As you move forward with your decision to implement an AED program, it is important to remember that a successful plan includes more than just going out and purchasing the AED.
An emergency response plan that includes an AED program is a commitment by everyone involved. It requires certain responsibilities along with proper training of designated employees in order to fulfill the long-term goal of creating a safer work environment.
While every place of business should consider an AED program because of the possibility of a cardiac arrest on the premises and the need for timely defibrillation, there are important responsibilities to be considered for successful implementation.
Compliance with PAD Policies
It is critical to learn the local, state, and federal regulations for AED ownership to ensure compliance. Both the FDA (Food and Drug Administration) and state regulatory agencies determine who can use AEDs and how they may be used.
Each state has different requirements and recommendations. Contact your state’s regulatory authority to learn the laws governing your state or check with local EMS agencies for information.
It is important to keep in mind that businesses and organizations that are required by law to implement an AED program but fail to do so are at greatest risk of liability if an individual suffers an SCA (sudden cardiac arrest) while on the premises.
All states have instituted PAD (Public Access Defibrillation) policies with recommendations or requirements regarding placement and upkeep of an AED. While state laws and regulations vary widely, here is a list of some of the common requirements:
- Location – requirement of specific types of organizations to acquire an AED, such as health clubs, schools, restaurants, and pools.
- Training – training and certification of specific individuals in the use of the AED as well as in CPR.
- Registration — location of defibrillators may need to be registered with the state or the local emergency medical authority.
- Maintenance – requirement that AEDs be tested and maintained to manufacturer’s standards.
- AED Program Administration – requirement to have a written AED program detailing information such as prescription information, medical direction, location, training, documentation, regulations, maintenance schedule and use of the AED. Documentation of an actual SCA event may be required.
- Medical Oversight – requirement that AED program is overseen by a physician.
- Prescription – prescription for an AED may be required before acquiring the equipment.
Even if not required by your state, it is important that designated employees learn CPR and appropriate use of the AED when the unit is placed into service. Formal training teaches the chain of survival and provides the confidence to react quickly in an SCA emergency.
Initial CPR/AED certification is valid for a specified amount of time, usually 1-2 years. Refresher classes are required to maintain certification.
AEDs, while easy to use, require ongoing management and maintenance. In addition to training volunteers, a well-designed AED Program includes testing and maintaining your device — a critical and often overlooked factor in deploying AEDs in organizations.
All AEDs need to be maintained in accordance with manufacturer specifications to ensure the unit will work properly at the time of need. These specifications are found in the operations manual, which will detail the operational test and checks.
Maintenance checks are typically required weekly or monthly depending on the manufacturer. Many models provide and document self-tests monthly, weekly, even daily.
Maintenance also includes tracking pad and battery expirations and replacements as needed.
Typically, pads need to be replaced every two years, but some have a shelf life of up to 5 years. Keep in mind that pads expire because the adhesive material they are made of breaks down over time. If they do not adhere properly to the victim, the AED will not be able to analyze the heart rhythm or deliver effective electrical therapy.
Battery life varies from two to ten years with some models offering a rechargeable option. Battery life varies according to how much it is used. Batteries operate functions such as AED self-checks as well as status light indicators when not in use.
Documenting maintenance checks and supply status is also an essential responsibility of an AED program.
Even if not required by law, AED Program documentation is an important part of an effective emergency response plan for SCA.
A good AED program includes written policies and procedures outlining the AED program criteria, responsibility of rescuers, location and access to unit, maintenance guidelines, step-by-step guide for use, and post-event procedures.
Documentation should also include logs of maintenance checks and supply expiration dates and replacements.
Appointing a Program Manager
It is important to identify an individual within your organization who will take the lead in implementing the AED program. The program manager should be committed to the long-term success of the program, gather information, act as the AED liaison and, be the facilities AED expert.
The program manager is responsible for ensuring all policies and procedures are followed, training is kept current, maintenance and upkeep of unit is performed, determining designated rescuers, and any other logistics related to the AED program.
Medical oversight is an important responsibility of an AED program and may be required to some degree in your state. The American Heart Association advises that a medical director be involved whenever an AED program is implemented within an organization.
Medical oversight is the physician supervision of any activity that involves medical treatment. Since CPR and AED are medical treatments, a physician may be required to oversee the planning and implementation of an AED program.
This physician is designated as the Medical Director of the program and is responsible for ensuring medical treatment is given following safe practices. The Medical Director typically establishes policies and directs training and quality control activities.
As advisor for an AED program, the medical director may be responsible for some or all of the following activities:
- Writing a prescription for the AED
- Assisting with the development of an emergency response plan
- Approving AED program policies and procedures
- Overseeing training
- Evaluating post-event data
There are certain responsibilities that may be required after the use of an AED. These activities should be outlined in the policies and procedures of the AED program and may be done by the Program Manager, the Medical Director, or by a contracted organization.
- Complete the Response – When EMS arrives, they need to know the specifics about the event, such as whether someone witnessed the cardiac arrest, how long the victim was down and how many shocks were delivered.
Upon arrival, EMS personnel attach their own defibrillator to the patient and assume CPR responsibilities. The pads you attached to the victim must be disposed of and someone must clean up any leftover packaging or waste.
- Put the AED Back in Service – The AED must be prepared for the next response after each use. The AED pads must always be replaced. Any medical supplies that were used, such as disposable gloves, razors, or barrier devices need to be replenished. Also, be sure to check the manufacturer guidelines to determine if the battery or charge pack needs to be replaced. The unit may need to be cleaned and disinfected.
- AED Event Information – your AED policy may specify that data, such as heart rhythm and when shocks were delivered, collected by the AED during a cardiac arrest be retrieved from the defibrillator. This data can be transferred to a computer for later review by your medical director or local EMS.
- Written Documentation — someone from your emergency response team must document the cardiac arrest event in writing. Generally, this requires completion of a post-event form called a medical incident or accident report form. Complete this in writing as soon as possible after the incident. This report will include the date, time and location of the event, name of person completing report, whether or not SCA was witnessed, who started CPR and when, arrival time of AED, operator of AED, and name of responding EMS.
- Medical Oversight and Quality Improvement – your AED policy may stipulate that the medical director review event data to suggest improvements or changes in practices or policies. The medical director may suggest changes to improve effectiveness in areas such as training, AED location, procedures, or responder roles. Sometimes, doctors at the receiving hospital will request data to help determine a cause for the cardiac arrest.
- Debriefing — after the medical director reviews the event data, he or she may issue a report to your AED program manager. A review meeting, or debriefing, may help everyone involved during the emergency response learn from the experience and improve your organization’s response procedures. The purpose of a debriefing is to identify actions that went well and where there is an opportunity for improvement. Topics discussed may include how quickly 911 was called, the AED location and, how well CPR was performed.
A debriefing can also provide support to the lay responders involved in the event to ensure that this stressful event does not have a negative impact on psychological and emotional health. Responders have the opportunity to discuss their emotions and concerns in a supportive environment.