AED PROCEDURE MANUAL

Each year, sudden cardiac arrest (SCA) strikes more than 250,000 Americans. During a heart attack blood flow to the heart muscle is blocked, resulting in symptoms that may last for hours. However, during SCA the victim immediately becomes unresponsive, stops breathing, has no pulse and will die within minutes without intervention.  The primary cause of sudden cardiac arrest is ventricular fibrillation, a condition in which the heart's normal electrical signal becomes erratic, causing the heart to cease pumping blood effectively. When this occurs, defibrillation, or restoring the heart's natural rhythm by applying an electrical shock, is the best treatment for SCA. The chance of survival decreases by approximately 10% with each minute that passes after the time of attack. The response time by EMS is often more than 10 minutes. Widespread deployment of automated external defibrillators (AED) allows "targeted responders" in a business setting to provide early defibrillation to victims in the first critical moments after a SCA. As many as 50,000 deaths each year in the United States could be prevented. Use of an AED does not replace the care provided by emergency medical services (EMS), but is meant to provide a lifesaving bridge during the first few critical minutes it takes for advanced life support providers to arrive.

The following procedures are designed to ensure that the operation and maintenance of the services and equipment used at the university and responsibilities of personnel associated with the AED Service are in compliance with manufacturer's guidelines and regulations adopted by the Board of Health.

1.  The Medical Director has authority over the entire AED program and its participants. General responsibilities include the following:

• Establishment and maintenance of the guidelines for care included in this protocol.
• Ensures quality assurance and compliance with procedures.
• Ensures that Targeted Responders are properly trained.
• Provides positive reinforcement to individuals and the system, as well as corrective instruction.
• Conducts an annual review of program paperwork (training, procedures, QC, maintenance, inspections, etc.)
• Establishment of cooperative agreements with the participating Early Defibrillation Service and local EMS agencies.
• Functions as a resource to the agency in planning, scheduling and participation in the initial training and continuing education programs for the service=s personnel.
• Development of a mechanism to assure the continued competency of service personnel to include periodic training and semi-annual skill proficiency demonstrations. 
• Periodic review of service activities as they relate to patient care.
• Establishment of any other rules or activities needed to ensure the delivery of patient care within the service=s scope of practice.
• Cooperating with local public service agencies for the purpose of carrying out routine quality assurance programs which relate to the services activities.
• Conduct an annual review meeting with the Coordinator and Targeted Responders to review all paperwork, machine maintenance and oversee the review training.

2.  The following individual will serve as the Medical Director for the AED program at the university:

Dr. S. Beese
Radford University
PO Box 6899
Radford, VA 24142
540-831-5111

1.  The AED Coordinator is the primary liaison between the university's AED program and the Medical Director. This person has the following general responsibilities:

• Maintain all equipment and supplies.
• Organize training programs and regular re-training programs.
• Maintain all training records and Call Report/Patient Care Records for a minimum of 5 years.
• Forward any incident data to the Medical Director and to Virginia EMS.
• Ensure that the AED is properly maintained after any use.
• Maintain and revise the procedure manual in accordance with state regulations and cooperation with program=s Medical Director.
• Renew state registration for the program every four years, or as otherwise specified by state regulations.
• Maintain all equipment inspection and maintenance records, financial records (as applicable), QC and supply records (such as lot #s for supplies).
• Maintain adequate coverage (# of Targeted Responders) for the facility.
• Instruct switchboard operators on the procedures for alerting Targeted Responders with documentation kept on file.
• Schedule annual review meeting with Medical Director.
• Display the ARegistration to Operate" certificate in a public area of the Early Defibrillation Service.
• Notification, keeping current location and extent of its operations to the EMS agency with primary responsibility for providing emergency response and ambulance transport services.

2.  The following person will serve as the AED Coordinator for the university:

Tom Smithwick, Safety Director
Radford University
PO Box 6909
Radford, VA 24142
540-831-7790

1.   Targeted Responders have the following responsibilities:

• Successfully complete a course and be currently certified in Adult CPR/AED which has been approved by the Board of Health. Any individual currently certified in Virginia as an EMS First Responder, Emergency Medical Technician or an equivalent approved by the Office of EMS shall be deemed as meeting this training requirement.
• Comply with all federal, state, and/or local laws applicable to their operations.
• After an incidence, complete the  AED Call Report/Patient Care Record and the Office of EMS-Incident Report and turn the completed paperwork into the AED Coordinator within 24 hours.
• Attend a Review Course every six months in order to retain status as a Targeted Responder.

2.  The following individuals have received AED training: 

EMERGENCY PROCEDURES

In case of emergency initiate the Cardiac Chain of Survival:

1.  Early Recognition & Early Access

Activate Emergency Response 

• Ensure that the scene is safe.
• Check the victim for responsiveness. Tap shoulder and shout; AAre you OK?@
• If the victim is unconscious, call 9-911 immediately.
• Have someone get the AED. Provide dispatcher with location, emergency details and notify them that an AED is being deployed. Do not hang up until the dispatcher hangs up
• Call Campus Police at 831-5500.
• Campus Police will activate the call for targeted responders if one is not already at the scene. Campus Police will call the front desk at the Dedmon Center or the Work Control Center in the University Services Center and ask the person on duty to broadcast a call over the PA system for a targeted responder.
• Designate one person, if possible, to wait at the front entry and lead the EMS personnel to the victim.

• Airway. Perform head-tilt, chin lift to open airway.
• Breathing. Look, listen, & feel for breathing for about 5 seconds. If breathing is absent, use barrier mask to deliver 2 rescue breaths. Each breath should last about 2 seconds. BARRIER MASKS ARE REQUIRED TO PERFORM RESCUE BREATHING.
• Circulation. If breaths go in, check carotid pulse for no more than 10 seconds. If pulse is absent, begin CPR.

• If the victim shows no sign of circulation perform CPR until the AED arrives.
• Give 15 compressions in about 10 seconds. Compress the chest about 2 inches deep. 
• Give 2 rescue breaths.
• Continue CPR. 15 compressions/2 rescue breaths. Check pulse after 4 cycles and every few minutes thereafter.

When defibrillator arrives:

• Confirm the absence of a pulse
• Place the AED near head of patient on same side as the rescuer.
• Turn on the AED.
• Bare and prepare chest (cut chest hair & dry the chest if wet).
• Follow the AED=s verbal and visual prompts.
• Apply electrodes to upper right chest just under the collar bone and lower left side on the ribcage below the breast (following drawings on pads).
• Stand clear and allow the AED to analyze.
• If indicated, deliver shock by pressing the orange button.
• If no shock is indicated recheck the pulse for no more than 10 seconds. Do not remove the pads. 
• If no pulse is present perform CPR for 1 minute.
• Stand clear, let the AED reanalyze the rhythm
• Continue care per AED Treatment Algorithm.  

AED Precautions:

• Do not touch the victim while the AED is analyzing or defibrillating.
• Do not use the AED on a victim lying on a conductive surface such as metal bleachers or water.
• Ensure that the pads make good contact with the skin. Clip chest hair and dry the chest if necessary.
• Do not use alcohol to wipe the chest.
• Do not use a cellular phone or radio transmitter within 6 feet of the AED.
• Do not use the AED around flammables such as gasoline. 
• Do not use the AED in a moving vehicle.
• Do not use the AED with regular pads for a child under 8 or under 55 pounds.
• Do not use the AED if the victim is wearing a nitroglycerin patch or other patch on the chest.
• Check the pads to make sure the gel has not dried out. 

• Victim=s name.
• Any known medical problems, allergies or medical history.
• Time the victim was found.
• Number of shocks delivered.
• Length of time defibrillator has been used.
• Level of your first aid training and other relevant training, certification, or education (examples include R. N., Medical Technician, etc.)
 

EQUIPMENT

1.  The following AED units are located at the University:

2.  AED's are ordered through the American Red Cross. The contact person is:

Betty Whittaker
American Red Cross
Roanoke Valley Chapter
352 Church Ave. S.W.
Roanoke, VA 24016
540-985-3546

MAINTENANCE

1. A check of the status indicator will be performed daily. A flashing black hourglass indicates that the AED is ready for use. Call the AED Coordinator if you see anything other than a flashing black hourglass.

2.  Daily checks in the Dedmon Center will be performed by the Director's secretary.

3.  Daily checks at the University Services Center will be performed by the Safety Director.

4.  Daily checks for the RU Clinics Mobile Unit will be performed by the driver.

Monthly

1. The AED Coordinator will complete the AED Inspection Form  on a monthly basis and ensure that deficiencies are corrected.

After Use

1. The AED Coordinator will do the following after any AED use:

• Notify the Medical Director.
• Conduct employee incident debriefing, as needed.
• Complete and disseminate the Office of EMS-Incident Report within 5 business days following the incident to the responding EMS agency and within 15 business days following the incident to Virginia EMS  
• Restock any used electrode pads, batteries, PC cards, or gloves. Inspect unused supplies for any damage or old expiration dates.
• Label and retain PC cards from patient care episodes for a minimum of 5 years.
• Remove and replace battery in the AED and do a Battery Insertion Test (BIT) prior to replacing the AED into service.
• Inspect the exterior and connector for dirt or contamination. Clean the AED if needed. Review User=s Guide for list of appropriate cleaning agents.
• Check the Status indicator. Verify alternating dark and hourglass shapes indicating readiness for use.
• Ensure all supplies, accessories and spares are present and are in operating condition. Check expiration dates and any obvious signs of damage.

Supplies

1. The following supplies will be kept at each AED station:

• AED
• Two sets of electrodes
• Installed battery and one spare
• Installed PC data card and one spare
• Mouth barrier device
• Two sets of gloves
• Waterless handwash
• Scissors
• Razor
• Hand towel
• Red bag

2.  Recommended optional items:

• Storage bracket or container
• Carrying case
• Gauze
• Tape
• First Aid Kit
• Biohazard Clean-up Kits