Presenter Disclosure Information Cheryl Rickens RN BSN UPMC

Presenter Disclosure Information Cheryl Rickens, RN, BSN UPMC Prehospital Care EMS Specialist, AED Program Community Preparedness: Public Access Defibrillation 1 FINANCIAL DISCLOSURE: No relevant financial relationship exists UNLABLED/UNAPPROVED USES DISCLOSURE: None

Community Preparedness Public Access Defibrillation • Sudden Cardiac Arrest (SCA) – Impact • Over 326, 000 out-of-hospital cardiac arrests (OHCA) annually • Only 5%-10% of OHCA patients survive to hospital discharge 2

Community Preparedness Public Access Defibrillation • Time is critical – Collapse to treatment – For every minute that passes without treatment the chance of survival decreases by 10% 3

Community Preparedness Public Access Defibrillation • AHA OHCA Chain of Survival 4

Community Preparedness Public Access Defibrillation • OHCA – Early CPR and Early Defibrillation can make a difference • CPR – Goal is high-quality CPR = chest compressions – Depth – Rate – Recoil 5

Community Preparedness Public Access Defibrillation • AEDs (Automated External Defibrillator) – Witnessed OHCA • Better survival chance vs unwitnessed OHCA due to timing factor – Early CPR – Early Defibrillation of a shockable rhythm Can markedly improve chance of survival • associated with a potential doubling of rate of survival 6

This is why need a Public Access Defibrillation Program 7

Community Preparedness Public Access Defibrillation • What makes a good PAD Program? – Medical Direction Program – Start with a knowledgeable team • Medical Director • Program Manager – Familiar with current guidelines, laws, resources 8

Community Preparedness Public Access Defibrillation • Project Management – Standard Operating Guideline/Procedure – Best Practices – Clearly outline responsibilities • The “who” and the “how to” 9

Community Preparedness Public Access Defibrillation • • • Training What is required by your state? Any nationally recognized organization is acceptable Example of a guideline: 10 people or 10% of staff Preference is to include people who want to be trained and involved in program vs generically make mandatory – For example: floor wardens 10

Community Preparedness Public Access Defibrillation • AED Placement – Law or guideline – State vs Federal • Federal Cardiac Arrest Survival Act of 2000 • PA: hotels, health clubs, schools – American Disabilities Act • Important for wall mounting of AED 11 – Good Samaritan Law • Act in “good faith” • Civil liability protection • Several revisions expanding protection • Have an AED, maintain it – Medical Direction Program is key to success for PAD Program

Community Preparedness Public Access Defibrillation • Funding the AED • Cost of an AED: – AED – Battery – 2 sets of adult pads • Attached and spare – Carry case – Prep kit • Medical scissors, razor, towel, gloves, face mask or face shield – Pediatric component (optional) • 12 Pads or key format • Continued: – Storage mode • Cabinet, wall bracket, wall hook – Signage • • Above or near device Directional if needed

Community Preparedness Public Access Defibrillation • Funding the AED (continued) • Start-up and on-going costs – – – 13 Pads Battery Pads-battery pack Prep kit Device replacement Warranty extension • Restock AED after use • Track expiration dates – Programs • • • Manufacturer Vendor/distributor Organizations Fee for service or free Provide a notification

Community Preparedness Public Access Defibrillation • AED Selection – AEDs follow same algorithm – Semi-automatic (push flashing button) or automatic (shock in 5 seconds with countdown) – CPR coaching feature • Metronome • Instructions on how to do CPR • 2 minute timer 14 – Escalating or fixed joules – Real-time ECG – Adult only (required) or pediatric component (optional; pads or key format) – Purpose of AED may reflect IP rating consideration • Stationary in an office or being transported such as with First Responders, athletic trainers – Consistency of AED type is preferred if multiple AEDs on site/campus

Community Preparedness Public Access Defibrillation • AED manufacturers – – – 15 Cardiac Science Defibtech Heart. Sine Technologies Philips Healthcare Physio-Control Zoll Medical Corporation

Community Preparedness Public Access Defibrillation • AED Maintenance – – Warranty protection Protection in general Inspect AED every month Also consider daily or weekly check • Document Readiness Indicator – Readiness Indicator • All AEDs have • Based on AED self-check 16 • AED checks itself everyday – For all or some of the following: • • Internal circuitry Battery life Pads connection Pads integrity – Internal mini-shock • If have this capability, usually done monthly – If pass: green, flash, “OK” – If fail: different indicator & chirp

Community Preparedness Public Access Defibrillation • Monthly AED Inspection – – – Replacement date of battery Expiration dates of all pads Contents of prep kit Carry case (clean and intact) Storage mode • If cabinet with alarm, battery replacement at least once/year • If cabinet, location and # of key 17 • Also have: – Site name – AED manufacturer name • ie: Philips – Model name and # of AED • ie: HS 1 M 5066 A – Serial # of AED • ie: A 16 C-12345 – Institution biomedical equipment # and date check – AED Program Manager contact information – Sign/initial and date

Community Preparedness Public Access Defibrillation • AED Placement • Site Assessment very important to actually do – Walk test • Guideline: 3 to 5 minutes max from site of collapse to retrieving AED then return to victim – Barriers such as automatically locking doors, ID entrance only access doors – How many floors, elevators, stairs wells – Cannot be locked in a room – Large congregation of people – Areas of physical exertion 18

Community Preparedness Public Access Defibrillation • AED Placement • Ideal vs reality – based on funds – For example: 5 story building • Ideal is an AED on every floor • Reality is an AED on floors 1 -3 -5 or 1 & 4 OR only one AED on 1 st floor (main floor) • Plan budget to add AEDs 19

Community Preparedness Public Access Defibrillation • AED Placement (continued) • Consider placement at: – Security or reception desk area • This area would probably also have easily available phone access – Lobby or main entrance area – By elevators • Usually centrally located to hall, so would need 1/floor – By stairs • Usually at ends of hall, so would need 2/floor 20

Community Preparedness Public Access Defibrillation • EMS • Involve local EMS to help with: – – – 21 Starting PAD Program Site assessment AED selection and placement Training Post AED use

Community Preparedness Public Access Defibrillation • What to do if use AED? • Need to obtain information from device – the ECG – Software (fee) – Manufacturer website (free) – Infra Red connection, cable, data card reader – Lap top (take to AED) or desk top computer (stationary; need to take AED) 22 • Paperwork – Details of event – Review of event • QA/QI • Clean and restock AED

Community Preparedness Public Access Defibrillation • New Trend - Placing AEDs based on mathematical optimization • Based on “hot spots” – Where in the community do OHCAs occur? – Where are AEDs located? – What is the time factor of OHCA to AED location and actual use of AED? • • Track and trend using a scatter plot map Geographical approach (clusters) vs building-based approach Consider using this approach when placing new AEDs and to re-locate existing AEDs to optimize use of AEDs based on where majority of OHCA occur This will take cooperation with public entities (local government, EMS, etc) and businesses to look at data and decide on AED placement vs placing AEDs in business owned building/area • New Trend - Pulse Point 23

Resources • American Heart Association – Website – Highlights of the 2015 AHA Guidelines Update for CPR and ECC • Circulation – AHA Statistical Update, Heart Disease and Stroke Statistics-2016 Update – T. C. Y. Chan, et al. Identifying Locations for Public Access Defibrillators Using Mathematical Optimization. 2013 THANK YOU! Cheryl Rickens 24 Email: rickensc@upmc. edu Office: 412 -647 -5938