Best Practice Model for Implementation of an Automatic External Defibrillator Program
|By Bruce Dalton MD, MPH, FACOEM
The purpose of this Automatic External Defibrillator (AED) best practice is to provide fundamental information regarding the development of an effective AED program. These best practice guidelines will address the following action items:
This best practice discusses the fundamental principles for the implementation of an AED program. These guidelines are not intended to be exhaustive and cannot address all local issues. There may be additional acceptable ways to address this topic as well that are not included within these guidelines.
Best Practice Information
By placing an automated external defibrillator in a key location in the workplace you may give anyone struck down by sudden cardiac arrest (SCA) another chance at life. Sudden cardiac arrest can happen anywhere, anytime, to people of all ages. SCA is usually caused by an electrical malfunction that makes the heart quiver ineffectively in an abnormal rhythm called ventricular fibrillation. It sometimes is triggered by a heart attack but can also happen even without any blockage of blood flow to the heart. A lifesaving pulse of electricity must be delivered quickly to restore the hearts rhythm and pump blood throughout the body. Defibrillation is the only effective treatment for sudden cardiac arrest caused by ventricular fibrillation.
Time is of the essence. Typically, only 5 to 10 percent of people struck by SCA survive; but, if people in ventricular fibrillation get the lifesaving AED shock within 3 minutes of collapsing, the survival rate can increase to 74 percent. Placing AEDs in key locations and making sure employees are trained to use them may mean the difference between life and death.
Review Laws and Regulations
Laws vary among states and specific local regulations may apply in your area. Be sure to review your state and local laws and regulations for AED program implementation. Typically, state and local AED laws and regulations require:
Consult Local Emergency Medical Services (EMS)
Notifying your local EMS is good practice and in some locations is a requirement when implementing an AED program. As a minimum, the local EMS should be informed of the location of each AED in every facility. EMS may want to play a role in drills simulating emergencies. This is often a good idea as it gives everyone a chance to practice and improve each step of the emergency response.
Identify Your Response Team
Determining who is likely to respond in an emergency will affect how and where an AED is mounted or stored. Typically, emergency response personnel should be trained in AED use. Other employees trained in the AED program would include maintenance, management and office staff members. The size and layout of your facility may also determine how many people youll want to train to respond.
Defibrillation is recommended in less than 4 to 5 minutes ideally in less than three minutes. Every additional minute of delay lowers the rate of successful resuscitation by 7 to 10 percent. To achieve a good response time youll want to put an AED in good central location, ensure clear communications and have enough people trained to respond quickly. If you have a large facility you may want to place additional AEDs around the facility for quick response.
Applying an AED and delivering the first shock takes roughly one minute. To meet a goal of less than 3 minutes from drop to shock, 2 minutes are allotted to get the AED to and on the stricken employee. Walking at a brisk pace, one can cover about 300 feet per minute.
You will want good coverage of areas where large numbers of people work. Avoid locating an AED in high-traffic areas such as hallways near restrooms, reception areas and main entrances.
Consider locating AEDs so they are:
Arrange For Medical Supervision
Although AEDs are designed for use by laypeople with minimal training, they are classified as medical devices by the U.S. Food and Drug Administration and can not be purchased without a prescription from a physician. A physician should be designated as providing ongoing medical oversight of your AED program. This supervising physician should sign off on your AED plan, review AED plan and training taking into account new treatment recommendations evaluate data recorded on an AED during a medical emergency and help assess each use of an AED to suggest any improvements.
Choose Equipment and Vendor
Seek the advice of your local EMS and your program supervising physician regarding the type of AED to buy. Ask about the reputation of the vendor for reliability, durability and after-sales support. Selecting a single brand of AED for use within a facility will greatly simplify training and maintenance.
Important considerations include:
Develop the AED Plan
Integrate your AED program into your emergency response plan. Policies and procedures will need to be updated as laws and regulations change, as best medical practices evolve and as you learn from your own experience using AEDs.
Your AED Plan should include:
What to do after an event, such as downloading and transferring of data from the AED, notifying the medical director, reviewing the event to determine how procedures might be improved, holding a stress debriefing for rescuers, replenishing supplies, and returning the AED to service
Employee Training And Refresher Training
When training is conducted, only AED training devices incapable of delivering a shock or AED rhythm simulators (AEDs with PC training cards) should be used. The training devices and rhythm simulators allow using shockable and nonshockable scenarios that can enhance decision-making skills and diversify training activities. An AED rhythm simulator is a live AED whose shock delivery feature has been overridden for training purposes through the insertion of a PC training card or other device. AED training devices or AED rhythm simulators should never be connected to humans only to manikins.
Personnel using the AED must complete a training session at least annually including instruction in:
If selecting the right people and equipment are keys to implementing an AED program; then, scheduling, documenting, and maintaining equipment are keys to keeping the program operating smoothly and effectively.
Select a Program Manager to track workplace responder schedules to ensure full shift coverage and account for vacations, transfers, retirements and job changes. Also, he or she must track training records so new employees can be trained when necessary and veteran workplace responders can maintain their certifications. CPR, AED, first aid, and bloodborne pathogens certifications expire in one- to three- year intervals depending on the course.
Equipment maintenance includes inspecting and servicing medical supplies regularly to verify that all supplies are present. The AED program manager should establish maintenance and routine inspection and resupply procedures, either through vendors or by assigning the duty to employees. Expiration dates on all supplies and equipment must be tracked and maintenance records kept.
Important documentation includes:
Other Responsibilities of an AED Program Manager includes:
Once an AED program is fully implemented, the Project Manager should be sure to follow the policies and procedures developed to keep the equipment, supplies and trained responders in tip-top shape to handle a cardiac emergency.
Schedule periodic operational checks for AEDs and supply inventories. Order new supplies as needed. Schedule training for new employees and hold refresher training at least annually. This enables your responders to refresh skills, renew certifications, and learn about changes in equipment, policies and procedures. Revise your policies and procedures as you learn from any experience using the AEDs, or as medical best practices change or equipment is updated.
Promote Your Program
Your AED intervention program is no good if no one knows about it. An internal communications campaign will help employees become familiar with your program and inform them how to alert trained responders if they witness a cardiac emergency.
Good communications is the key to help all the departments at your facility benefit from the AED initiative.
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