When Life Is Measured in Minutes

Sudden cardiac arrest can occur on the job and reacting to it properly is critical.

By Alexandra Walsh

Here are some sobering statistics from the National Safety Council.

  • Deaths from heart attacks occur 70% of the time before reaching the hospital.
  • Someone without oxygen can suffer brain damage in just 4 minutes and brain death in just 8 to 10 minutes.
  • In many cases, it can take 10 minutes or more for emergency medical personnel to arrive at their destination.
  • More than 4100 workers died on the job in 2020.

Sudden cardiac arrest can occur at work and on jobsites. According to recent statistics from the American Heart Association, there are 250,000 out-of-hospital sudden cardiac arrests annually. The actual number that happen while people are at work is unknown.

Sudden cardiac arrest is caused by an abnormal, uncoordinated beating of the heart or loss of the heartbeat altogether, usually as a result of a heart attack.

Workplace occurrences such as electrocution or exposure to low oxygen environments can lead to cardiac arrest. Overexertion at work can also trigger sudden cardiac arrests in those with underlying heart disease.

If an employee collapses without warning and is not being attended to promptly and effectively, the employee may die.

The outcome of occupational illnesses and injuries may rely on prompt, properly administered first aid. This will depend on determining what first-aid supplies are needed and where to place them at your workplace.

In the Occupational Safety and Health Administration’s (OSHA) Best Practices Guide: Fundamentals of a Workplace First-Aid Program, the agency notes a first-aid program should be reviewed periodically to determine if it still continues to address the needs of the specific workplace. This includes assessing first-aid supplies that should be added or modified to account for changes since the previous review.

Standards of Care

Because sudden injuries or illnesses, some of which may be life-threatening, occur at work, the OSHA First Aid Standard (29 CFR 1910.151) requires trained first-aid providers at all workplaces of any size if there is no “infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees.”

In addition to first-aid requirements of 29 CFR 1910.151, several OSHA standards also require training in cardiopulmonary resuscitation (CPR) because sudden cardiac arrest from asphyxiation, electrocution, or exertion may occur.

CPR may keep the victim alive until Emergency Medical Services arrives to provide the next level of medical care. However, survival from this kind of care is low, only 5% to 7% according to the American Heart Association.

First-Aid Kit Supplies

The supplies in the company’s first-aid kits should be adequate, reflect the kinds of injuries that occur, and be stored in an area where they are readily available for emergency use.

A specific example of the minimal contents of workplace first-aid kits is described in the American National Standards Institute standard Z308.1. The kits described are suitable for small businesses, OSHA points out. It is best if a staff member determines how many first-aid kits are needed for large operations and whether it’s appropriate to supplement the kits with additional first-aid equipment and supplies.

Also, if you have unique or changing first-aid needs, consider upgrading your kits. Using OSHA Forms 300 and 301 or other records may be helpful to identify your workplace’s first-aid supply needs. Consultation with the local fire and rescue service or emergency medical professionals also may be beneficial.

OSHA says an automated external defibrillator (AED) should be considered when selecting first-aid supplies and equipment. The agency recommends employers give a specific person the responsibility of choosing the types and amounts of first-aid supplies.

Automated External Defibrillators

With recent advances in technology, AEDs are now widely available, safe, effective, portable, and easy to use. They provide the critical and necessary treatment for sudden cardiac arrest caused by ventricular fibrillation, which is the uncoordinated beating of the heart leading to collapse and death.

Using AEDs as soon as possible after sudden cardiac arrest—within 3 to 4 minutes—can lead to a 60% survival rate. CPR is of value because it supports the circulation and ventilation of the victim until an electric shock delivered by an AED can restore the fibrillating heart to normal.

All worksites are potential candidates for AED programs because of the possibility of a sudden cardiac arrest and the need for timely defibrillation. Each workplace should assess its own requirements for an AED program as part of its first-aid response

Several issues should be considered in setting up a worksite AED program: physician oversight; compliance with local, state, and federal regulations; coordination with local EMS; a quality assurance program; and a periodic review.

Placement of Kits

OSHA’s 1910.151(b) standard states: “In the absence of an infirmary, clinic or hospital in near proximity to the workplace which is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid.”

Regarding “near proximity,” the agency says that in areas where incidents resulting in suffocation, severe bleeding, or other life-threatening or permanently disabling injury or illness can be expected, a 3- to 4-minute response time is required. In other circumstances when a life-threatening or permanently disabling injury is unlikely, a longer response time of 15 minutes is acceptable.

Employers can use these response times to determine the placement of first-aid supplies in the workplace. For example, if you have a work area where life-threatening injuries could occur, first-aid kits should be accessible within 4 minutes. For work areas where life-threatening injuries aren’t expected to happen, first-aid kits should be accessible in less than 15 minutes.

When deciding on the number of AEDs to purchase, remember that responders should be able to reach the victim, make an assessment, and begin treatment within 3 to 4 minutes.

Skills Update

First-aid responders at the company may have long intervals of time between learning and actually needing to use their CPR and AED skills. Numerous studies have shown a retention rate of six to 12 months of these critical skills.

The American Heart Association’s Emergency Cardiovascular Care Committee encourages skills review and practice sessions at least every six months for CPR and AED. Instructor-led retraining for life-threatening emergencies should occur at least every year. Retraining for non-life-threatening response should occur periodically.


These websites can provide additional information about AED program development and are great resources of information about safety and cardiac arrest.

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Alexandra Walsh is the vice president of Association Vision, a Washington, D.C.–area communications company. She has extensive experience in management positions with a range of organizations.