Take this advice to heart

This week I'm going to tackle a topic that involves technology and should be very close to your heart -- and is a pet concern of mine: cardiac defibrillators and why every company, large or small, should have one.

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A week ago, a middle-aged man on a commuter train outside of Boston went into cardiac arrest. While bystanders performed CPR, the train lumbered on, making regular stops, for 20 minutes until it reached downtown Boston. The man died.

The conductors argued that they thought the man could get better care at the downtown station, despite the fact the suburban towns through which the train traveled have excellent medical facilities. What the conductors probably didn't realize is that CPR -- as valuable as it is -- is only a "holding action," and an individual's chances of survival decrease rapidly with every minute of CPR.

What actually saves many lives is the reversal of a condition called ventricular fibrillation, a disturbance in which the heart beats in an abnormal sequence, due to a malfunction in its internal electrical impulses. The only thing that can reverse that, when it can, is early defibrillation: the application of a controlled electrical shock. Had there been such a device on the train, the Boston victim's chances might have improved significantly.

After several similar incidents on airplanes, U.S. airliners now carry the devices, and already they have been used successfully in several cases. The same has occurred in other ground-based venues where they've been tried.

Unlike the unwieldy paddle-type units that you might see on such television shows as "Emergency 911" or "ER," the newer units -- called AEDs (Automated External Defibrillators) -- can be operated by anyone with a few hours of training. These contain internal algorithms that monitor cardiac activity and advise the user when a shock is required. They then deliver a controlled, pre-programmed shock to the patient.

They have been made not only fool-proof, but "damn-fool proof." Not only will they deliver a shock when required, they will prevent the user from delivering a shock when inappropriate. All the user needs to do is attach two patches to the patient, follow the voice prompts, and push a button when told to do so.

Slightly larger than a laptop computer, the AEDs cost about the same as a fully-loaded "road warrior" machine, putting them squarely within the budget abilities of almost any organization. In fact, the question is whether any company, large or small, can afford not to have one.

Given the availability of the technology, its low cost, and ease of operation, I think you could make a good case that there is an ethical obligation on companies to provide this benefit for its workers. In fact, I think the burden is on managers to show why they can't afford it.

The prime way to justify such an expense is to determine the danger from someone's suffering cardiac arrest, the probability of an AED being successful, and the total benefit to be achieved -- and then offsetting that against the cost. The last time I checked the units were about $3,000.

I think it's clear -- or it should be -- that the danger is there. People of all ages and all medical conditions suffer out-of-hospital cardiac arrest. The AED units have proven themselves successful in enough situations to warrant their consideration. And the net benefit -- saving the life of someone who might otherwise die -- is well worth the minimal cost involved. Even in cases in which early defibrillation doesn't work, the person's family would at least have the knowledge that everything possible was tried.

It's important to understand that not every case of ventricular fibrillation will respond to the shock. Sometimes the heart is too damaged, and sometimes drugs are required to provide a boost to cardiac activity. But many cases will respond and, if only one does, then the small investment of a few thousand dollars will have been worth it.

Many companies offer CPR training. And while that should continue, AEDs would be a perfect adjunct to increase, by several orders of magnitude, the chances of survival for an affected employee.

If you work in a rural or suburban setting, then distance and scarce resources may be your enemy, increasing the time it will take for emergency crews to get to you. If you work in a city, then traffic congestion and competing emergencies may work against you. In either case an on-site defibrillator will increase the chance of survival.

I know from firsthand experience the frustration of performing CPR and watching life slip away as the minutes ticked by waiting for a defibrillator to arrive. I'd like to see AEDs become standard equipment in every building -- just as fire extinguishers are. If you agree, you may want to print this out and give it to an appropriate person at your company.

Do you have any ideas for ethics topics? Drop Carlton Vogt a note at ethics_matters@infoworld.com. To discuss any of these issues, you can go to the Ethics Matters forum at http://www.infoworld.com/forums/ethics .