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The purpose of these guidelines is to:
The design of a PAD program in any facility will be somewhat unique and depend on many factors, including:
The design process and key elements of a PAD program cited in these guidelines are intended to provide a foundation upon which individually tailored programs are developed and implemented. The primary goal of PAD is to have lifesaving defibrillation and trained personnel readily available in the event of a cardiac arrest.
In the United States annually, approximately 250,000 adults die from sudden cardiac arrest each year (Heartsaver AED, Dallas, TX 1998, p1-4). Sudden cardiac arrest is an abrupt disruption of the heart function, generally caused by the abnormal heart rhythm called ventricular fibrillation. Ventricular fibrillation can sometimes be successfully treated. The method of treatment is defibrillation. Automatic External Defibrillators are designed to defibrillate a person who is found in ventricular fibrillation.
AEDs deliver an electric shock to a person’s heart in an attempt to return it to its normal rhythm. Traditionally, AEDs and other defibrillation devices have been brought to locations by the local emergency medical services (EMS) system. The size, cost and complexity of these devices have limited their use. With recent advances in technology, many of the previous constraints have been reduced or eliminated. Increasingly, AEDs are being deployed in public facilities such as recreational facilities, shopping malls, airports and schools. This potentially decreases the time between when a person experiences sudden cardiac arrest and access to defibrillation.
Time is critical if one is to survive a sudden cardiac arrest. Lay rescuers can be trained to quickly respond to, identify and treat a cardiac arrest patient and activate the formal EMS system. Decreasing the time from cardiac arrest to defibrillation should increase the incidence of survival from a cardiac arrest.
“Public access” to AEDs does not mean that any member of the public who witnesses an event should use an AED.“Public access” refers to the accessibility of the device itself; so that trained individuals may retrieve and utilize the device. While AEDs are reasonably uncomplicated to use, only persons who have received proper training should use the AED.
The majority of emergency communication dispatchers in the state of Delaware are certified as “emergency medical dispatchers”. If 911 receives a call AND it is determined that the patient is in cardiac arrest, the dispatcher may talk the caller through the use of the AED. This direct step-by-step instruction would be considered training.
It is important to recognize that just placing an AED is not enough. A PAD program in an ongoing event, and should be reviewed on a regular basis and improved when ever possible.
Each PAD program should include the following major components:
There are key roles that must be filled in order to effectively initiate and run an AED program. These are:
Currently recognized training organizations within the State of Delaware are American Heart Association, American Red Cross, National Safety Council and The American Health and Safety Institute (Delaware Early Defibrillation Regulations). All training programs should include a component that describes and explains the facility specific issues. All refresher programs should include this component to assure that all responders are aware of the most current information regarding their specific PAD program.
Any person or entity, who in good faith and without compensation renders emergency care or treatment by the use of an AED, shall be immune from civil liability for any personal injury as a result of such care or treatment (Delaware Code, Title 16, Chapter 30 ).
Protocols should clearly address procedures for activating a response. Issues to address include:
While there is no single formula to determine the appropriate placement and access system for AEDs, there are several elements that should be considered.
There are several characteristics that contribute to proper placement of AEDs. The major characteristics are:
Note: All AEDs must be registered with the OEMS. Visit our forms page for the registration application.
The Service Coordinator must notify OEMS of the specific location, make, model and serial number of AED units. This information will be shared with the emergency communications centers so that the location of the units can be entered into the dispatch system.
AEDs are medical devices that are to be used under the advice and consent of a physician and only by individuals with the proper training and certification. Medical oversight is an essential component of the program and is provided by the State EMS Medical Director (Early Defibrillation Program Regulation, Section 6).
With every AED the following additional equipment should be placed:
The Service Coordinator or their designee will conduct scheduled maintenance checks of the unit, according to manufacturer's recommendations. Which will include:
The Delaware Early Defibrillation Program Regulations clearly state that whenever an AED is used (placed on a patient and the unit turned on) that a copy of the AED report be delivered to the hospital within 10 hours of event. A copy of the report MUST also be submitted to OEMS with in 72 hours.
After every incident involving the use of an AED a thorough post-event review of system performance should be undertaken. The programs Service Coordinator should also assure routine and regular assessment of the operating state and condition of the AED and support equipment.
A post event review should be conducted as soon as possible. All aspects of system performance, people, device and protocols should be addressed in a non-judgmental manner, with the focus on improving effectiveness. Post event reviews should be arranged and conducted with sensitivity to issues of medical and patient confidentiality.
An essential post-event consideration is the psychological effect on the lay responders. Using an AED can be a stressful experience for those individuals who are not accustomed to handling emergency response regularly. Debriefing and post event support is especially important if the patient is friend or family or if the rescue is unsuccessful
It is our hope that when an AED is placed, that it will never have to be used. However, the placement of an AED in your facility will add tremendous peace of mind for your staff knowing, should a cardiac arrest occur, by using the AED, they will give that person the best chance for survival. We commend your interest and look forward to your participation in this program.
For more information, please contact the program office.