Automated External Defibrillator

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1 Automated External Defibrillator 1. INTRODUCTION An automated external defibrillator (AED) is used to treat victims who experience sudden cardiac arrest. It must only be applied to victims who are unconscious, without a pulse and not breathing. The AED will analyze the heart rhythm and advise the operator if a shockable rhythm is detected. If a shockable rhythm is detected, the AED will charge to the appropriate energy level and advise the operator to deliver a shock. 2. REFERENCES Safety Procedures and Guidelines- Texas A&M-Corpus Christi, Section 1.1- Accident Reporting Texas Health and Safety Code, Chapter 779-Automated External Defibrillators Medical emergency action plan-division of Student Affairs Critical Incident Response Plan 2000 for the purposes of this policy Infection control procedure for occupational exposure to bloodborne pathogens: OSHA Health and Safety Compliance Manual for Health Care Facilities, Bloodborne Pathogens Policy and Exposure Control Plan State immunity from liability exclusion: -Civil Practice and Remedies Code, Chapter 108-Limitaiton of Liability for Public Servants -Civil Practice and Remedies Code, Chapter 104-State Liability for Conduct of Public Servants -Civil Practice and Remedies Code, Chapter 74-Good Samaritan Law: Liability for Emergency Care 3. PROCEDURES A. The AED and first aid emergency care kit will be brought to all medical emergencies. The AED may be used on any person who is at least eight (8) years of age. The AED should only be placed on a person after the following symptoms have been confirmed: 1. Victim is unconscious; 2. Victim is not breathing; and, 3. Victim has no pulse and/or shows no signs of circulation such as normal breathing, coughing or movement B. Each AED will have one set of defibrillation electrodes connected to the device and one spare set of electrodes with the AED. One resuscitation kit will be connected to the handle of the AED. This kit contains two pair gloves, one razor, one set of trauma shears, towels, and one facemask barrier device.

2 C. Additional procedures are detailed in Automated External Defibrillator Procedure attached to this policy. 4. DIRECTION AND LOCATION A. The AED devices are owned by Texas A&M University-Corpus Christi, Environmental, Health and Safety Office. This office is responsible for appointing the medical advisor and AED training coordinator. B. The AED devices are under the supervision of the University Safety Coordinator. C. Per the manufacturers recommendations, the AED devices are placed in areas that are easily accessible, where the service alarm will be readily heard, and periodical inspection of the AED will be facilitated. The AED s are located at: 1) AED 1 = University Police Department, assigned to patrol officer on duty; 2) AED 2 = University Policy Department, assigned to patrol officer on duty; 3) AED 3 = Field House, Room 103, wall mount; and, 4) AED 4 = Glascock Fitness Center, Room 105, wall mount D. System Verification and Review: the medical emergency response system is ultimately successful if necessary medical assistance is provided to victims in a timely and safe manner. Since actual use of this system procedure is expected to be very infrequent, other measures of effectiveness are required. 1) Annual System Assessment: Once each calendar year, the University Safety Coordinator or their designee, usually the AED training coordinator, shall conduct and document a system readiness review. This review shall include assessment of the following elements: a) Training Records b) Equipment operation and maintenance records 2) Monthly System Check: Once each calendar month, the University Safety Coordinator or their designee, usually the AED training coordinator shall conduct and document a system check. These records shall be retained for a period of seven (7) years. This check shall include review of the following elements: a) Phone operator checklist availability b) Emergency kit supplies c) AED battery life d) AED operation and status

3 5. AUTHORIZED USERS The AED device may only be used by: A. MERT members: Anyone who have successfully completed the American Heart Association Heartsaver AED training within the last two (2) years. B. Trained University Employee Responders: Any Texas A&M University Corpus Christi employee who has successfully completed an approved CPR and AED training program such as the American Heart Association Heartsaver AED or American Red Cross course and has a current successful course completion card. 6. RESPONSIBILITIES A. Medical Advisor The medical director of the AED program is the University medical advisor. The advisor is responsible for 1. Providing medical direction for the use of the AED device; 2. Writing a prescription for use of an AED device; 3. Reviewing and approving guidelines for emergency procedures related to use of AED s and CPR; and, 4. Evaluating post-event review forms and digital files downloaded from the AED. B. University AED Training Coordinator The University AED Training Coordinator is responsible for 1. Selecting MERT members and distribution of MERT member lists; 2. Organizing the AED training for emergency responders; 3. Coordinating equipment and accessory maintenance; 4. Revising this Automated External Defibrillator Policy as necessary, usually reviewed annually. 5. Monitoring the effectiveness of this system; and, 6. Communicating with the medical director on issues related to medical emergency response program including post event reviews. C. MERT Member A MERT Member is a Medical Emergency Response Team Member. The University Police Department ( UPD ) is the designated campus MERT, since they are the first responders to campus emergencies. The UPD is alerted of campus medical emergencies through calls received

4 by the UPD dispatch office. The UPD is responsible for: 1. Activating Corpus Christi Emergency Medical Services ( EMS ) by calling 911; 2. Providing prompt basic life support including AED and first aid according to training and experience; 3. Maintaining current First Aid, CPR and AED training; 4. Understanding and complying with the requirements of this procedure; and, 5. Following detailed procedures and guidelines as set forth by UPD policy and procedures. D. University Police Department Dispatcher The UPD dispatcher is authorized to deploy assistance and aid to the location of the emergency. The UPD Dispatcher is responsible for: 1. Receiving emergency medical calls from internal locations; 2. Assessing the emergency to determine the appropriate level of response; 3. Contacting Corpus Christi EMS; 4. Deploying the MERT to the location of the emergency; and, 5. Assigning others to meet the responding EMS vehicle to direct EMS personnel to the site of the medical emergency. E. Trained Employee Any University employee can, at their discretion, provide voluntary assistance to victims of medical emergencies. The extent of which these individuals respond shall be appropriate to their training and experience. These responders are encouraged to contribute to emergency response, but only to the extent that they are trained and prepared. The emergency medical response of these individuals may include CPR, AED or medical first aid. 7. TRAINING A. Initial Training: Training is coordinated by the University Safety Coordinator via the campus AED training coordinator. The AED training coordinator is responsible for maintaining record of AED training in accordance with Texas Legislation outlined in the Texas Health and Safety Code, ) MERT members: Must complete training adequate to provide basic first aid, CPR and AED. Training is provided on site. The AED training course provided is the American Heart Association Heartsaver AED course. MERT members are also trained in universal precautions against bloodborne pathogens. Each directorate will offer the members of the MERT and designated trained employees the hepatitis B vaccination series free. Individual directorates are

5 responsible for ensuring that training records are kept up to date with the AED training coordinator. 2) Trained Employee Responder: These responders will possess various levels of training in emergency medical response with training supplied by various sources. Trained employee responders can assist in emergencies, but must only participate to the extent allowed by their training and experience. For those employees designated to act as first responders in a medical emergency, training is the same as outlined for MERT members. B. Refresher Training: Individual departments are tasked with ensuring that the required refresher training is performed every six months. Records of such training will be reviewed at the time of the annual system assessment. The AED training coordinator is available to assist in accomplishing this required refresher training. First aid, CPR and AED training is renewed every two years. 1) Each MERT member and trained employee responders will have access to AED Challenge interactive training software. Contact the University AED Training Coordinator to obtain the software. 2) Each MERT member and trained employee responder will refresh AED skills using the computer based training. Every 6-12 months each will perform a three scenario test and submit this test to the AED training coordinator. 3) Refresher training is informal and available from certified instructors. 4) Renewal training is provided in the same fashion as the initial training. 8. MEDICAL RESPONSE DOCUMENTATION A. Post Incident Internal Documentation: It is important to document each use of the medical emergency response system. A report should be filed every time an AED device is used. NOTIFY THE UNIVERSITY SAFETY COORDINATOR AT AFTER ANY INCIDENT FOR WHICH THE AED IS USED. The following forms must be sent to the University Safety Coordinator via the AED Training Coordinator within 24 hours of a medical event: 1) Incident Report: usually completed by responding MERT member for each accident requiring first aid of any type. These reports are maintained for UPD use and do not require review by the AED medical director; and, 2) Injury and Illness Report: should be submitted by a MERT member or trained employee volunteer responder who handled the emergency. The report is for review by the AED medical director. An incident report can also be used.

6 B. Post Incident External Documentation: Medical emergencies involving the use of an AED require special documentation. Any and all patient information generated during AED use must be collected and placed in the patient s confidential medical file. A copy of AED use information shall be presented to the medical director of the AED program and the Nueces County EMS director within 72 hours of the emergency. At a minimum, event information supplied shall include any recorded data, and all electronic files captured by the AED. See Appendix 1, Data Management. 9. EQUIPMENT MAINTENANCE All equipment and accessories necessary for support of medical emergencies shall be maintained in a state of readiness and per manufacturer guidelines in accordance with legislation outlined in Texas Health and Safety Code, Specific maintenance requirements include: A. The UPD dispatcher shall be informed of changes in availability of emergency medical response equipment (i.e., is the AED available?). If equipment is withdrawn from service, the dispatcher shall be informed and then notified when equipment is returned to service. The UPD dispatcher is responsible for informing response teams of changes to availability of emergency medical equipment such as the AED. B. The University Safety Coordinator is responsible for having regular equipment maintenance performed. All maintenance tasks shall be performed according to equipment maintenance procedures as outlined in the operating instruction. See Appendix 2" for detailed maintenance and testing. The routine testing and inspection may be delegated by the Safety Coordinator to those directorates housing the AED. It is the Safety Coordinator s responsibility to ensure that the testing is done as prescribed. Monthly reporting of maintenance & inspection is due to the Medical advisor by the second Wednesday of each month. C. Following use of emergency response equipment, all equipment shall be cleaned and/or decontaminated as required. Most emergency response equipment is of the disposable type and shall be disposed of accordingly. After use, the AED is to be cleansed with a clean damp sponge or cloth and if necessary may be further cleaned with ammonia, isopropyl alcohol, or peroxide. 10. POST EVENT REVIEW Following each deployment of the MERT, or if another trained responder uses an AED device, a review shall be conducted to learn from the experience. The University Safety Coordinator will conduct and document a post event review. All key participants in the emergency must participate in the review. Included in the review will be identification actions that went well and the collection of opportunities for improvement as well as critical incident stress debriefing. A summary of the post event review must be sent to the Medical Advisor. The University Safety Coordinator will maintain a copy of the post event review summary according to the record retention policy.

7 By undersigning, I indicate I have read and understood the Automated External Defibrillator Policy, and I agree to comply with the policy. DR. BOBBY HOWARD, D.O. MEDICAL DIRECTOR SYSTEM OWNER REPRESENTATIVE SAFETY COMMITTEE REPRESENTATIVE VICE PRESIDENT, STUDENT AFFAIRS EXECUTIVE VICE PRESIDENT, FINANCE AND ADMINISTRATION PRESIDENT AUTOMATED EXTERNAL DEFIBRILLATOR POLICY Automated External Defibrillator Procedure Note: If AED is not immediately available, perform CPR until the LIFEPAK 500 unit arrives on the scene. Use of the AED is authorized for emergency response personnel trained in CPR and use of the AED. Medical Emergency Response Team Member (MERT) Assess scene for safety Determine unresponsiveness Activate system (dial 911) Open airway (A) Check for breathing (B)- if no breathing give two breaths

8 Check for pulse and or signs of circulation such as normal breathing, coughing, or movement (C) If no pulse and/or signs of circulation, apply AED immediately Turn on AED Apply electrodes) according to the diagram on back of electrodes to victims bare chest. Shave chest hair if it so excessive it prevents good seal between electrodes and skin. Press pads to skin. Stand clear of victim while machine analyzes heart rhythm SHOCK ADVISED Clear area, make sure no one is touching the victim. Push shock button when instructed. Device will analyze and shock up to 3 times. After 3 shocks device will prompt to check pulse (or for breathing and movement) and if absent, start CPR. If pulse and/or signs of circulation such as normal breathing and movement are absent, perform CPR for one minute. Device will countdown one minute of CPR and will analyze when CPR time is over. NO SHOCK ADIVSED Device will prompt to check pulse (or for breathing and movement) and if absent, start CPR. If pulse and/or signs of circulation such as normal breathing and movement are absent, perform CPR for one minute. If pulse/signs of circulation such as breathing and movement are present, check for normal breathing. If victim is not breathing normally, give rescue breathing at a rate of 12 per minute. AED will reanalyze after one minute. Continue cycles of analyses, shocks (if advised) and CPR until professional help arrives. Victim must be transported to hospital. Leave AED attached to victim until EMS arrives and disconnects AED. Promptly notify the University Safety Coordinator of event University Safety Coordinator will ensure: AED data will be downloaded within 24 hours (weekdays) with copies sent to EMS and authorizing physician via the AED training coordinator. After use: the AED will be wiped clean according to policy. Electrodes will be replaced and reconnected to device and contents of attached resuscitation kits will be replaced if used. Authorizing Physician Signature Date Print or type name Address

9 Telephone Registration number This authorization expires Appendix I Data Management I. Overview of data storage and retrieval A. Everytime you use the Lifepak 500 AED on a patient, data is stored digitally inside the AED. This allows for post-incident review for quality control, training, and research purposes. B. It is important that this data is printed or transferred as soon as possible to save the information. C. Whenever power is on, the LIFEPAK 500 AED automatically stores: Event Log Data Power on Patient connected Analysis started Shock advised Shock delivered Code Summary Data A summary of critical resuscitation events and the heart rhythm (ECG) segments associated with those events Continuous ECG Data minutes ECG from the time of power on to power off D. A patient record is created when the AED is connected to the patient and begins to store data. The AED can store a maximum of 2 patient records. 1. In order to create a new patient record, the AED must be turned off for at least 60 seconds, then turned on and electrodes connected to the patient. You can turn of the AED briefly without affecting the current patient if you restore power in less than 60 seconds. 2. You can turn on the AED without creating a patient record as long as electrodes are not connected to a patient or simulator. This may be necessary when performing an external test or to transfer data. II. Data retrieval A. Certain hardware and software are necessary in order to download data from the LIFEPAK 500 AED. B. Data retrieval is performed as soon as possible after an event for review by the AED program medical director, the Nueces County EMS director and for patient records. C. Notification of the University Safety Coordinator will ensure that the machine is retrieved for these purposes.

10 Appendix 2 Maintenance and Testing The LIFEPAK 500 AED performs and automatic self test every 24 hours. If the automatic selftest detects a low battery condition or a condition that requires service, the AED activates an audible alarm. It is therefor important to place the AED where the alarm is likely to be heard and to periodically inspect the AED. The AED also performs a self test everytime you turn on the AED. These self-tests do not eliminate the need for regular maintenance. Perform an inspection on a regular basis and after each time the AED is used: Date Inspection criteria: Comment: Examine AED case, connector, battery well, battery pins and accessories (electrodes) for foreign substances, damage, cracks, bends, discoloration, expiration AED readiness display: OK; Battery indicator display: Battery low or Replace battery- have battery replaced immediately Service indicator display requires maintenance Examine accessory cables-bend and flex the cable and inspect for cracks, damage, extreme wear, broken or bent connectors and pins Confirm that electrode connectors engage securely Electrodes plus spare set Equipment: scissors, face mask, gloves, towels OK present? Expiration dates: / Initial

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