Automated External Defibrillation (AED) Treatment Algorithm (Adult by tracy12


									AED Program Protocols for the State of Nevada
Program Overview


Protocol Scope o This protocol serves as a program outline for the State of Nevada AED (Automated External Defibrillator) program which is in place at the following locations:  Capitol Complex, Carson City, NV.  The Governor’s Mansion, Carson City, NV  Grant Sawyer building, Las Vegas, NV o All other Agencies within the State of Nevada are encouraged to implement an AED program and will be provided with assistance in the setup of their program but are not covered by this protocol


Program Coordinator o Coordinator will assist in recruitment of individuals to serve as providers. o Coordinator shall ensure that training occurs as needed to maintain current status and to ensure a working level of skill and knowledge. o Coordinator will ensure that providers maintain current provider status o Coordinator will ensure provide quality assurance review  Review and investigate all complaints, and concerns regarding the use of the AED  Review all uses of the AED or an incident where it should have been used but was not  Implement corrective actions as needed to remedy any identified insufficiencies in the protocols o Provide providers contact with Employee Assistance Program in the event that the AED is utilized. o Ensure that the AED and all support equipment is protected from theft or damage


Medical Oversight o Medical Oversight is provided by Dr. ______________________________. It is the role of the medical oversight physician to provide the prescription necessary to purchase the AED and to ensure the program’s safety and effectiveness and to review and approve these protocols. o The Medical Director is also responsible for case review of each event when the AED is used. Specifically, but not exclusively, it should be determined if the AED was used in an appropriate manner and in accordance with these protocols


Coordination with local EMS o Although not mandatory, it is strongly advised that local EMS and Fire Authorities be notified of the existence of an AED program in all locations where it is implemented o Upon arrival at the scene of a medical emergency, the individuals with the highest level of medical training will take charge.

Program Elements:  Site Assessments o Site Assessments will be performed prior to implementation and placement of an AED
program and device. These site assessments will be conducted by the AED Program Coordinator o Site Assessment will include device location and placement. Considerations will include ease of access for providers and security of locations. Alarmed AED cabinets may be included in placement considerations. o Based on AED placement and responding personnel locations, a customized response plan, specific to each location will be implemented  The response plan for 9-1-1 notification, AED Device retrieval and response to victims’ location are supplemental to a particular locations’ Emergency Evacuation Plan.  A 9-1-1 activation plan is a mandatory part of the locations’ response plan. This activation plan will alert AED providers to the emergency and simultaneously alert local EMS providers. The Activation plan will cover notifications during normal working hours. Access restrictions and “off hour” emergencies must be considered. Notification methods, both internally, to Agency AED providers and externally, to local Emergency Medical Services (EMS) should be covered in detail as a part of the activation plan. o Equipment maintenance must be conducted in accordance with manufacturers’ recommendations. Specific procedures and intervals must be prescribed in a written maintenance plan. Additionally, maintenance procedures must be documented upon completion.  Training o All State of Nevada employees who are expected to use an AED in a cardiac emergency must be trained in CPR and the appropriate use of an AED device and trained in the use of the particular AED that they are most likely to use. These employees are also required to keep, at a minimum, current CPR/AED Heartsaver certifications. The American Heart Association Heartsaver CPR/AED course is the preferred training course.    Providers with a “duty to act” are required to render care but only when it is safe to do so and only to their level of training Volunteer providers shall provide care when it is safe to do so, to the level of their training and if the responder is willing.

Do Not Resuscitate Orders o Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) Orders may be expressed or be presented to the responder and will be honored if any of the following conditions are met:  Any card or form is presented that identifies the patient, states the patient does not wish resuscitative measures and is signed and dated by the patient.  The patient is wearing a medical alert bracelet or necklace that states “do not attempt resuscitation” or similar. o In the event that any of these conditions are met, the responder is directed to contact 9-1-1 and inform the operator that the patient is unconscious, unresponsive and has a DNR request o In the event that these conditions are not met or are unclear, responders are directed to continue resuscitative attempts until EMS assistance arrives. Patient care will be transferred to EMS and they will make further determinations. Applicable Legislation o NRS 618.384 encourages the placement and use of AED’s


o o 

NRS 41.500 protects AED care providers from civil prosecuting for rendering care Federal Government “Public Health Improvement Act” Section 248 protects providers form civil liability.

Equipment o Each Agency providing an AED is responsible for the procurement of the AED device. o The AED must be maintained in accordance with the manufacturers recommendations and instructions. o Adult AED pads are required to be provided with each AED. It is strongly recommended that 2 “reserve” sets be kept with the AED at all times. o Pediatric pads may be made available by the providing agency, if the agency believes that a situation may arise which warrants AED use on a pediatric patient AND if agency providers are properly trained. o Additional CPR Personal Protective Euipment supplies and equipment are required At a minimum, the following equipment should be supplied.  Medical grade gloves in small, medium and large sizes  Resuscitation mask  Eye protection  Towel or gauze pads o A bloodborne pathogens spill kit is also recommended. These are commercially available and contain all necessary elements. o Equipment status checks should be performed daily and after each use. Additionally once per month and after each use, a supplies check should also be performed. Attachment 2 is provided to record this activity. These forms must be kept on site for a minimum of 36 months. o All supplies must be replaced on or before the expiration date on the packaging. o If the AED does not properly function during any self test or status check refer to the manufacturers troubleshooting guide for possible corrective actions. If these actions are unsuccessful contact the manufacturer regarding repairs.

Automated External Defibrillation (AED) Treatment Algorithm (Adult ONLY) Immediately Upon Arrival, Verify Sudden Cardiac Arrest  Verify unconsciousness  Activate emergency AED response system and 911  Identify/Respond to special situations^  Open airway  Verify no breathing Not Breathing  Start rescue breathing (1 breath every 5 seconds)  Monitor signs of circulation* (ea 30/60 seconds)  Deliver 2 slow (2 sec ea) breaths  Check for signs of circulation No Circulation ^ Special Situations 1. Water: Patient in water, or chest of patient wet.  Quickly move patient from water  Ensure chest is dry before applying pads 2. Patient less than 8 years of age, or less than 55 pounds  Outside of State Protocol unless you are provided supplemental pediatric. 3. Transdermal Medications/Patches  Remove, and dry residue (wear gloves) 4. Implanted Pacemakers/ICDs  Place pad 1 inch away from an implanted Pacemaker or ICD.  If the event is a WITNESSED ARREST ONLY, and an ICD is known to be defibrillating the patient, allow 30-60 seconds for the ICD to complete its course of treatment. Provide ventilations as required without compressions. Allow only 1 treatment interval, then continue the AED protocol and place pads 1 inch away from the implanted ICD (if location known.) Memory aid for “no shock indicated”      Check for signs of circulation If signs of circulation present, check breathing If inadequate breathing, start rescue breathing (1 breath/5 seconds) If adequate breathing place in a recovery position If no signs of circulation, analyze rhythm: repeat “shock indicated” or “no shock indicated” sequences  Perform CPR until AED arrives and is ready to attach  Compressions at rate of 100/min  Compressions to ventilations at 15:2  Power on the AED first  Attach AED electrode pads (stop chest compressions for pad placement) and connector  Unit automatically analyzes (Clear!)  Shock (Clear) up to 3 times if advised.

 If breathing is adequate, place in recovery position  If inadequate, start rescue breathing  Monitor signs of circulation* (ea 30/60 seconds)

Yes, Breathing

Yes, Circulation

After 3 shocks or after any “no shock indicated”:  Check for signs of circulation*  If no signs, perform CPR for 1 minute

*NOTE: Signs of Circulation: Lay rescuers check for normal breathing, coughing, or movement (typically assessed after 2 rescue breaths delivered to the unresponsive, non-breathing victim.)
Adapted from AHA AED Treatment Algorithm 08/2000

Unit will automatically analyze for a shockable rhythm – stay clear  Attempt to defibrillate if indicated  Repeat until relieved by EMS

Attachment 1 Quick Reference Contacts for AED Site Coordinators Only AED Medical Dr. Boswell, DO AED Trainer Director Officer Phone (775)-885-4695 Phone Fax (775)-841-1139 Fax E-mail Address Select Occupational Services Email Address 1201 South Carson Street Address Address Carson City, Nevada 89701 Address
(Do Not Call Medical Director - Call AED Program Coordinator below)

Joan Tiearney, Risk Mgt 775 687-3190 775 687-3195 200 Roop St., #200 Carson City, NV 89701

State of Nevada AED Program Coordinator Phone Fax E-mail Address Address

Joan Tiearney, Risk Mgt

AED QA Officer

Joan Tiearney, Risk Mgt

775 687-3190 775 687-3195 200 Roop St., #200 Carson City, NV 89701

Phone Fax Email Address Address

775 687-3190 775 687-3195 200 Roop St., #200 Carson City, NV 89701

Capitol Complex AED Coordinator Phone Fax E-mail Address Address

Sgt. Randy Smith, NCP

775 684-5400

Grant Joe Dabrowski Sawyer Bldg AED Coordinator Phone 702 486-2670 Fax Email Address Address 555 E. Washington Las Vegas, NV 89101

State of Nevada Capitol Bldg Carson City, NV 89701

Attachment 2
Automated Defibrillators: Maintenance Check List
AED Unit Model: .

AED Unit Serial #: AED Unit Location: Daily: Inspect the Status Indicator and general physical condition. Monthly: Check Supplies and AED Unit according to manufacturer’s instructions.

. .

Indicate whether all requirements have been met. Note corrective action(s). Initial at bottom of form.

Date of Monthly Check: (near st 1 ) ___/___/_____ Time

Status Indicator:

Daily (Check) a. Self test okay, verify by noting visual indicator per manufacturer’s instructions.
Supplies: Monthly(Initial)

1___ 2___ 3___ 4___ 5___ 6___ 7___ 8___ 9___ 10___ 11___ 12___ 13___ 14___ 15___ 16___ 17___ 18___19___ 20___ 21___ 22___ 23___ 24___ 25___ 26___ 27___ 28___ 29___ 30___31___ J____ F____ M____ A____ M____ J____ J____ A____ S____ O____ N____ D____

a. Minimum of 2 sets of defibrillation pads (preferably 3) sealed - within expiration date, undamaged. b. Ancillary supplies (AED PPE kits for each unit inc. pocket mask, eye protection, nitrile gloves S/M/L, razor, shears, towel, sterile 4x4 or Ab. Pad, and penlight,. PPE Kits contain hi-lighted items, and are checked by the providers. c. Spare unopened battery within “Install Before” date (Min 1 battery installed with good indication is the window.) Not required for G3 d. 1 PC data cards, undamaged
Data/voice recording capability is optional, but data recording is encouraged as long as the card can be erased without special accessories/tooling.

J____ F____ M____ A____ M____ J____ J____ A____ S____ O____ N____ D____

J____ F____ M____ A____ M____ J____ J____ A____ S____ O____ N____ D____ J____ F____ M____ A____ M____ J____ J____ A____ S____ O____ N____ D____ J____ F____ M____ A____ M____ J____ J____ A____ S____ O____ N____ D____ J____ F____ M____ A____ M____ J____ J____ A____ S____ O____ N____ D____

e. If applicable check security wall box/case for proper alarm function/condition
Unit: Monthly

Clean, no dirt or contamination, no damage present In-service: Inspected by: Remarks, Problems, Corrective Actions

Technical Support Number for AED Problems: _______________________ (Mfg. Rep)

Attachment 5

Upon completion of emergency event, application of AED, and transfer of victim from site do the following:

Site AED Coordinator: 1. Notify the victim’s supervisor of the event. Inform them of the receiving hospital and recommend that they contact personnel, if necessary, for notification of victim's designated emergency contact. 2. If possible interview witnesses and team members for any pertinent information and to evaluate procedures, performance and identify any needs for improvement in the site AED program (provide each responder and witness with an Attachment 6, have them fill them out, collect them and mail under “Medical Confidential – For State AED Program Coordinator Only”). 3. Notify the State of Nevada AED Program Coordinator of the event at phone 775 687-3190. 4. Check with those involved for any immediate need for EAP/CISD and notify the AED Program Coordinator, or direct the employee to contact their EAP at (775)687-3869 or (702)-486-2929 as appropriate. 5. Check and restock AED equipment. If directed by QA Officer, remove used data card. 6. Order any supplies needed to replace those used. 7. Forward completed forms for each responder/witness (Attachment 5 ‘Event Documentation Form’, Attachment 6 ‘Emergency Response Worksheet/Witness Statement), copy of the site’s Emergency Plan including evacuation diagrams (note locations of incident and participating responders starting locations, AED storage locations), to the AED Quality Assurance Officer by Next Day, traceable means. 8. If responder had exposure to victims body fluids: contact with blood or vomit without protection of mask or gloves, initiate follow-up as prescribed in your site’s Bloodborne Pathogen Program, Exposure Control Plan (29 CFR 1910.1030). If the unit or non-disposable equipment is contaminated, place in biohazard bag call the manufacturer’s representative for instructions for decontaminating without damaging your unit. State AED Program Coordinator/QA Officer: 1. Within 24 hours, he shall notify the AED Medical Director of the event by phone. 2. Shall perform a QA investigation of the AED use event. 3. Shall review the QA findings with the AED Medical Director at least once every 12 months, and implement any required changes, retraining, or improvements to the State’s AED Program.


Complete as much information as available.

Date of Event: ____/____/____ Location of Event: _________________________________________________________________ Victim Information: Gender: _____M _____F Age:_____________

Name: __________________________________________________

Agency: ____________________________________________________________________ Applicable Medical History: ____________________________________________________ Description of condition prior to event: ____________________________________________ Event Witnessed: No ______ Yes ______ (Include names of witnesses if available)


Names of AED Team Responders: ________________________________________________________________________________ CPR attempted: Yes___ No____ Shock Indicated: Yes___ No___ Estimated time (in minutes) from collapse till CPR started ___________________________ Estimated time (in minutes) from collapse to first defibrillation _______________________ Patient Outcome at site:  Return of pulse & breathing  Return of pulse with no breathing  No return of pulse or breathing  Became responsive  Remained unresponsive Name of facility patient transported to (if known)________________________ Ambulance Company./Fire Dept. Name:_______________________________ Patient outcome after transport (if known):______________________________________________ Comments: ________________________________________________________________________________ ________________________________________________________________________________ AED Medical Director notified (date notified) _________ (For Program QA/Program Coordinator Use) Name of person preparing report ______________________________ Phone (_____) _____-________ x____ Signature____________________________________________ Report Date ______

Attachment 6
Emergency Response Worksheet / Witness Statement (Filled out by Each Responding AED Team Member or Event Witness: Only parts known) Date ____/____/____ Agency Site:_________________________________

Location of Incident: (Show on copy of Evacuation Diagram attached to this document)

Description of Activity or Witness Statement:

Event Information: Times (approximations if necessary) Time Notified/Method: Time AED Responder on Scene: Time AED applied: Time EMS notified (from 911 dispatch record): EMS arrived at event scene: Time Ambulance started enroute to hospital:

Your Information Name: ______________________ Addr: ______________________ City:_____________ST___ZIP___ Ph: Day: ( )-____-_____x____ Ph Nt ( )-____-_____x____ Hm Phn ( )-____-_____ Employer:____________________

Notes: (Attach additional sheets as needed) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Signature ______________________________________________ Date ___/___/___ Time: ___: ___ Reviewed by: AED QA Officer: Signature: _______________ Date Reviewed: ___/___/___ Time: ___: ___ Medical Director Review Recommended: Yes / No Reviewed: ___/___/___ Time: ___: ___ Comments/Improvements/Action Items from Review: QA:____________________________________ Medical Director: ____________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________________

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