There is scientific consensus that regular exercise can reduce the risk of cardiovascular disease and events. However, medical evidence suggests that vigorous physical activity can be a trigger for sudden cardiac arrest (SCA) in susceptible competitive young athletes with hidden congenital abnormalities or sedentary adults with coronary heart disease.
SCA is the electrical malfunction of the heart that can only be restored to its natural rhythm with rapid initiation of CPR and timely defibrillation on patients with a shockable rhythm known as ventricular fibrillation (VF) or ventricular tachycardia (VT). The chance of survival from an SCA declines approximately by 10% for each minute defibrillation is delayed.
In the USA, recommendations have been published by leading health and industry organisations such as the AHA and ACSM for health/fitness facilities to install automated external defibrillators (AEDs) where a probability of one event occurring every 5 years was considered to be a high risk. Since the publication of the Cardiac Arrest Survival Act 2000 as a federal law, many states in the USA have passed legislation that mandates AEDs at public locations, including schools and certain health/fitness facilities (Sekendiz & Quick, 2011).
In Australia there are currently no laws or industry standards that require AEDs at public locations including health/fitness facilities. In 2012, St John Ambulance Australia, the Australian Resuscitation Council and the National Heart Foundation of Australia jointly called on the federal, state and territory governments to increase the number of AEDs in places where large amounts of people visit, including fitness facilities and sport venues. Under the Work Health and Safety Act 2011 (Cth) business operators must consider and manage all health and safety risks associated with the services that they supply. The First Aid in the Workplace Code of Practice recommends businesses where large number of people visit or at remote locations to install an AED for use by trained or untrained persons to minimise the risk of fatality from SCA. Despite nationwide subsidy programs and campaigns to make AEDs more accessible and affordable at public sport clubs, the uptake and promotion of AEDs in the health/fitness industry has been suboptimal. Therefore, knowledge on the incidence of SCA at health/fitness facilities is crucial for evidence informed policy for placement of AEDs.
In order to fill this gap of knowledge, an Australia first research study was conducted by Dr Betul Sekendiz, which was published in Emergency Medicine Australasia in 2021 (Sekendiz, 2021). The research study analysed the de-identified electronic data obtained from the Queensland Ambulance Services for the 8-year period from January 2007 to January 2015. The results revealed approximately one in 10 non-traumatic out of hospital sudden cardiac events in public places occurred at exercise and sport facilities.
Among these facilities, health/fitness facilities had the second highest incidence of cardiac arrest (29, 12%) after golf clubs (41, 16%). The standardised incidence rate of an SCA at health/fitness facilities was reported to be 1 in 100,000 participants per year. All events were witnessed and 79% (23) of facilities had bystander-initiated CPR present on arrival of paramedics. However, only 57% of the bystanders were applying CPR effectively. Effective CPR is described as minimally interrupted and approximately 100 compressions per minute with a minimum depth of 4–5 cm into the chest wall, according to the adult basic resuscitation guidelines.
A lack of bystander-initiated AED was also identified at these health/fitness facilities, which was utilised at only 13.8% (4) of the facilities. While it is unknown whether an AED was installed at these facilities, a cross-sectional study in 2009–2010 in Queensland reported only one in five health/fitness facilities had an AED (Sekendiz et al., 2014).
Earlier studies found higher rates of bystander-initiated CPR and AED at exercise and sport facilities that is associated with greater survival to hospital discharge and better neurological outcomes. The results of this study supported these findings; however, found that effectiveness of bystander-initiated CPR when combined with an AED was more important to increase the odds of survival by more than twofold.
An AED is a portable and sophisticated medical device designed to be safely used by a non-medically trained first responder. It automatically checks for the heart rhythm of a patient and prompts the rescuer to initiate shock or apply CPR as necessary through audio-visual feedback. Therefore, it is highly unlikely to cause harm to a patient while using an AED. There are also Good Samaritan laws that protect the volunteer rescuers from liability when an AED is used in good faith without recklessness (Sekendiz & Quick, 2011).
Furthermore, an advanced AED equipped with sensory accelerometer technology can capture the rate and depth of each chest compression and assist a rescuer to deliver effective CPR. This may explain the findings in this study that showed effectiveness of CPR was highest when bystanders used an AED (90.6%, 29).
in this regard, utilisation of AEDs at health/fitness facilities can enhance the quality of bystander CPR until paramedics arrive, which is extra crucial for timely response at remote or regional geographical locations or at facilities during non-supervised hours.
In conclusion, current evidence shows that SCA is a reasonably foreseeable type of adverse health event in the health/fitness facilities in Australia. Effective bystander CPR combined with an AED can significantly increase the chances of survival of a patient by more than two-fold. Therefore, emergency response plan and procedures at health/fitness facilities should include an AED and regular practice drills with staff and volunteers to maintain CPR skills which can start to decline after the first 3 months of training.
The cost of installing and maintaining an AED is unburdensome and is outweighed by the benefits of saving a life. If you are considering installing an AED or need assistance with your health/fitness facility`s risk assessment including emergency response plan and procedures, don`t hesitate to contact FIRMC® with your inquiry.
References
Sekendiz, B. (2021). Incidence, bystander emergency response management and outcomes of out-of-hospital cardiac arrest at exercise and sport facilities in Australia. Emergency Medicine Australasia, 33: 100-106. https://doi.org/10.1111/1742-6723.13595
Sekendiz, B., Gass, G., Norton, K., & Finch, C. (2014). Cardiac emergency preparedness in health/fitness facilities in Australia. The Physician and Sportsmedicine, 42(4), 14-19. https://doi:10.3810/psm.2014.11.2087
Sekendiz, B., & Quick, S. (2011). Use of automated external defibrillators (AEDs) in managing risk and liability in health/fitness facilities. International Journal of Sports Management and Marketing, 9(3-4), 170-184. https://doi:10.1504/IJSMM.2011.041570