Purpose

The purpose of these guidelines is to:

• Provide a framework for a public access defibrillation (PAD) programs.
• To familiarize administrators with essential elements of such a program.

The design of a PAD program in any facility will be somewhat unique and depend on many factors, including:

• The population demographics of the facility
• The physical size of the facility.
• Location of specialty areas within the facility.

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.

The Concept of Public Access Defibrillation (PAD)

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.

Program Development

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:

• SERVICE DIRECTION / COORDINATION: Direction/coordination of the program.
• TRAINING: Training, certifying and retraining personnel in CPR and the use of an AED
• LEGAL STATUTES: Knowledge/understanding the legal statutes surrounding the use of an AED
• PROTOCOL DEVELOPMENT
• AED PLACEMENT
• INTEGRATION WITH THE OFFICE OF EMERGENCY MEDICAL SERVICES (OEMS)
• MAINTAINING HARDWARE AND SUPPORT EQUIPMENT on a regular basis and after each use
• DOCUMENTATION
• PERIODIC REVIEW of the program

Service Direction/Coordination (Early Defibrillation Program Regulation, Section 9)

There are key roles that must be filled in order to effectively initiate and run an AED program. These are:

• The Service Director – This is the individual who is administratively responsible for the facility and who directly supports the efforts to establish a program.
• The Service Coordinator – This is the person who would be responsible for the day-to-day operations of the PAD program in accordance with the responsibilities listed in the Early Defibrillation Program Regulations.

Training/Certification

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.

Legal Statutes

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 ).

Protocol Development

Protocols should clearly address procedures for activating a response. Issues to address include:

• Activation of an internal response to the emergency.
• Activation of EMS (911) at the time of the incident.
• Notification of OEMS in regards to unit placement and protocols.
• Follow-up procedures.

AED Placement

While there is no single formula to determine the appropriate placement and access system for AEDs, there are several elements that should be considered.

• Response Time: The optimal response time is 3 minutes or less. This interval begins from the moment person collapses to when the AED is at the victim’s side. Survival rates decrease by 7 to 10 percent for each minute that defibrillation is delayed.
• Physical Layout of the Facility: Response time should be calculated based upon how long it will take for a responder with an AED walking at a rapid pace to reach a victim. Be sure to take into consideration areas with difficult access (secured areas within a building).
• Demographics: Because the likelihood of an event occurring increases with age, consideration should be given to the age profile of the facility.
• Visitors : Facilities that host large numbers of visitors are more likely to experience an event. An appraisal of the demographics of visitors should be included in the assessment.
• Specialty areas : Facilities where strenuous physical activity occurs are more likely to experience an event therefore, specialty areas should be considered to have a higher risk.

Characteristics of Proper Placement

There are several characteristics that contribute to proper placement of AEDs. The major characteristics are:

• An easily accessible position (e.g. physically accessible, no barriers).
• A secure location that prevents or minimizes the potential for tampering, theft and/or misuse by unauthorized users. There are wall mounted cabinets that are available from the manufacturer for AED placement (similar to the wall mounted fire extinguisher cabinets) these cabinets can be alarmed.
• A location that is marked, publicized, and known to trained individuals.
• A publicized location with information on how to initiate internal and external response.
• A location that is near a telephone, that can be used to call 911 and lay rescuers.

Note:  All AEDs must be registered with the OEMS. Visit our forms page for the registration application.

Integration with the Office of Emergency Medical Services

Notification

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.

Medical Oversight

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).

Maintaining Hardware and Support Equipment

Suggested Support Equipment

With every AED the following additional equipment should be placed:

• Non-latex protective gloves
• Pocket mask, and/or barrier device for mouth to mouth resuscitation
• Disposable razor
• Medium size bandage or blunt end scissors
• Spare electrode pads

Periodic Maintenance

The Service Coordinator or their designee will conduct scheduled maintenance checks of the unit, according to manufacturer's recommendations. Which will include:

• Verifying placement
• Verifying battery installation
• Checking status/service indicator light
• Inspecting exterior components
• Checking supplies

Documentation

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.

Periodic Review and Follow up

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

Conclusion

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.

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