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Best Practice Model for Implementation of an Automatic External Defibrillator Program

By Bruce Dalton MD, MPH, FACOEM

Purpose

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:

  • Review federal, state and local laws and regulations
  • Consult local emergency medical services
  • Identify your response team
  • Site assessment
  • Arrange for medical supervision
  • Choose equipment and vendor
  • Development of AED Plan
  • Employee training and refresher training
  • Program management
  • Program quality assurance
  • Promotion of the program

Scope

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 heart’s 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:

  • Training to operate an AED
  • Coordination with the emergency medical service in your community
  • Medical direction
  • Record-keeping for each use of an AED

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 you’ll want to train to respond.

Site Assessment

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 you’ll 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:

  • Highly visible, such as in wall mount brackets or glass cabinets on building walls in general view – similar to fire extinguishers
  • Near expected responders
  • Close to where the largest number of people spend their time
  • Protected from tampering, theft or damage (recessed mounts and alarmed cabinets are also available)

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:

  • Reputation of the AED manufacturer for product quality and customer service
  • Compatibility with the equipment of local EMS
  • Easy operation, with clear voice prompts
  • Biphasic technology with capability to adjust shocks and energy levels to match the victim’s needs
  • Defibrillation electrodes that are pre-connected to save precious seconds
  • Maintenance-free batteries
  • Support such as a service team for on-site repairs and a computer-based refresher courses
  • Includes internal self-test features

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:

  • Who manages the AED program
  • Who provides medical supervision
  • Standing orders stating when the AED should be used, when it should not be used, and training required to use it
  • How internal responders and the community’s emergency medical services team will be notified
  • Types and locations of AEDs and other equipment (such as gloves, facemask for CPR)
  • Training and refresher training policy
  • A process and schedule for checking and maintaining equipment
  • A process to periodically review and update the policy and procedures
  • Any record that must be kept each time an AED is used
  • How to handle data recorded by the AED during use (patient’s heart rhythm, AED assessment, and any shock delivered)

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:

  • The proper use, maintenance, and periodic inspection of the AED
  • Defibrillator safety precautions to enable the user to administer a shock without jeopardizing the safety of the patient, the user, or other individuals
  • Assessment of an unconscious person to determine if cardiac arrest has occurred and the appropriateness of applying an AED
  • Recognizing that an electrical shock has been delivered to the patient and that the defibrillator is no longer charged
  • Rapid, accurate assessment of the patient's post-shock status to determine if further activation of the AED is necessary
  • The operations of the local emergency medical services system, including methods of access to the emergency response system, and interaction with emergency medical services personnel
  • The role of the user and coordination with other emergency medical service providers in the provision of CPR, defibrillation, basic life support, and advanced life support
  • The responsibility of the user to continue care until the arrival of medically qualified personnel
  • Schedule refresher training at least annually or sooner if your AED Plan or equipment changes.

Program Management

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:

  • Site assessments
  • AED and equipment locations
  • Training and certification expiration dates
  • Communications to employees on emergency notification and response procedures
  • Medical prescriptions and medical oversight responsibilities
  • AED and site-specific protocol
  • Maintenance logs of equipment and supplies
  • Incident log with outcome.

Other Responsibilities of an AED Program Manager includes:

  • Establishing and documenting policies and procedures to ensure consistency throughout the organization
  • Researching all federal, state, and local regulations for every site where an AED will be placed, because state and local laws vary with regard to oversight and training requirements
  • Continuously monitoring all federal, state, and local legislation to track changes in laws
  • Obtaining a prescription for the AED from a physician licensed in the state where the unit will be located
  • Securing a state-licensed physician to provide program oversight where required by law.
  • Overseeing the development of medical protocols
  • Selecting AED and medical equipment suppliers
  • Determining the number and location of AEDs within every facility
  • Coordinating the program with local EMS
  • Writing training guidelines to ensure consistency among facilities
  • Scheduling training for all workplace response teams and tracking certification expiration
  • Maintaining the equipment at every facility where an AED is deployed, through employees or a vendor
  • Documenting and monitoring compliance with workplace regulations and "Good Samaritan" requirements
  • Ensuring event data is downloaded and evaluated in compliance with regulations following an incident
  • Program Quality Assurance

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.

  • Ways to publicize your program include:
  • Poster and brochures
  • Decals on doors
  • Newsletter articles
  • Notice on your intranet
  • E-mail
  • Announcements at meetings
  • Announcements at new hire orientations

Good communications is the key to help all the departments at your facility benefit from the AED initiative.


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