A utomated E xternal D efibrillators (AED) in Schools

1. Automated External Defibrillators (AED) in Schools Randall S. Fischer, B.A., EMT-POperations Director, Ringdahl EMS Program Coordinator, EMSC

2. A Collaborative program of Children’s Hospitals and Clinics Emergency Medical Services Regulatory Board University of Minnesota Medical School Claudia Hines, RN, Manager Randy Fischer, NREMT-P, Program Coordinator Jennifer Piccolo-Fisher, Office Coordinator Lee Pyles, MD, Co-Medical Director, U of M Jeff Schiff, MD, Co-Medical Director, Children’s Hospitals & Clinics Mary Ann McNeil, Director, U of M Depart. of Emergency Medicine

3. How Common is Sudden Cardiac Arrest? • One of the leading causes of death in U.S. • At least 250,000 suffer SCA each year • Median age of victim is 65 years, but it affects people of all ages, even teenagers.

4. What is Sudden Cardiac Arrest (SCA)? • Electrical system in the heart malfunctions • Heart unexpectedly and abruptly stops beating • Not the same as a heart attack. • Usually caused by an abnormal heart rhythm called Ventricular Fibrillation • Results in death if not treated immediately.

5. SCA: a public health crisis

6. Why is early defibrillation so important? • Chance of survival from SCA diminish 7-10% with every minute after collapse

7. 1st Responder Applies AED 10 20 0 5 15 Public AED Applied Why is Public Access Defibrillation so Important? 1st Responder On-Scene Paramedics On-Scene 9-1-1 Called Call Dispatched Victim Collapse Transport To Hospital 75% Chance of Survival

8. Why is Public Access Defibrillation so Important? According to the May 3, 2004 issue of Aviation Week & Space Technology, American Airlines has used an AED on its aircraft 89 times in the last 7 years and saved 50 lives (a 56% survival rate).

9. Why put AED’s in schools? • SCA in adolescents is a growing concern • Some seemingly healthy physically fit children collapse without warning. • Knowing CPR, First Aid and AED operation is critical. • Schools are community gathering points • Adults (higher risk populations) often present at schools • Basketball, football, wresting, and other sporting events • Band, choir, and play performances • Community education programs and other events • Schools are a disaster resource • Contact your local emergency manager and disaster coordinator • Homeland security funds are available for preparedness. • Teaching a future generation • Strengthen the chain of survival and Educating teachers, staff, students how to SAVE A LIFE! • Introducing students to healthcare and recruiting a new healthcare workforce for the future. • Teaching a valuable “Life Skill”.

10. Everyone needs to know… What, Where, When, Why and How to use an AED

11. SCA in a Basketball CoachChippewa Falls, Wisconsin

12. Of the 600,000 Cardiac Arrest, 16,000 Are Pediatric Patients.

13. A blow to the chest can bring on cardiac arrest, as seen in children struck by a baseball or other sports. This unusual cause of SCA is called Commotio Cordis.

14. “Chain of Survival” • Early Access – Dial 911 Immediately • Early CPR – Everyone should know CPR • Early Defibrillation –1st Responders & PAD • Early ACLS – Local Ambulance service/ED • Everyone should learn CPR & AED skills. • Prevention – Controlling/Reducing risk factors • Recognition – Signs / Symptoms • Action – Call 911, Check ABC’s, Perform CPR, operate an AED. • Steps to “Save a Life”

15. Key to Surviving SCA Early Defibrillation • Only effective treatment is an electrical shock delivered by a defibrillator. • Time is critical – each minute of delay before defibrillation reduces survival by about 10%. • CPR (Cardiopulmonary Resuscitation) can help maintain the flow of oxygen to the brain and vital organs, but • CPR cannot convert VF to a normal rhythm. Eisenberg MS. Annuals Emerg Med. 1990;19:179-186.

16. What is an AED? • Device that “Looks” for a shockable heart rhythms. • Delivers a defibrillation shock only if needed. • Will not shock if not needed. SAFE! • Small, portable, about the size of laptop computer. • About $2,000 per unit.

17. Anytime someone collapses and is unresponsive or unconscious. When to use an AED

18. Do you have to be medically trained to use defibrillator? • No. Automated external defibrillators (AEDs) are simple, safe and easy to use • Non-medical personnel can use AEDs with minimum of training

19. American College of Emergency Physicians American Heart Association American Public Health Association American Red Cross Canadian Association of Emergency Physicians Citizen CPR Foundation Emergency Care Research Institute Heart and Stroke Foundation of Canada International Association of Chiefs of Police International Association of Fire Chiefs International Association of Fire Fighters International Liaison Committee on Resuscitation National Association of EMS Physicians National Association of State EMS Directors National Association of State EMS Training Coordinators, Inc. National Center for Early Defibrillation National Heart Lung and Blood Institute National Safety Council Occupational Safety and Health Administration Who supports increased access to defibrillation?

20. Athletic trainers promote AED use • Concordia College, Moorhead • < 1 month after the AED was purchased used on a retired professor • massive heart attack after playing a lunch-hour basketball game in the gym. • AED used by the athletic trainer – Stephanie Brandt. • Alive today • Syracuse University • Football referee collapsed during a game in September • AED used by the Athletic trainer – Tim Neal • Alive today • University of Iowa • Spectator collapsed in the bleachers. • AED used by the Athletic trainer – Dan Foster • “The results were dramatic. The immediate success has resulted in a continued high quality of life for the patient, an increase in AED purchases in the community and an improved general public awareness of AED’s.

21. Developing Your Community “Champions”. • School Administration • School Nurse, Public Health • Teachers and Health Educators • Parents • Local Ambulance Service (EMS) • Police/Law Enforcement • Community Service or School Liaison Officer • Hospital and Healthcare organizations

22. New York Schools and AED’s

23. Site Assessment • Priority buildings • Campus Security/First Responders • Large number of people • Amount of time occupied • Public or large events • High risk group? • Current Location(s) • Cover entire campus • Plan for additional units/locations • Easy access • Obvious location for public use and school observation.

24. Liability risk of using an AED • President Clinton in 2000 initiated a bill (Cardiac Arrest Survivor Act) that grants legal immunity to good Samaritans who use AED’s. • Since then, most states have rewritten their own good Samaritan laws to include language about the use of AED’s. • Minnesota Statute includes AED specific language • A plaintiff in a fitness facility received a $2.5 million award after a lawsuit charging the facility for not meeting a member’s emergency-response needs when the plaintiff had a heart attack and there was no AED available. (Chai versus Sports Fitness Clubs of America, Circuit Court, 17th Judicial District, Broward County, FL) • Represents a shift toward requiring fitness-related facilities and possibly other institutions to have AED’s available. • UnderstandingAEDProgramLegalIssues1104F.pdf

25. Other considerations • Maintenance cost of units • Every use or every 2.5 years: Replace pads/battery pack: $90.00 • Initial and on-going training • CPR / AED training, 4 hour class • 1 Hour review every year, • Safety training meeting refresher • All school lyceum for students/staff • Develop policies, test, and practice in school • Campus/Community Awareness – Students & Staff • Community-wide effort to train and inform public on CPR and AED’s • Basketball game half-time demonstration • Debriefing and EAP/support after use • Local EMS/Hospital/Regional EMS program can assist or arrange. • Physician oversight • Usually local EMS/Ambulance Medical Director

26. SCA in a HS Football Referee

27. CPR and AED Review • Shake and Shout • Call 911 – Get AED • Open Airway • Check Breathing • If no breathing Give 2 Breathes • Check for Circulation or “Signs” of Life? Coughing, moving, pulse? • Start CPR • Attach Defibrillator – As soon as it is there! • Follow voice prompts and defibrillate if indicated A – B – C –D

28. Want More Information? Randy Fischer, Program Coordinator Emergency Medical Services for Children 2550 University Ave. West # 216 South St. Paul, MN. 55114 Phone: (612) 578-8690 or (800) 660-7022 fischers@info-link.net www.emscmn.org

29. AED Videos • Good Morning America • WCCO – Chippewa Falls, WI Video • Football Referee Video • KARE 11 – AED Video • New York Schools and AED’s • Airport Security Camera – SCA Video

30. Good Morning America Video

31. WCCO – Chippewa Falls, WI

32. Football Referee Video

33. KARE 11 – AED Video

34. Airport Security Camera – SCA