Tualatin Valley Fire & Rescue Community AED Program - Saving Lives Through Early Defibrillation

Contents

1. Overview

2. Common Questions Answered

1. What exactly is an AED?

2. What are the liabilities and guidelines associated with purchasing and using an AED?

3. What is the process for establishing our business as an AED site?

3. TVF&R's Community AED Program Components

Appendix 1.   AED Site Checklist

    Downloadable/printable version

Heart disease is the single greatest cause of death in the United States. Every year, almost 500,000 adult Americans die of coronary heart disease. Of those, 250,000 die of sudden cardiac arrest before they reach a hospital. Ventricular fibrillation, a disturbance in the heart's electrical activity, is the most common initial form of sudden cardiac arrest. A fibrillating heart quivers with chaotic electrical energy but does not pump blood or generate a pulse. Ventricular fibrillation can be lethal, but it is treatable. If the heart can be shocked quickly with a defibrillator (i.e., "defibrillated"), a normal heart rhythm may be restored and many victims can survive. In other words, sudden cardiac arrest need not be fatal.

Time is the enemy. The survival rate for sudden cardiac arrest falls almost 10% every 60 seconds; if a victim of sudden cardiac arrest can be defibrillated within a minute the survival rate can be close to 90%!  Clinical research has determined that reducing the interval between onset of sudden cardiac arrest and delivery of defibrillation by even one or two minutes not only significantly increases survival rates, but that it does so more than all other emergency cardiac care combined.

Survival from sudden cardiac arrest typically depends upon a series of events. Someone has to immediately recognize the problem, call 9-1-1, and start CPR.  CPR buys time, keeping oxygen in the blood flowing to vital organs to give the victim the best chance of survival until defibrillation is administered. Defibrillation as early in the sequence as possible is essential for survival. Finally, emergency medical personnel trained in advanced life support (paramedics) can provide advanced airway procedures and medications to maintain a restored heartbeat, increase the amount of oxygen in a victim's system, and minimize the chance of defibrillation. TVF&R has trained Firefighter/Paramedics that respond to every 9-1-1 medical call within our district.  More important, every fire apparatus in the district has a defibrillator on board ready to save someone's life.

The goal of our community AED (automated external defibrillator) program is to facilitate AED distribution as much as possible in order to shorten the interval from sudden cardiac arrest to defibrillation. This does save lives. Sudden cardiac arrest happens everywhere. Whether you are a large corporation, a small business, or a government entity, TVF&R is committed to helping you successfully meet all the requirements necessary to place one or more AEDs at your site. The following pages contain the information needed to guide you in establishing your own successful AED site. Please feel free to contact Linda Wert at 503-259-1687 with any questions or concerns not addressed within this packet. If Linda is unable to address your particular question, one of TVF&R's AED Resource Managers will contact you as soon as possible.

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1. What exactly is an Automated External Defibrillator (AED)?

An AED is capable of identifying life-threatening cardiac rhythms (electrical activity in the heart) that can be converted by a metered electric shock. It analyzes the cardiac rhythm and determines whether a shock is needed based on preprogrammed parameters in its internal computer. Shocks can be delivered according to one or more standardized, automated protocols, incorporating one of several modes depending on the type of AED used. All modern AEDs have visual and/or verbal prompts that guide the user through the entire rescue process.

AEDs available to the public today are portable and can weigh less than four pounds; most are slightly larger than a laptop computer.  They can hang on the wall or be carried in a small case.  As AED designs and end-users have evolved, prices have dropped: the range is typically $1100-1600, but promotional or contract prices may be lower.  Maintenance requirements vary by manufacturer, but all currently available models are designed to be low-maintenance, with long-life batteries. Modern AEDs run their own internal self-tests automatically and indicate readiness by visual display.  Typical requirements include checking the AEDs weekly to ensure operational status and presence of ancillary equipment.

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2. What are the liabilities and guidelines associated with purchasing and using an AED?

There is a detailed discussion on liability and other legal issues associated with AEDs from Richard Lazar, Esq., and a useful summary from the American Heart Association (PDF, 31 kB).

A pair of bills, Oregon Senate Bill (SB) 556 (2009) and Oregon Senate Bill 1006 (2010), both established and updated ORS 431.690, as well as updating ORS 30.802, requiring certain "public assembly areas" to have AEDs and extending Good Samaritan protection to single buildings 50,000 sq. ft. and larger and where at least 50 people congregate during business hours, including commercial, office, retail, deliberation, and transportation uses (e.g., shopping malls, large retail stores, office buildings, transportation terminals), but excluding property used for education or worship.  Requirements for higher education campuses were specified as well.  The law took effect January 1, 2010, with updates effective upon passage on March 4, 2010.

Oregon House Bill (HB) 3482 (2005) established program guidelines and some liability protection for users and purchasers of AEDs within the state, as well as providing resources for school districts and mandating AEDs for health clubs, a defined in ORS 431.680.  Oregon Administrative Rules 333-030-0105 requires all residential camps with 100 or more on-site campers and staff to have at lest one AED with pediatric capability (excerpt with full text of OAR 333-030-0105(8)).  Oregon Senate Joint Resolution 32 (2001) strongly encouraged placing AEDs in public buildings.

ORS 30.802 Liability for use of automated external defibrillator

(1) As used in this section: (a) 'Automated external defibrillator' means an automated external defibrillator approved for sale by the federal Food and Drug Administration; (b) 'Public setting' means a location that is:
  (A) Accessible to members of the general public, employees, visitors and guests, but that is not a private residence;
  (B) A public school facility as defined in ORS 327.365; or
  (C) A health club as defined in ORS 431.680.

(2) A person may not bring a cause of action against another person for damages for injury, death or loss that result from acts or omissions involving the use, attempted use or nonuse of an automated external defibrillator when the other person: (a) Used or attempted to use an automated external defibrillator;  (b) Was present when an automated external defibrillator was used or should have been used; (c) Provided training in the use of an automated external defibrillator; (d) Is a physician and provided services related to the placement or use of an automated external defibrillator; or (e) Possesses or controls one or more automated external defibrillators placed in a public setting and reasonably complied with the following requirements:
  (A) Maintained, inspected and serviced the automated external defibrillator, the battery for the automated external defibrillator and the electrodes for the automated external defibrillator in accordance with guidelines set forth by the manufacturer.
  (B) Ensured that a sufficient number of employees received training in the use of an automated external defibrillator so that at least one trained employee may be reasonably expected to be present at the public setting during regular business hours.
  (C) Stored the automated external defibrillator in a location from which the automated external defibrillator can be quickly retrieved during regular business hours.
  (D) Clearly indicated the presence and location of each automated external defibrillator.
  (E) Established a policy to call 9-1-1 to activate the emergency medical services system as soon as practicable after the potential need for the automated external defibrillator is recognized.

(3) The immunity provided by this section does not apply if: (a) The person against whom the action is brought acted with gross negligence or with reckless, wanton or intentional misconduct; (b) The use, attempted use or nonuse of an automated external defibrillator occurred at a location where emergency medical care is regularly available; or (c) The person against whom the action is brought possesses or controls one or more automated external defibrillators in a public setting and the person's failure to reasonably comply with the requirements described in subsection (2)(e) of this section caused the alleged injury, death or loss.

(4) Nothing in this section affects the liability of a manufacturer, designer, developer, distributor or supplier of an automated external defibrillator, or an accessory for an automated external defibrillator, under the provisions of ORS 30.900 to 30.920 or any other applicable state or federal law.

Full text (Chapter 551 Oregon Laws, 2005)

Oregon Senate Bill 1033 (2010) requires each public and private school campus to have at least one AED by January 1, 2015.

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The following steps are necessary to establish a recognized AED site within TVF&R's response area.  If you're not sure whether you are located within TVF&R's response area please contact us.  We'll be happy to point you in the right direction.

1. Initial interest:

1. Potential site representative contacts Linda Wert at 503-259-1687; Linda is the AED program contact for TVF&R.

2. TVF&R enters potential site contact information into AED Database

3. TVF&R mails Community AED Program Packet to the potential site

2. Decision to become an AED site:

1. Contact Linda Wert at 503-259-1687 and indicate intention to be an AED site.  An AED Site Coordinator must be identified as part of this step.

2. At this point in the process one of two routes may be taken:

1. AED sites within Washington County that have no physician willing to serve as AED site Medical Director may contact Louisa Partain of Washington County EMS, at 503-846-8699. Washington County EMS will then become the AED Program Administrator and provide guidance through the rest of the process, along with support for initial training.

2. All other AED sites must continue with the following steps:

3. Obtain initial AED training from an Oregon State Public Health-approved course. The following is a list of currently approved courses:

1. American Heart Association (AHA) Heartsaver AED (or other classes with AED modules)

2. American Red Cross (multiple classes with AED modules)

3. EMP Medic First Aid (multiple classes with AED modules)
   Most of these courses last less than 4 hours and include CPR as part of the course. Prices differ depending on which course you choose and whether it is taught on-site.

Tualatin Valley Fire and Rescue provides CPR and AED training through Lifeline Health & Safety.  For more information, call Lifeline at 503-243-2277 or visit their website.

4. The AED site must purchase one or more AEDs.  Most users can find AEDs that meet their site needs for less than $1500; prices vary considerably and may be far less.  The manufacturer you choose should give you an on-site orientation to their particular machine and recommend how many AEDs you should purchase based on the size of your site.  In addition, the manufacturer should provide you with the maintenance schedule and requirements for your particular AED.  Examine more than one brand, and do so with a critical eye; remember that the least expensive machine may not be the one best suited to your needs.  The following is a list of manufacturers currently selling AEDs to the public.  AEDs should be programmed with current AHA CPR/AED protocols.

• Cardiac Science/Powerheart: Brian McKinney: (503) 367-7368

• Defibtech: Information: (866) 333-4248

• Heartsine Technologies: Information: (866) 478-7463

• Philips Medical/HeartStart: Kory Brown: (503) 222-5574

• Physio-Control: Jon Cole: (800) 442-1142 x72844

• Welch Allyn: Jerry Brennan Rounds: (503) 710-7000

• Zoll Medical: John Phelps: (541) 729-0412

• WA/OR purchasing contract for public and not-for-profit entities

NOTE: Access Cardiosystems AEDs have been recalled and the company is out of business. Physio-Control has a recall on some of their Lifepak 500s and 2008 and 2009 recalls on some of their Lifepak CRs (manufactured when Physio-Control was part of Medtronic) and a voluntary recall on some Lifepak CR and Lifepak Express AEDs; Heartsine has a recall on some of their Samaritan AEDs; Welch Allyn has recalls from 2005, 2006, and 2007 on some of their AED 20s, a 2007 recall on some AED 10s, a 2008-09 recall on some AED 10s and MRL JumpStarts, and a recall for some of their PIC 50s; Defibtech has a recall on some of their Lifeline and ReviveR AEDs.  Philips has a voluntary recall on some of their HS1 AEDs, manufactured in 2005.  Cardiac Science has a voluntary recall on several AED models, manufactured or serviced in 2009-2010.  Zoll has a recall on some of its AED-Plus units.  Current information on updates may be available on the FDA's medical device recall page.

5. The AED site must have a licensed physician sign a prescription stating that they assume the responsibility of being the AED site's Medical Director. There are multiple resources for obtaining a medical director. Your physician is the head of your AED program and approves the medical protocols for the operation of your AED.

   1. The manufacturer from whom you buy your AED may provide you with a physician medical director; there may an annual fee involved. Ask them when you purchase your AED.

   2. Your business or parent company may have a physician that they already employ for health services.

   3. Your county's EMS office may be able to provide physician oversight.

   4. Tualatin Valley Fire and Rescue may be able to help you obtain a medical director if you are unable to do so otherwise.

6. Your AED Site Coordinator must submit the following documentation to TVF&R:

   1. A completed AED Site Checklist (Appendix 1) with the attached documentation:

      1. Training/Retraining policy: a paragraph or two that outlines how many employees you initially trained and through whom you received the training, and your commitment to keep their AED training current (must be retrained every two years).
         
         TVF&R will provide on-site drills at least annually for free, but it is the responsibility of your AED Site Coordinator to contact Linda Wert at 503-259-1687 approximately a month ahead of the date and time you would like the engine crew to arrive and conduct a 30 minute training session. The exact time may change if the engine crew is running 911 calls.  NOTE: these sessions do not provide certification or serve as formal refresher training.
         

      2. Maintenance and testing policy and procedures: based on the manufacturer's recommendations

      3. Copy of physician's signed prescription for an AED

      4. Copy of your physician approved AED medical protocol

7. Final Approval: TVF&R approves your documentation and enters you into the 911 database.

   1. Once you receive notification from TVF&R you may place your AED(s) in service.

   2. Your AED Site Coordinator must notify Linda Wert at 503-259-1687 of any future changes in your contact information or changes to your AED program

   3. Most importantly, if you do have an event where your AED is used please contact Linda Wert at 503-259-1687 and report the date, time, and circumstances. If anyone at your workplace experiences stress or anxiety related to the event you can also contact TVF&R as a resource for Critical Incident Stress Debriefing.

Use the AED Site Checklist (Appendix 1) as a step by step guide. The numbers of the checklist correspond with the more detailed explanations listed above. The requirements may seem numerous and complex, but the process actually can be completed in a month or less (without requiring AED use on anyone involved!). If any questions arise during the process contact Linda Wert at 503-259-1687. If she is unable to answer your questions you will be contacted promptly by one of TVF&R's AED resource managers, on-duty Firefighter/Paramedics who should be able to meet your needs.

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TVF&R's AED Program Components

1. Public AED Awareness and Education Goals: through mass media, including; television, radio, newspapers, journals, pamphlets, and word of mouth

1. Raise awareness of our AED program and the benefits of having AEDs in the community

2. Educate the community in AED use and how it is an integral part of our EMS system

3. Encourage all potential AED sites within our District to purchase AEDs and meet the requirements to put them in service.

1. Large corporations, jails, non-hospital medical facilities, shopping malls, recreational facilities, golf courses, retirement communities, small businesses, municipal facilities

2. Act as a resource and guide for potential AED sites by:

1. Having an established TVF&R AED program with the following roles:

1. Program Medical Director: Dr. Mohamud Daya

1. provides all medical direction and oversees the entire program

2. resource for connecting potential AED sites with a physician for medical direction (may include himself)

2. Program Chief: Mark Stevens (EMS Chief)

1. oversees the administration of the program and related training

2. oversees all other positions

3. Program Coordinator: Scott Malone

1. enters all pertinent information into the AED Database

2. acts as the district contact for all engine companies

4. TVF&R Technical Support: Jeff Rubin (Emergency Manager)

1. maintains TVF&R's AED website and Community Guide

2. provides program information, technical information, and public education

5. Program Contact Manager: Linda Wert

1. manages contact information

2. refers questions to AED resource managers

6. Washington County 9-1-1 Liaison: Shirlee O'Conner

1. sends approved AED site information to WCCCA to be entered into the 9-1-1 Database

7. AED resource managers:

1. three Firefighter/Paramedics, one on each shift, who are able to answer questions and guide potential AED sites that have contacted the Program Contact Manager with questions

2. Making this Community AED Program Packet readily available by requests and by posting it on the internet

3. Having a contact number, 503-259-1687, for potential AED sites to start the process and call if they have questions that are not answered by the Community AED Program Packet

4. Maintaining a list of resources

3. Provide initial and continuing training:

1. Provide AHA AED courses through CPR Lifeline

2. Provide on-site training at least annually at AED sites via a 30 minute session taught by a TVF&R engine company crew (NOTE: this does not serve as formal refresher training)

3. Notify AED sites when their training needs to be updated by keeping track of training dates on the TVF&R AED Database

4. Maintain information on all AED Sites within TVF&R's boundaries:

1. By maintaining up to date information on the TVF&R AED Database

2. By corresponding with local government agencies, AED manufacturers, and the public to ensure we have a list of all AED sites within TVF&R's boundaries.

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1. Contact Linda Wert at 503-259-1687 to obtain a TVF&R Community AED Program Packet or access the entire document on the internet.

2. After reading the entire Community AED Program Packet and choosing to save lives by becoming an AED site, contact Linda Wert and give her the name and contact information of the person your AED site has chosen as their AED Site Coordinator.

3. Obtain approved AED training for all employees that have the potential for operating the AED or AEDs.

4. Purchase an AED or AEDs.

5. Obtain a prescription from a physician who has agreed to be your AED site's Medical Director.

6. Document your AED site's program components:

1. Training/Retraining Policy

2. Maintenance Testing Policy and Procedures (downloadable log in PDF)

3. Physician approved AED Medical Protocols

4. Copy of your Medical Director's prescription for an AED

7. Place a copy of this packet with your AED site's documentation and plan for future training. Arrange with TVF&R at least annually for practice, and keep all employees current ? train new employees as part of their orientation and existing employees at least every 2 years.

8. Send copies of your documents and this completed checklist to TVF&R for final approval.

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NOTE: Some material on this page is from commercial websites.  Use of this material does not constitute an endorsement by TVF&R.