, at least you can say you had attempted to provide adequate cover, but on this occasion your emergency plan failed. However, if you have no AED and your emergency plan fails, you will be sued and almost certainly lose, as your failed to offer the best emergency plan available, depsite having both the means and the knowledge to do so.

If you think you can win a court case against you for not stocking an AED then you will be bucking a serious trend. As Dirty Harry might say, "You feelin lucky?"

The AED is only as good as your emergency response program, if the procedures are bad, then you're likely to get sued regardless.

AEDs just enhance your emergency program, they don't define it, make it or carry it out.

In an emergency that has a a bad outcome, the investigators are going to want to tick all the boxes

Was the emergency services called in time?
Did a CPR trained person attend as quickly as possible?
Were their first aid certificates up to date?
Did they practice their skills properly?
Was the AED brought to the scene quickly?
Was it used properly according to the training?
Were security informed and allow quick easy access for the ambulance?

These and other such questions will be asked.... the weak link in all this is the human element. 99.99999% of the time the AED will work absolutely like it should. And that 0.00001% of the time it fails, it's probably not going to be your fault.

Sometimes legal teams advise against stocking AEDs. On occasions like this, you should ask your legal team to provide you with cases where companies who were being sued for not stocking an AED and have won. Compare this to the amount of companies that have lost legal cases for not stocking an AED, then make an informed choice. Ostrich theory, ie, sticking your head in the sand and hoping it doesn't happen to you is not a legal defense.

Ultimately, the choice of whether to stock or not stock an AED is about saving a life not liability.

If you take time to break down the steps of a CPR emergency you will find that the chances of being sued are incredibly small, whereas the chances of being sued if you do not have an AED gets bigger everyday. I'll say that one more time, the chances of being sued if you do not have an AED gets bigger everyday.

Another argument against not stocking AEDs roughly goes like this - Calling the emergency services is the only thing that can be done for a patient, anything else could possibly endanger the victim. So as to avoid any further complications in the life-saving process, do as little as possible, then you can't be found responsible or at fault.

This argument is seriously flawed. If this argument were true, then first-aid would never have been created. Samaritan laws, or the likes, exist to protect people from being sued when they come to a person's aid. In an emergency it is essential that we offer as much assistance through first aid as possible. First-aid has been developed by medical professionals, and really makes a critical difference in an emergency. The process has been broken down into steps and in order to save a life we simply follow our training. Using a defibrillator is just one recommended step in the process. This step has been sanctioned by all governing bodies. globally. If your emergency procedure only includes CPR and no AED then what you're effectively doing is saying, "Well, I'll follow these steps here, but I don't want to follow that one." Which is overriding professional advice.

If the best path legally and morally was to do nothing or just half of the steps recommended before the ambulance arrived, then first aid wouldn't exist, and would have been annihilated by the lawyers years ago.

There are an ocean of doctors and medical professionals that actively support AEDs and are happy to stake their professional reputations on them. Contrary to this, there are how many professional bodies that actively encourage people NOT to have AEDs? I think none. How many lawyers actively promote, in public, that AEDs should not be used. How many lawyers stake their careers on this kind of advice. I think none.

The day I see a large law firm come out and say that AEDs should NOT be used by any reasonably, confident citizen is the day I will take the ACTIVE ABSTINENCE argument seriously and probably get out of the life-saving business.

Until then, I recommend that you get an AED. Your liability does not increase if you own one but your chances of saving someone significantly increases. It really is a no brainer. Throughout history, medical development has been plagued by "nay-sayers" who have worked tirelessly behind the scenes to thwart good ideas. The AED is no different.

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