QUICK REFERENCE CONTACTS
AC/AHS AED MEDICAL DIRECTOR: Warren Silverman, MD
Phone: 518-782-2200
Fax: 518-786-1875
E-mail:
Address: 776A Watervliet Shaker Road
Latham, New York 12110
AC/AHS AED PROGRAM SPECIALIST: Edward E. Rolfe, Jr.
Phone: 518-782-2200
Fax: 518-786-1875
E-mail:
Address: 776A Watervliet Shaker Road
Latham, New York 12110
CPR and AED Training can be provided through any of the following organizations:
· American Heart Association
· American Red Cross
· National Safety Council
· ASHA – American Safety and Health Institute
· Medic First Aid International
If training is to be provided by an organization other than what is listed above, the training curriculum and provider must be approved by the AC/AHS Program Medical Director prior to training being received.
Training provided by Access Compliance Rate $ ______
Training provided by outside source Rate $ ______
HEALTH UNIT CHANGE OF INFORMATION FORM
Please complete this form if your AED Site Coordinator or Area Nurse Manager’s contact information changes, or if your AED unit is located anywhere other than in the health unit with the other emergency equipment. Fax it to 518-786-1875.
AED Site Coordinator or ANM Contact Information
Name: ______
Phone: ______
Fax: ______
E-mail: ______
Address: ______
______
______
Relocation of AED within your current building
Serial Number / Old Location / New LocationClosing of Health Unit: Please contact the AC/AHS AED Program Staff at 518-782-2200 to coordinate returning your AED equipment to AC/AHS if your facility closes.
AUTOMATED EXTERNAL DEFIBRILLATOR PROGRAM AND PROTOCOL
1. Introduction and Overview
In 1990, the American Heart Association challenged the medical equipment industry to create and manufacture a device that was small, lightweight, easy to use, durable, maintenance free, and voice prompted to defibrillate individuals who experienced a sudden cardiac arrest (SCA). Within 3 years, the industry accepted this challenge, creating a device that is known today as an Automated External Defibrillator (AED).
The design of AEDs is intended for use by emergency medical technicians, police, firefighters, and other first responders (including trained lay responders) to safety use on persons afflicted with a sudden cardiac arrest. A delay in returning a victim’s heart to normal electrical activity within 5 minutes significantly reduces the chance for survival. For optimal benefit, defibrillation must occur as soon as possible after a collapse from a cardiac arrest. AEDs enable minimally trained personnel to safely restore a victim’s heart from ventricular fibrillation (completely disorganized electrical activity, and its consequent absence of effective pumping activity) to the victim’s previous electrical activity, and in turn, effective pumping activity. Studies have shown AEDs to be safe and effective in the hands of trained first responders.
The importance of providing AED access is illustrated by the following facts:
· Approximately 350,000 people die of cardiac arrest in the United States per year.
· Over 95% of these occur outside of a hospital-and no more than 5% of these survive.
· For each minute that a person’s heart is in ventricular fibrillation, the chance of survival decreases by 10%.
· In cities where AEDs are widely used by first responders, 45% of victims survive sudden cardiac arrest. In cities where they are not used, less than 2% survive. Nationwide, the survival rate is less than 10%.
· In cities where CPR training is widespread and EMS response is rapid, the survival rate increased from 9% to 30% when automated external defibrillators were made available to first responders.
· In locations where AEDs have been deployed and where adequately trained personnel are available to respond, survival rates have reached up to 57%.
Whereas most adults spend at least a third of their day at work, it is prudent to place AEDs in the workplace where sudden cardiac arrest may likely occur. Since most local Emergency Medical Services require several minutes to reach a work site, placing an AED within the work place decreases the amount of time it would take for an AED to be available to defibrillate a victim, thereby increasing the victim’s chance for survival.
Under the Occupational Safety and Health Administration’s OSHA General Duty clause, employers have a legal obligation to provide a safe work place. In the OSHA Technical Bulletin, December 2001, OSHA recommends that employers should consider the use of AEDs in the workplace in the event of a sudden cardiac arrest. Simply calling 911 for local EMS may no longer be enough. OSHA’s 2003 bulletin 3185 states that “about 10,000 sudden cardiac arrests occur at the workplace. Waiting for the arrival of emergency medical system personnel results in only a 5-7% survival rate. Studies have shown that immediate defibrillation results in up to a 60% survival rate one year after a sudden cardiac arrest.”
AC/AHS recommends placement of automated external defibrillators in the following types of locations:
· Work places where large numbers of people are present, either as employees or visitors from the general public (large office buildings or complexes.) However, a smaller number of occupants should not preclude an agency from placing an AED on site where it may also be of benefit to those working there;
· Work places where access is limited due to security measures;
· Work places where, due to the size of the physical facility, remote location, or working aboard a ship, AED access from emergency medical service personnel may be delayed in reaching the victim;
· Work places where, due to the nature of the work performed and work place hazards (e.g., high voltage electricity, certain chemical exposures, drowning, hypothermia, etc.), workers are at higher risk of sudden cardiac arrest and ventricular fibrillation.
2. Scope
This document describes the policies and procedures for the AC/AHS Health Unit relating to its early defibrillation program and utilizing employees who serve as trained responders in CPR and AED therapy in the event of a sudden cardiac arrest.
3. Purpose
The purpose of this document is to establish a consistent guideline for application, location, maintenance, and various other components described herein involving your Health Unit’s early defibrillation program. It is the intent of your Health Unit to provide the appropriate AED coverage for this entity in accordance with established guidelines and applicable federal, state, and local laws. A response time of three (3) minutes from a witnessed collapse, or discovery of the victim, to the arrival of first responders is the intended goal in order to increase survivability in the event of a SCA.
4. Definitions
· AED Response Team Member/First Responder/Lay Responder or Rescuer. In this protocol we use these terms interchangeably to refer to an individual who is trained in CPR and AED usage and is expected to respond to SCA medical emergencies.
· Automated External Defibrillator (AED). A semi-automated computerized medical device programmed to analyze heart rhythm, recognize rhythms that require defibrillation, and provide visual and voice prompts to the device operator. The AED instructs the operator to deliver an electric shock if indicated after ensuring all personnel are clear.
· Cardiopulmonary Resuscitation (CPR). Artificial ventilation and/or external cardiac compression applied to a victim in respiratory and/or cardiac arrest.
· Emergency Medical System (EMS). Professional community responder agency for emergency events, which provides medical assistance and/or ambulance transport.
· Sudden Cardiac Arrest (SCA). A significant life-threatening event when a person’s heart stops or fails to produce a pulse.
· Chain of Survival. The Chain of Survival is a four-step process of providing treatment to victims of sudden cardiac arrest. The first link is early access to care (calling 911 to request EMS personnel to the scene). The second link is early CPR. The third link is early defibrillation available at the site of the emergency with trained rescuers able to deliver an electric shock to the victim. The fourth link is early advanced care (i.e. paramedic/doctor).
5. Early Defibrillation Program Goal
The goal of the Early Defibrillation Program is to participate actively in the Chain of Survival by providing a trained responder with an AED to the victim of a sudden cardiac arrest (SCA), on site, within three minutes of a witnessed collapse or discovery of the victim.
Chain of Survival
1 2 3 4
Early Access à Early CPR à Early Defibrillation à Early Advanced Care
AED PROTOCOL POLICY
This policy addresses requirements for medical direction, acquisition, placement, training, and implementation of your AED program.
1. AED Medical Direction
Health and Human Services’ and the General Services Administration’s “Guidelines for Public Access Defibrillation Programs in Federal Facilities” state that “AEDs are medical devices that are to be used under the advice and consent of a physician only by individuals with the proper training and certification. Therefore, medical oversight is an essential component of federal government AED programs.” These guidelines can be found at http://www.foh.dhhs.gov/public/WhatWeDo/AED/HHSAED.ASP.
The 2005 American Heart Association Guidelines for CPR and Emergency Cardiac Care (ECC) state that oversight by a health care provider is a key component in lay rescuer AED programs.
The role of the AC/AHS Medical Director is to:
· Provide medical leadership, including coordination with local EMS and 911 centers.
· Provide guidance in equipment selection and deployment.
· Develop guidelines for responder actions.
· Oversee medical care that is rendered through the program, including review of all AED Team responses to medical emergencies.
· Ensure appropriate initial training and skill maintenance.
· Assume overall responsibility for the conduct and operation of all victim care related activities.
2. AED Protocol Disclaimer
The scope of this protocol is specific to first responder use of AEDs and CPR as it relates to AED use. This protocol is intended to be complementary to your agency’s existing emergency response protocol. This protocol in no way covers or fulfills the obligation of a general medical emergency protocol. This protocol covers AED use by first responders. Some members of the AED response team will be lay responders and some may also be trained health care personnel. As stated in the American Heart Association’s 1997-1999, Heartsaver AED for the Lay Responder and First Responder, pages 6-7, “A lay rescuer cannot attempt to help in a manner that exceeds his or her skills or violates training.” Trained health care personnel who respond to emergencies will follow their own agency’s protocol for the treatment of conditions other than those requiring the use of an AED.
3. “Do Not Attempt Resuscitation” (DNAR) Requests
A situation may be encountered where the victim of cardiac arrest has previously expressed a wish to forego resuscitation attempts if cardiac arrest occurs. A “Do Not Attempt Resuscitation” request will be honored if the victim is wearing a “Do Not Attempt Resuscitation” (DNAR) Medical Alert bracelet or necklace. If a victim is found to be in apparent cardiac arrest, and the above stated requirement is met for DNAR, respect the person’s wishes. Call 911 and report the problem as a “collapsed, unresponsive person who has documented a no-CPR request”, remain with the person, and await EMS personnel arrival.
If it is undocumented or unclear whether the victim has a valid DNAR order, proceed with assessment, CPR, and AED use as indicated by the victim’s condition. The EMS professionals and hospital personnel will make any further determinations.
MOLST forms will also be honored. (Medical Orders for Life Sustaining Treatment)
4. Program Notification & Employee Education
The AC/AHS AED Program Staff recommends that agencies involved in the AED Program notify ALL of their employees regarding the existence of this program. Some methods of communication include: email, posted notifications on bulletin boards, handouts in a public area such as the employee lounge/cafeteria, the front lobby, and in staff meetings. It is recommended that more than one form of communication be utilized by your agency to ensure that all employees are notified of this program.
Cards with your site-specific procedure are strongly recommended by the AED Program Staff. These cards can be placed by each employee’s phone.
COMPLIANCE WITH AED PROTOCOL
Maintaining quality in AHS’ AED Program is essential to ensure an appropriate response from the AED Response Team during a sudden cardiac event. In order to maintain high standards in the AED Program, the following actions will be implemented when a participating Agency is non-compliant with the AED Protocol developed and supervised by AHS.
The following will apply to all aspects of the AED Program as written by the AHS AED Program Staff for a specific site. The following interventions are intended to: 1) maintain the readiness of the Agency’s AED Response Team to react to a sudden cardiac event and, 2) limit liability for the Agency and AHS. These interventions are not meant to be punitive in any way, but will maximize safety and minimize liability.
Definition:
A major flaw is defined as a situation that endangers the integrity of the AEDP.
Action:
If there is a major flaw with the Agency’s compliance with the site-specific AED Protocol, the AHS AED Medical Director will have the discretion to suspend medical supervision and oversight of the AED Program as well as strongly recommend the AED machines be removed from first responder access until the major flaw is corrected.
A request to take corrective action to remedy the situation shall be made by the AHS AED Medical Director to the Agency AED Site Coordinator, Program Representative, or other designated individual.
After the major flaw has been corrected, the AHS AED Medical Director will communicate to the Agency Program Representative or his/her delegate to re-open their AEDP.
Examples: Lack of an agency AED Site Coordinator.
In this situation, the integrity of the program is threatened as there is no mechanism for maintaining records of equipment and supply inventories, equipment operating status, coordinating training, maintaining certification records or coordinating mock drills and periodic update training.
Lack of properly trained responders.
In this instance, there is no legal protection for your Agency or the AED responders. Untrained/poorly trained responders decrease the probability of a successful outcome at a sudden cardiac event.
For other non-compliance issues, the following “actions” will be completed in sequence as outlined until the non-compliance issue is resolved or the series of “actions” has been completed.