NUI Galway Automated External Defibrillator (AED) Policy

NUI Galway Automated External Defibrillator (AED) Policy 1. Executive Summary 2. NUI Galway AED Co-ordinator 3. Local AED Co-ordinators 4. Applicable Documents 5. Medical Control 6. AED Responder (including Occupational First Aiders**) Responsibilities 7. Other s Responsibilities - Heads of Colleges, Schools, Support Services - Bystanders. 8. Switchboard Operator Responsibilities 9. Equipment 10. Location of AEDs 11. Initial Training 12. Renewal/Skills Review Training 13. Medical Response Documentation 14. Equipment Maintenance 15. System Verification and Review 16. Annual System Assessment 17. Weekly System Check 18. Post event review 19. Adverse Events/Complaints. 20. Approvals 21. Appendix 1 - AED Operation Appendix 2 - AED Locations/Policy Distribution List Appendix 3 - References/Resources Appendix 4 - Weekly Equipment Checks Appendix 5 - Infection Control Procedure Appendix 6 - NUI Galway Colleges, Schools, and Support Services Local Cardiac Arrest Response Plan 1 of 12

1. Executive Summary An automated external defibrillator (AED) is used to treat victims who experience sudden cardiac arrest (SCA). It is only to be used on victims who are unresponsive and not breathing. The AED when applied correctly will analyse the heart rhythm and advise the operator if a shockable rhythm is detected. If a shockable rhythm is detected, the AED will charge to the appropriate energy level and advise the operator to deliver a shock. The Task Force on Sudden Cardiac Death (2006) highlighted that the current survival rate for sudden cardiac conditions is very poor, typically less than 1% in the absence of an effective emergency response system. But if an AED is used promptly, the victims chances of survival can increase significantly, e.g. if an AED is used within five minutes the victim has a 50% chance of survival and potentially higher with younger patients. The Task Force identified university and colleges as facilities where AEDs should be placed because the incidence of cardiac arrest is high. In 2007, the first AED was provided in NUI Galway and since then the programme has expanded to provide a current total of 13 on campus and AEDs are also in place in Aras Shorcha Ní Ghuairim Carna and Aras Uí Chadhain, An Cheathru Rua. The purpose of this policy is to set out the personnel, equipment, documentation and information necessary to establish and maintain an effective NUI Galway AED programme for the benefit of all the University community and environs. 2. NUI Galway AED Co -ordinator: The NUI Galway Safety Office will co-ordinate this AED policy and practical requirements on NUI Galway Campus other than where other local arrangements are in place. Responsibilities: Co-ordination of training for AED Responders; Promotion of the AED availability amongst the university community; Checking centrally that the equipment and supplies are in date; Revision of policy as required; Monitoring the effectiveness of the system; Communication with the Medical Director on issues related to medical response program including post event reviews; Centrally restocking consumable items where required. 3. Local AED Co-ordinator: The thirteen AEDs on Campus are regarded as being owned by their respective units (see Appendix 2, who will be responsible for the maintenance and checking of their local AED(s) and the training of their immediate staff where applicable. AEDs are also in place in Aras Shorcha Ní Ghuairim Carna and Aras Uí Chadhain, An Cheathru Rua. Responsibilities: Co-ordination of local training for any immediate AED responders within their respective area where applicable. Otherwise the training is co-ordinated by NUI Galway s Organisation and Staff Development. Weekly check of AED unit and kit (see 17 below). 4. Applicable Documents: 2 of 12

Signs and lists of AED Responders adjacent to the AEDs and contact details in an emergency. Emergency information on the NUI Galway Safety Office website. Safety Contacts Posters (Locally displayed). Infection control procedure for occupational exposure to blood borne pathogens (Appendix 5). NUI Galway insurance policy. 5. Medical Control: The Medical Advisor of the AED program is Dr. Fionnguala Lysaght (Student Health Unit). The Medical Advisor of the AED program is responsible for: Providing medical direction for the use of AEDs. Reviewing and approving guidelines for emergency procedures related to the use of AEDs and CPR. Evaluation of post event review forms and digital files downloaded from the AED. 6. AED Responder (including Occupational First Aiders**) Responsibilities: All authorised trained occupational first aiders or other personnel to commit to attending the initial and Skills Review training every 8 months. Staff or other personnel who have successfully completed an approved CPR and AED training program (and maintained their Skills Review training) within the last two years will have their names and extension numbers displayed beside the relevant AED unit and on the WEB. As of March 2009, the Occupational First Aid Training** will include training in AED use. In recognising that AED Responders are acting in a voluntary capacity, as far as possible they should be tactful and respectful e.g. not removing the casualty s clothing unnecessarily. 7. Others Responsibilities: Heads of Colleges, Schools and Support Services must ensure that adequate local arrangements are in place to ensure a prompt response to a cardiac emergency as part of their occupational first aid arrangements. This includes the following measures: o Ensuring that local Occupational First Aiders (and other staff where appropriate) are trained in AED use: o Ensuring that there is a local plan (Appendix 6) in place to respond to a cardiac emergency, setting out the different roles and required actions; o Ensuring that all staff are aware of the location of the nearest AED(s), and what they can do in the event of such an emergency. Bystanders can, at their discretion, provide voluntary assistance to victims of medical emergencies. The extent to which these individuals can respond shall be appropriate to their training and experience. These responders are encouraged to contribute to emergency response only to the extent that they are capable. The emergency medical response of these individuals may include other first aid measures or simply but critically by assisting other trained personnel e.g. by bringing the AED to the emergency location (See Appendix 6). 3 of 12

8. Switchboard Operator Responsibilities: Receiving emergency medical calls from internal locations; Contacting the external 999/112 Emergency Services if required (Red card details); Contacting trained NUI Galway AED Responders or others, where notified about a cardiac incident or other unconscious casualty; Contacting Security so that they can assist in responding to the emergency e.g. by directing the ambulance to the scene. 9. Equipment: There are three AED models available throughout NUI Galway. These are: Defibtech lifeline AED, Medtronic Life Pak CR Plus and Laerdal Heart Start FR 2+ Defib. The AED and kit will be brought to all cardiac emergencies. As in all cases the casualty must display ALL the symptoms of a cardiac arrest i.e. the AED will be used only after the following symptoms are confirmed: Victim is unconscious; Victim is not breathing (A&B). The AED can be used on any person who is at least 1 year of age where all the symptoms of cardiac arrest are confirmed. However, in the case of a child casualty (i.e. aged between 1 and 8 years), the current recommendation is that as most cardiac arrests in children are thought to result from respiratory failure or shock rather than from a shockable arrhythmia. As a result there is a concern that the repeated interruption of CPR to try to detect and treat a rhythm uncommon in that age group may introduce more risk than benefit. Therefore while Child-AED pads are provided with each AED, AED Responders should carryout CPR on children and only use the AED on a child where they have additional medical training and on that basis have determined that the use of the AED is appropriate in that particular case. 10. Location of AEDs See Appendix 2 Each AED will have one set of defibrillation electrodes for both adults and children with the device and one spare set of the adult type with the AED. Also with each AED there will be a kit with: large and medium disposable gloves (total 2 pairs); flannel or other means of drying; face mask (with valve); razor; scissors; antiseptic wipe(s) Pre-Hospital Emergency Care Council s (PHECC) Cardiac First Response Report (CFRR) and completion guide Aspirin (300mg) X 2. 11. Initial Training: AED Responders must complete approved AED training which covers basic first aid, CPR and AED use. Training will be arranged by Organisation and Staff Developement in NUI Galway. The AED course follows the American Heart Association protocols. The NUI Galway Organisation and Staff Developmentwill keep training records of the NUI Galway staff and other personnel whose training they have arranged. 12. Renewal/Skills Review Training: 4 of 12

AED Responders must obtain documented renewal training at least every 2 years. The AHA recommends that AED Responders regularly complete skills reviews. In consultation with relevant agencies and training providers this training will take place every 8 months so that AED responders will attend training twice annually. 13. Medical Response Documentation: Internal Post AED-use Documentation: The following forms should be sent to the NUI Galway Safety Office within 24 hours of a medical event: An AED responder must fill in a First Aid Report Form when the AED is used. Medical emergencies involving the use of an AED require special documentation. A copy of AED use information shall be presented to the Medical Director of the AED Program and the AED Program Co-ordinator within 72 hours of the emergency. At a minimum, event information shall include any recorded data, and all electronic files captured by the AED. In the event of a cardiac emergency (including chest pain, CPR, use of an AED, etc.) the Pre-Hospital Emergency Care Council s (PHECC) Cardiac First Response Report (CFRR) is to be completed. A copy of this form together with the completion guide is available at each of the AEDs, and the form and its completion is covered at the Cardiac First Responder training. 14. Equipment Maintenance: All equipment and accessories necessary for support of medical emergency responses shall be maintained in a state of readiness. Specific maintenance requirements include: The NUI Galway Switch Board (dial 0 ) shall be informed of changes in availability of emergency medical response equipment. If equipment is withdrawn from service, the Switch Board shall be informed and then notified when equipment is returned to service. The relevant Local AED Co-ordinator shall be responsible for completing the weekly equipment maintenance check (see also #17). Any maintenance tasks shall be performed according to equipment maintenance procedures as outlined in the operating instructions. Following use of emergency response equipment, all equipment shall be cleaned and/or decontaminated as required. If contamination includes body fluids, the equipment shall be disinfected according to procedure No staff member shall attempt any repairs other than the standard replacement of a battery or component before the expiry date. Batteries, pads or other accessories are managed by the Safety Office who organise replacements. If any problems are notes please report immediately to the Safety Office. If an AED exhibits an operational problem or a malfunction it should be immediately reported to the Safety Office who will contact the supplier for service. 15. System Verification and Review: The medical emergency response system is ultimately successful if necessary medical assistance is provided to victims in a timely and safe manner. Since actual use of this system procedure is expected to be very infrequent, other measures of effectiveness are required. 5 of 12

16. Annual System Assessment: Once each calendar year, all of the key parties (see Appendix 2) shall conduct a system readiness review. This review shall include review of the following elements: Equipment Operation and Maintenance Records. In addition the Safety Office will review: Training Records. 17. Weekly System Check: Once each week, the Local AED Co-ordinator shall conduct and document a system check (see Appendix 4). These records shall be collated by the Safety Office and the check shall include the following: Verification that the list of phone numbers of AED Responders are available and as far as possible current (beside the AED if updates required contact the Safety Office directly); Emergency kit supplies; AED operation and status. 18. Post event review: Following each deployment of an AED, a review shall be conducted to learn from the experience. The Medical Director shall conduct and document the post event review. All key participants in the event shall partake in the review. Included in the review shall be the identification of actions that went well as well as any aspects that need to be improved. A summary of the post event review shall be sent to the NUI Galway Safety Working Group and relevant parties and a copy of the post event review summary shall be kept in accordance with the record retention policy. The appropriate debriefing of the AED Responder(s) will be arranged directly after the incident as part of the Critical Incident Stress Management. 19. Adverse Events/Complaints. In the event of any adverse event or complaint e.g. equipment failure or dissatisfaction as to how an incident was handled, contact the System Co-ordinator in the first instance or where appropriate the Medical Director or Director of Safety. In the particular case of AED device failure the System Co-ordinator will contact the Medical Devices Department of the Irish Medicines Board. 20. Approvals: Function Printed Name Signature Date Medical Director Dr. F. Lysaght Director of Safety Dr. K. Loftus System Co-ordinator Alice Daly (NUI Galway Safety Office) 6 of 12

Appendix 1 - AED Operation AED is only used on an unconscious casualty who is not breathing. COMPLETE 2 MINUTES OF CPR BEFORE USING AED where you did not witness the collapse. Following initial analysis: Shock Advised: 1. Clear area, making sure no one is touching the victim. 2. Push SHOCK button when prompted. 3. After a shock is given continue Cardio Pulmonary Resuscitation (CPR) unless AED advises otherwise. 4. When 2 minutes of CPR have been performed the device will automatically evaluate the victim s heart rhythm and further shocks may be given (with CPR in between) ONLY if advised. No Shock Advised: 1. Device will prompt to administer CPR for 2 minutes. 2. AED will automatically evaluate victim s heart rate after two minutes of CPR. 3. If remaining unconscious and not breathing continue cycles of CPR and shocks (if advised) until professional help arrives. 4. Victim must be transported to hospital. 5. Leave AED attached to victim until an ambulance arrives and the trained personnel disconnect the AED. 6. Turn over care of the victim to the cardiac ambulance personnel. Once they have arrived, follow the directions of the trained emergency services staff for further actions 7. Complete required documentation (see part 13 of the main policy), 8. If victim is only not breathing normally, give rescue breaths according to training. 9. If victims is only unconscious (i.e. able to breathe but not responsive) place them on their side, in the recovery position, and monitor their breathing closely, where trauma is not involved. 7 of 12

Appendix 2 AED Locations The AED Policy once finalised will be generally available to NUI Galway personnel via the Safety Office web-site In addition a hard-copy will be provided to: Medical Director: Dr. F. Lysaght Each Local AED Co-ordinator (see table below). Security Switchboard Building Location Local Co-ordinator (Management Unit) Áras na Mac Léinn Ground Floor Foyer Ann Kenny + (Student Health Unit) Áras Moyola Ground Floor Foyer Lorraine Kent + Speech and Language Therapy (School of Nursing and Midwifery*) James Hardiman Library Ground Floor Foyer Loretto O Donohoe (James Hardiman Library) Sports Pavillion Dangan Main Entrance Reception Eamon Joyce, Steven Flaherty (Buildings Office Sports Pavilion) CIMRU Building, Nuns Island. Main Entrance Corridor, Right Turn. Aodh Dalton (College of Engineering + Informatics) Clinical Sciences Institute First floor, adjacent to the restaurant (main entrance). Marion Fannon (Clinical Sciences Institute) Quadrangle Archway Sheila Gorham (Press & Information) DERI First Floor, IDA Business Park, Seán O Riain (DERI) Lower Dangan Orbsen Building First Floor, Adjacent NCBES Liam Brennan (NCBES) Reception Arts Science Concourse Bank end of Concourse Adjacent Anthony Curling (Buildings) to O Flaherty Theatre Cairnes Building St. Anthony s side of Friars Joseph Mee (School of Psychology) + Sports Centre Ground Floor Reception Barry Phelan (Kingfisher) Sports Centre Ground Floor First Aid Room Barry Phelan (Kingfisher) Aras Shorcha Ní Ghuairim Carna Main Corridor, inside main door. Seamus O Concheanainn + (Acadamh na hollscolaíochta Gaeilge) Aras Uí Chadhain, An Cheathru Rua. Block 1, inside main door. Treasa Uí Lorcáin + (Acadamh na hollscolaíochta Gaeilge) + Demotes where additional staff are assisting/providing cover in the weekly AED checks. 8 of 12

Appendix 3 - References/Resources Reducing the Risk: A Strategic Report of the Task Force on Sudden Cardiac Death Department of Health and Children 2006 ISBN 1-873820-74-7 Cardiac First Response Training Manual Pre-Hospital Emergency Care Council 2008 ISBN 978 0-9557951-0-7 Cardiac First Responders Guide Health Services Executive, Irish Heart Foundation and Pre-Hospital Emergency Care Council March 2008 Advisory External Defibrillator National Pre-Hospital Standards 2008 UCD School of Medicine & Medicinal Science Centre for Immediate Care Services 9 of 12

Appendix 4 Weekly Equipment Checks AED Weekly Inspection Record Weekly AED inspections must be documented and records to be held for three years by the NUI Galway Health and Safety Office. To be completed once a week and after every use (please refer to device manual). Local AED Co-ordinator: Date Status OK (Medtronic) or Status Indicator (Defibtech-light flashing green) BLS kit OK Comments Signature 10 of 12

Appendix 5 Infection Control Policy for AED Use 1. While the risk is minor, Occupational First Aiders and AED Responders may be at risk of exposure to infectious diseases in the course of administering Cardio-Pulmonary Resuscitation (CPR) and using an AED. 2. Exposure can occur if: (a). Blood or other body fluid/substance comes into contact with broken skin, open wounds, eyes or mouth of the responder. (b). A skin penetrating injury happens to the responder. (c). Contaminated first aid equipment or materials are used. In administering CPR/using an AED, route (a). is the most likely exposure route and will only be an issue if the recommended Personal Protective Equipment is not used. 3. The infectious diseases which may be transmitted by body fluids include Hepatitis A, B, C and HIV. 4. Responders must take the appropriate measures to reduce the risks of infection to biological agents in the course of administering first aid. Use the appropriate personal protective equipment i.e. put on gloves before touching the casualty and have a pocket mask to hand. Gloves and pocket masks are available in all first aid kits and AED cabinets, and pocket masks are also provided to personnel at AED training. Use gloves/pocket Mask once only. Assume that all blood and body fluids of the victim are infectious. Do not use gloves/pocket mask if they appear defective or contaminated in any way Where possible, wash hands with soap and water before and after administering first aid, and after removing protective gloves. Refer to NUI Galway Health and Safety Guidance Note Hand Wash Protocol, at http://www.nuigalway.ie/administration_services/healthsaf/index.php?menu=33&page=48. Use protective gloves once only. Use latex gloves after consulting the University s latex glove policy, at http://www.nuigalway.ie/administration_services/healthsaf/index.php?menu=33&page=48. Cover new or existing cuts and grazes with waterproof dressings. Responders with known skin disorders especially of the hands should seek medical advice regarding the risk of infection and required protective/preventive measures they personally need to take. Avoid hand-mouth and hand-eye contact. 5. Management Of Spillage Of Body Fluids/Contaminated Waste: In the case of spills of body fluids or any contaminated waste after the emergency report directly to the Safety Office. 6. It is not normally necessary for first aiders in the workplace to be immunized against Hepatitis B virus unless the risk assessment indicates that it is appropriate (HSE Blood Borne Viruses in the Workplace). For further information contact the Health and Safety Office and refer to NUI Galway Health and Safety information on vaccination at http://www.nuigalway.ie/administration_services/healthsaf/index.php?menu=33&page=48. 11 of 12

Appendix 6 NUI Galway Colleges, Schools, Research Institutes and Support Services Local Cardiac Arrest Response Plan Heads of Colleges, Schools, Research Institutes and Support Services(Units)must ensure that adequate local arrangements are in place to ensure a prompt, co-ordinated response to a cardiac emergency as part of their occupational first aid arrangements. The following are the key measures: o o Ensure that there are sufficient local Occupational First Aiders (OFAs) (and other staff where appropriate) trained in AED use; Person responsible: Head of Unit Ensure that there is a local plan in place to respond to a cardiac emergency, setting out the different roles and required actions, as follows; Person responsible: Head of Unit o In the event of discovering/witnessing someone collapse (the casualty ), local staff member, student or other to call the ambulance (Red Card) and nearest Occupational First Aider(s). Ensure that the location is safe before approaching the casualty. Person responsible: All personnel o If the casualty is not responsive:- Call for help ensure ambulance called (Red Card), ensure at least 2 OFAs called, send for AED, get help from Bystander(s) Person responsible: All personnel Get the AED (on opening AED cabinet door audible alarm will sound). Familiarise yourself with all the AED locations now. Person responsible: All personnel OFA/Cardiac First Responder to carryout CPR and use AED in accordance with training: Person responsible: Trained Occup. First Aider/ Cardiac First Responder. Other local Personnel/Bystanders can assist by: o Directing ambulance to location of casualty Person responsible: Other local Personnel/Bystanders o Managing other bystanders Person responsible: Other local Personnel/Bystanders o Ensure that all staff and others are aware of the location(s) of the nearest AED(s), and what they can do in the event of such an emergency. Person responsible: Head of Unit o After treatment the OFA/Cardiac Responder completes the Cardiac First Response Report (PHECC) Person responsible: Trained Occup. First Aider/Cardiac First responder. 12 of 12