HEART SAFE SCHOOLS 1
TABLE OF CONTENTS 3 Letter: Project ADAM Wisconsin Heart Safe School Recognition 4 About: Project ADAM Wisconsin Heart Safe School Recognition 5 Acknowledgements & Community Partners 6 Steps to become a Heart Safe School 7 Tips for Getting Started 8 Heart Safe Schools Checklist 10 Cardiac Emergency Response Plans About: Cardiac Emergency Response Plans Tool: Cardiac Emergency Response Plan Template 22 Cardiac Emergency Response Drills About: Cardiac Emergency Response Drills Tool: Drill Summary Checklist 26 Sudden Cardiac Arrest All Staff Awareness About: All Staff Awareness Training Handout: SCA Awareness - General Handout: SCA Awareness for Athletics 30 Youth CPR-AED Awareness CPR-AED Educational Resources Lesson Plan: Compression Competitions 32 Getting the Word Out Heart Safe Schools Press Release 34 Project ADAM Wisconsin Additional Resources CPR-AED Training Needs Assessment AED Placement Funding Support Project ADAM Champion Award 39 Heart Safe Schools Incident and Feedback Forms Project ADAM CPR-AED Incident Form Heart Safe Schools Feedback Form 2
Dear Wisconsin School, We are excited to announce a new Project ADAM initiative in Wisconsin, Project ADAM Wisconsin Heart Safe Schools. We are working to recognize schools as Heart Safe so there are best practices and resources all schools can follow to keep schools prepared for cardiac emergencies. After Adam Lemel lost his life on the basketball court, the Lemel Family and Children s Hospital of Wisconsin teamed up and decided we were not going to lose more lives in schools and communities. The day Adam died, he had a Sudden Cardiac Arrest and his heart went into ventricular fibrillation, meaning he had an irregular heartbeat. The chain or survival was not in place that day as an AED was not available when he collapsed on the basketball court. Project ADAM (Automated Defibrillators in Adam s Memory) has empowered schools and communities to be prepared for cardiac emergencies since Adam s death in 1999. We have provided resources to Wisconsin schools to set up CPR-AED programs including placement of AEDs, setting up cardiac emergency response teams and plans and providing grants for CPR-AED training support. We have reached over 800 schools with program resources and partnered with the Wisconsin Masonic Foundation to place over 280 AEDs throughout Wisconsin. We are ready to take the next step to educate and recognize our Wisconsin schools for all the steps they are taking to be prepared to save a life. Please utilize these resources and checklist to become a recognized Project ADAM Wisconsin Heart Safe School. This achievement will create awareness and educate your community about how we can prevent sudden cardiac death in our schools. Thank you for your partnership. We look forward to taking this next step as a state. Sincerely, The Lemel s Adam s Family Anoop K. Singh, Project ADAM Medical Director Alli Thompson, Project ADAM Administrator Aaron Kinney, Herma Heart Center Service Line Administrator The Project ADAM Wisconsin Advisory Board 3
ABOUT: Project ADAM Wisconsin: Project ADAM Wisconsin is a program provided by the Herma Heart Center and Children s Hospital of Wisconsin. Dr. Anoop K. Singh, Director of Cardiac Electrophysiology, Children s Hospital of Wisconsin, is the medical director of Project ADAM Wisconsin. This program assists schools with implementing CPR-AED programs to prevent sudden cardiac death. Our program is carried out in memory of Adam Lemel, who at the age of only 17, suffered a sudden cardiac arrest at his school and passed away. An AED (automated external defibrillator) and a practiced cardiac emergency response plan could have saved his life. All consultation and recognition of schools is free of charge to schools in Wisconsin, thanks to the support of Children s Hospital of Wisconsin, The Herma Heart Center and our generous donors to Project ADAM s mission. Project ADAM Mission Statement: Project ADAM is a not-for-profit program of Children s Hospital of Wisconsin, whose mission is to serve children and adolescents through education and deployment of life-saving programs that help prevent sudden cardiac death. Project ADAM s work is carried-out primarily, but not exclusively, through school systems. Project ADAM Wisconsin Heart Safe Schools: Through the Heart Safe Schools program in Wisconsin we hope to connect with schools across the state to offer up to date resources on preventing sudden cardiac death in our schools and communities. Wisconsin schools that complete the implementation checklist indicating that a comprehensive CPR-AED program is in place, will receive a framed certificate of recognition and a letter to their Superintendent. A sample press release is available for schools to notify local media and increase public awareness of their efforts. Schools will also get a partnership sticker to place near their school AED(s). Schools will also receive updates in the form of e-newsletters including up to date information. Schools can also request materials to complete sudden cardiac arrest staff awareness training. Schools can apply for grants to assist with the CPR-AED training but will be limited. For more information about how your school can participate, please contact Allison Thompson, Project ADAM Administrator in Wisconsin. Phone: 414-266-1666, Fax: 414-266-6248, ajthompson@chw.org 4
Acknowledgements & Community Partners Project ADAM would like to acknowledge the following community members and professionals for their contributions: Partners: Project ADAM Wisconsin Advisory Board Project ADAM National Affiliate Program Children s Hospital of Wisconsin and the Herma Heart Center Milwaukee Public Schools, Heart Safe Schools Program Wisconsin Masonic Foundation 5
STEPS - Project ADAM Wisconsin Heart Safe Schools 1. Complete the Checklist to be sure your school has the components to be a Heart Safe School. Please contact Project ADAM if you need support reaching any of these steps. 2. Complete and return the checklist electronically to projectadam@chw.org OR mail your checklist to the following address: Alli Thompson, Project ADAM Administrator Children s Hospital of Wisconsin P.O. Box 1997, MS B550A Milwaukee, WI 53201-1997 3. Heart Safe School recognition lasts two full years. Upon processing of your checklist, the following will be awarded to your school: Listing of your school on the Project ADAM website A letter to your superintendent A plaque certifying your school as Project ADAM Wisconsin Heart Safe 4. Get the word out! Being prepared for a sudden cardiac emergency is an amazing accomplishment, and should be shared with your community. Use our resources to do the following: Send a press release about your school being Heart Safe Plan drills with your staff so your emergency response plan is being carried out and everyone knows where the AED(s) is in your building. Plan a health fair or event to teach kids hands only CPR and how to use an AED Special Note: Project ADAM Wisconsin is committed to meeting individual schools where they are in the course of implementing a school CPR-AED program. Our Heart Safe Schools program is focused on the core elements of cardiac emergency response plans, cardiac emergency response drills and sudden cardiac arrest awareness. If you need support with AED placement or other steps in building your program, please reach out so we can offer support and resources. 6
Tips for Getting Started When you are in the process of making sure your school is ready for cardiac emergencies, and for recognition as a Heart Safe school, here are some things to think about: Cardiac Emergency Response Plans A written cardiac emergency response plan (guideline included) is completed with administration. You should think about times when your school is used after regular school hours (sports, concerts, meetings, etc.), access to AED, and how an emergency would be handled then. You should also inform your local EMS (district office or closest fire station) about your CPR-AED program. When you think about communication in your school, be sure to think of all areas of your campus, and how a witness would communicate to the front office if they have a victim. In most schools the front office staff will be your communications hub, and will usually do three things: call first responders (over head page and/or walkie-talkies), call 911, and send someone to the front of the school to direct EMS to the scene when they arrive. If some first responders need to be relieved of classroom duties, they can also send a stand-in/sub. In choosing your cardiac emergency response team, we would recommend 5-10 people, with current CPR/AED skills, or who will get this training. There should be a plan for updating this team at least every two years. Training your first responder team is usually accomplished using a lay certification CPR-AED course such as those from the American Heart Association, American Red Cross or American Safety and Health Institute (ASHI).You can check with your local EMS, Parks and Recreation department, local technical or community college or hospital to find resources for training. If finding training in your community is difficult, especially in high schools and middle schools where all students and staff are in the adult CPR age group, you can also consider Hands Only CPR training for this team. Cardiac Emergency Response Drills Emergency situations take everyone out of their comfort zone and it is invaluable to practice this response as realistically as possible with your team in your building. This is a good test of your plan and your communication with your team. There is a drill description and checklist you can use in this toolkit. Sudden Cardiac Arrest All Staff Awareness Since anyone could be the witness of a victim becoming unresponsive, it is important for everyone on staff to have a little information about incidence and recognition of a sudden cardiac arrest, the fact that time is critical, and what the plan is for your building. This can be done in 10-20 minutes at a staff meeting, and a script and Project ADAM Training Videos are available. Share the sudden cardiac arrest awareness handouts and Checklist with your administrator, PE teacher, coach or athletic director. This way everyone starts on the same page. They will need to work with you to set up training, staff awareness and practice drills. Special Note: Project ADAM Wisconsin is committed to meeting individual schools where they are in their course of implementing a school CPR-AED program. Our Heart Safe Schools program is focused on the core elements of cardiac emergency response plans, cardiac emergency response drills and sudden cardiac arrest awareness. If you need support with AED placement or other steps in building your program, please reach out so we can offer support and resources. 7
Project ADAM Wisconsin Heart Safe Schools Checklist A Comprehensive School Program for Prevention of Sudden Cardiac Death Name of School: Name of District: ES: MS: HS: Private: CPR-AED Program Coordinator: Email: How long have you had your CPR-AED program? Phone number: What brand AED(s) do you use? Number of staff trained as CPR-AED rescuers? Training: Am. Heart Red Cross ASHI Other We have had to use our AED: Yes No Please complete this checklist for the current program in your school (one form per school): Program Quality Yes No Need Help Comments A program coordinator is identified, who oversees the CPR-AED program activities. School has an AED inside each school building. The placement of the AED(s) makes it accessible from any part of the building or campus within 2 minutes (fast round-trip walk by staff transporting to victim when emergency is announced). AED(s) have clear signage. There is a designated cardiac emergency response team comprised of at least 10% of staff or approximately 5-10 people. CPR-AED training is updated: annually or every 2 years There is a system in place to track CPR-AED training, and identify those who require retraining or practice (including budget or plan for retraining). All faculty and staff know where the AEDs are located and how to access them. All faculty and staff have had awareness training on sudden cardiac death (warning signs, recognition, communication procedures, other staff roles, etc.) Project ADAM can provide a script or scheduled awareness trainings, 10-20 minutes at a staff meeting is sufficient. We have a communication code (overhead page or other) to notify responders and others in the area that an incident is occurring. Teachers outside with students always carry a communication device. 8
Program Quality Yes No Need Help Comments The AED device is checked monthly, or per manufacturer s directions. An AED maintenance check is documented each time in writing. We keep a CPR barrier device, scissors, gloves, razor, and towel in a case or pack near or attached to the AED. We hold at least one annual Cardiac Emergency Response Drill (AED Drill) to test our emergency plan, communication and emergency responders. We have a written plan and protocol for AED use in the school. Local EMS has been notified about the specifics of our program. Wisconsin Student athletes must have completed pre-participation physical form and can be found here: https://www.wiaawi.org/portals/0/pdf/forms/physicalcard.pdf If a device is used for sports events or after school activities, there is a written emergency response plan for when and how it is to be used (i.e. for offsite events or if more than one event is occurring at a time). The following items are not required, but we would like to know if they are in place. We have a physician medical director (Check one: local or with AED company ) This school has a certified CPR instructor on staff (not required, but helps maintain the program more inexpensively.) Students in our school are taught CPR and AED instruction in the grade or class. (not required, but an important addition to the curriculum) Other community groups that use the school building regularly have been made aware of our AED program, location of devices, etc. If High School level, students are taught CPR and AED instruction prior to graduation. Other comments about your program: Would you like to be added to our Project ADAM Wisconsin e-news: Yes No Email: Please mail, email or fax this checklist to: Allison Thompson Project ADAM Administrator Children s Hospital of Wisconsin, Herma Heart Center P.O. Box 1997, MS B550A Milwaukee, WI Email: ajthompson@chw.org Fax: 414-266-6248 Please call 414-266-1666 if you have any questions about your program or any of these requirements to be a Project ADAM Wisconsin Heart Safe School. When your program has been evaluated as complete, we will notify you with presentation of a framed certificate and add your school to the community of Project ADAM Wisconsin Heart Safe Schools. 9
1 Cardiac Emergency Response Plans 10
About: Cardiac Emergency Response Plans This plan should be in place for all schools, since sudden cardiac arrest can happen to anyone in the school, mostly to adults, sometimes to children of any age, and not just student athletes. When there is a student with a known cardiac condition that puts him at increased risk for a sudden cardiac arrest, the plan is critical. 1. The most important thing is to be able to recognize an SCA (sudden cardiac arrest), so that 911 can be called and CPR can begin immediately. Sudden witnessed unresponsiveness, or finding someone unresponsive, is the first sign for all potential witnesses (all staff) to know. There is also no purposeful breathing or respiratory movements. This means a sudden cardiac arrest until proven otherwise, and requires a 911 call, CPR for the victim and use of the AED. It s also important to know that: if the victim is not breathing normally (or is just gasping), CPR should be started immediately no pulse check is needed the victim may have some jerking movements that might make you think of a seizure a blow to the chest can cause sudden cardiac arrest if there is any doubt, it s better to start CPR--you will not hurt the victim 2. If these things are true, begin CPR with hard and fast compressions to the middle of the chest (on the lower half of the breastbone). Compressions should be at least 2 inches deep, and at a rate of at least 100-120 beats per minute (bpm) (to the beat of the song Stayin Alive ). If others are present send one of them to call 911, and get the school s AED if there is one. Someone else should be sent to the front of the school to direct EMS when they arrive. If no one else is around, the witness should call 911 before beginning compressions. 3. For an adult or teen victim, the AED should be turned on, following the prompts and applying pads as soon as it arrives. For an elementary-age child, give CPR for 2 minutes, then turn on and apply the AED. You cannot hurt the victim with CPR or the AED. It will not shock someone who does not need to be shocked, so don t hesitate at all to put it on. Continue following AED prompts, providing CPR after every shock if prompted, and switching rescuers every two minutes until EMS arrives. Effective CPR buys you time, causing circulation and protecting heart and brain cells, until the AED can be used to jump start the heart s natural beat. 4. In most schools the plan should be that a witness calls the front office ASAP, and staff there will: 1) call the designated first responder team using overhead PA and/or walkies 2) call 911 3) send the AED and 4) send someone to the front to direct EMS when they arrive. CPR should be started as soon as possible, within 1 minute if possible. The victim s survival decreases 10% with each minute of delay. 11
5. These are also important parts of a plan: There should be at least 5 staff members (or 10% of staff) with current training in CPR and AED use, including staff during after school hours and for sports. There should be someone responsible for checking the AED at least monthly for routine maintenance, and a budget for replacing pads (usually every 2 years) and batteries (usually every 4 years) as per manufacturer s recommendations. The AED, like your fire extinguishers, should be accessible to all at all times. It should never be locked or kept behind a locked door when people might be in the building. There should also be a plan in place for medical emergencies during after school activities/ sports practices and games/ band practice/ concerts, etc. A realistic cardiac emergency response practice drill should be done with the first responders using an AED trainer and a manikin at least annually. If there is a school nurse present, she or he can lead and direct the response team, making sure that all efforts are coordinated and complete, compressions are effective, etc. If no AED is present or available in the school, then continuous effective CPR, changing rescuers every two minutes, is critical to keeping the victim s heart and brain protected until EMS arrives. When this plan is in place and has been practiced, it is a template for any other medical emergency as well. 12
Cardiac Emergency Response Plan 13
This Cardiac Emergency Response Plan is adopted by: Effective: A cardiac emergency requires immediate action. Cardiac emergencies may arise as a result of a Sudden Cardiac Arrest (SCA) or a heart attack, but can have other causes. SCA occurs when the electrical impulses of the heart malfunction resulting in sudden death. Signs of Sudden Cardiac Arrest can include one or more of the following: Not moving, unresponsive or unconscious, or Not breathing normally (i.e., may have irregular breathing, gasping or gurgling or may not be breathing at all), or Seizure or convulsion-like activity. Note: Those who collapse shortly after being struck in the chest by a firm projectile/direct hit may have SCA from commotio cordis. The Cardiac Emergency Response Plan of (insert name of school/school district) shall be as follows: 1. Developing a Cardiac Emergency Response Team (a) The Cardiac Emergency Response Team shall be comprised of those individuals who have current CPR/AED certification. It will include the school nurse, coaches, and others within the school. It should also include an administrator and office staff who can call 9-1-1 and direct EMS to the location of the SCA. (b) Members of the Cardiac Emergency Response Team are identified in the Cardiac Emergency Response Team attachment, to be updated yearly and as needed to remain current. One of the members shall be designated as the Cardiac Emergency Response Team Coordinator. (c) All members of the Cardiac Emergency Response Team shall receive and maintain nationally recognized training, which includes a certification card with an expiration date of not more than 2 years. (d) As many other staff members as reasonably practicable shall receive training. 2. Activation of Cardiac Emergency Response Team during an identified cardiac emergency (a) The members of the Cardiac Emergency Response Team shall be notified immediately when a cardiac emergency is suspected. (b) The Protocol for responding to a cardiac emergency is described in Section 8 (below) and in the Protocol for Posting attachment. 3. Automated external defibrillators (AEDs) placement and maintenance (a) Minimum recommended number of AEDs for (insert name of school/school district): (1) Inside school building The number of AEDs shall be sufficient to enable the school staff or another person to retrieve an AED and deliver it to any location within the school building, ideally within 2 minutes of being notified of a possible cardiac emergency. (2) Outside the school building on school grounds / athletic fields The number of AEDs, either stationary or in the possession of an on-site athletic trainer, coach, or other qualified person, shall be sufficient to enable the delivery of an AED to any location outside of the school (on school grounds) including any athletic field, ideally within 2 minutes of being notified of a possible cardiac emergency. 14
(3) Back-up AEDs One or more AEDs shall be held in reserve for use as a replacement for any AED which may be out-of-service for maintenance or other issues. The back-up AED(s) should also be available for use by the school s athletic teams or other groups traveling to off-site locations. (b) This school will regularly check and maintain each school-owned AED in accordance with the AED s operating manual and maintain a log of the maintenance activity. The school shall designate a person who will be responsible for verifying equipment readiness and for maintaining maintenance activity. (c) Additional Resuscitation Equipment: A resuscitation kit shall be connected to the AED carry case. The kit shall contain latex-free gloves, razor, scissors, towel antiseptic wipes and a CPR barrier mask. (d) AEDs shall not be locked in an office or stored in a location that is not easily and quickly accessible at all times. (e) AEDs shall be readily accessible for use in responding to a cardiac emergency, during both schoolday activities and after-school activities, in accordance with this Plan. Each AED shall have one set of defibrillator electrodes connected to the device and one spare set. All AEDs should have clear AED signage so as to be easily identified. Locations of the AEDs are to be listed in the Cardiac Emergency Response Team attachment and in the Protocol for Posting attachment. 4. Communication of this Plan throughout the school campus (a) The Cardiac Emergency Response Protocol shall be posted as follows: (1) In each classroom, cafeteria, restroom, health room, faculty break room and in all school offices. (2) Adjacent to each AED. (3) Adjacent to each school telephone. (4) In the gym, near the swimming pool, and in all other indoor locations where athletic activities take place. (5) At other strategic school campus locations, including outdoor physical education and athletic areas. (6) Attached to all portable AEDs. (b) The Cardiac Emergency Response Protocol shall be distributed to: (1) All staff and administrators at the start of each school year, with updates distributed as made. (2) All Health Services staff including the school nurse, health room assistants and self-care assistants. (3) All athletic directors, coaches, and applicable advisors at the start of each school year and as applicable at the start of the season for each activity, with updates distributed as made. (c) Results and recommendations from Cardiac Emergency Response Drills performed during the school year shall be communicated to all staff and administrative personnel. See paragraph 5(b) below. (d) A copy of this Cardiac Emergency Response Plan shall be provided to any organization using the school. A signed acknowledgment of the receipt of this Plan and the Protocol by any outside organization using the school shall be kept in the school office. School administration and any outside organization using the school shall agree upon a modified Cardiac Emergency Response Plan. The modified Plan shall take into consideration the nature and extent of the use and shall meet the spirit and intent of this Plan which is to ensure that preparations are made to enable a quick and effective response to a cardiac emergency on school property. 15
5. Training in Cardiopulmonary Resuscitation (CPR) and AED Use (a) Staff Training: (1) In addition to the school nurse, a sufficient number of staff shall be trained in cardiopulmonary resuscitation (CPR) and in the use of an AED to enable (insert name of school/school district) to carry out this Plan. (It is recommended that at a minimum, at least 10% of staff, 50% of coaches, and 50% of physical education staff should have current CPR/AED certification.) Training shall be renewed at least every two years. The school shall designate the person responsible for coordinating staff training as well as the medical contact for school based AEDs, if available. (2) Training shall be provided by an instructor, who may be a school staff member, currently certified by a nationally-recognized organization to conform to current American Heart Association guidelines for teaching CPR and/or Emergency Cardiac Care (ECC). (3) Training may be traditional classroom, on-line or blended instruction but should include cognitive learning, hands-on practice and testing. (b) Cardiac Emergency Response Drills: Cardiac Emergency Response Drills are an essential component of this Plan. This school shall perform a minimum of 2 successful Cardiac Emergency Response Drills each school year with the participation of athletic trainers, athletic training students, team and consulting physicians, school nurses, coaches, campus safety officials and other targeted responders. A successful Cardiac Emergency Response Drill is defined as full and successful completion of the Drill in 5 minutes or less. This school shall prepare and maintain a Cardiac Emergency Response Drill Report for each Drill. (See Conducting Drills attachment.) These reports shall be maintained for a minimum of 5 years with other safety documents. The reports shall include an evaluation of the Drill and shall include recommendations for the modification of the CERP if needed. (It is suggested that the school / school district consider incorporating the use of students in the Drills.) 6. Local Emergency Medical Services (EMS) integration with the school/school district s plan (a) This school shall provide a copy of this Plan to local emergency response and dispatch agencies (e.g., the 9-1-1 response system), which may include local police and fire departments and local Emergency Medical Services (EMS). (b) The development and implementation of the Cardiac Emergency Response Plan shall be coordinated with the local EMS Agency, campus safety officials, on-site first responders, administrators, athletic trainers, school nurses and other members of the school and/or community medical team. (c) This school shall work with local emergency response agencies to 1) coordinate this Plan with the local emergency response system and 2) to inform local emergency response system of the number and location of on-site AEDs. 16
7. Annual review and evaluation of the Plan This school shall conduct an annual internal review of the school/school district s Plan. The annual review should focus on ways to improve the schools response process, to include: (a) A post-event review following an event. This includes review of existing school-based documentation for any identified cardiac emergency that occurred on the school campus or at any off-campus school-sanctioned function. The school shall designate the person who will be responsible for establishing the documentation process. Post-event documentation and action shall include the following: (b) (c) (1) A contact list of individuals to be notified in case of a cardiac emergency. (2) Determine the procedures for the release of information regarding the cardiac emergency. (3) Date, time and location of the cardiac emergency and the steps taken to respond to the cardiac emergency. (4) The identification of the person(s) who responded to the emergency. (5) The outcome of the cardiac emergency. This shall include but not be limited to a summary of the presumed medical condition of the person who experienced the cardiac emergency to the extent that the information is publicly available. Personal identifiers should not be collected unless the information is publicly available. (6) An evaluation of whether the Plan was sufficient to enable an appropriate response to the specific cardiac emergency. The review shall include recommendations for improvements in the Plan and in its implementation if the Plan was not optimally suited for the specific incident. The post-event review may include discussions with medical personnel (ideally through the school s medical counsel) to help in the debriefing process and to address any concerns regarding on-site medical management and coordination. (7) An evaluation of the debriefing process for responders and post-event support. This shall include the identification of aftercare services including aftercare services and crisis counselors. A review of the documentation for all Cardiac Emergency Response Drills performed during the school year. Consider pre-established Drill report forms to be completed by all responders. A determination, at least annually, as to whether or not additions, changes or modifications to the Plan are needed. Reasons for a change in the Plan may result from a change in established guidelines, an internal review following an actual cardiac emergency, or from changes in school facilities, equipment, processes, technology, administration, or personnel. 17
8. Protocol for School Cardiac Emergency Responders Cardiac Emergency Response Team PROTOCOL For All Schools Sudden cardiac arrest events can vary greatly. Faculty, staff and Cardiac Emergency Response Team (CERT) members must be prepared to perform the duties outlined below. Immediate action is crucial in order to successfully respond to a cardiac emergency. Consideration should be given to obtaining on-site ambulance coverage for high-risk athletic events. The school should also identify the closest appropriate medical facility that is equipped in advanced cardiac care. Follow these steps in responding to a suspected cardiac emergency: (a) Recognize the following signs of sudden cardiac arrest and take action in the event of one or more of the following: The person is not moving, or is unresponsive, or appears to be unconscious. The person is not breathing normally (has irregular breaths, gasping or gurgling, or is not breathing at all). The person appears to be having a seizure or is experiencing convulsion-like activity. (Cardiac arrest victims commonly appear to be having convulsions). Note: If the person received a blunt blow to the chest, this can cause cardiac arrest, a condition called commotio cordis. The person may have the signs of cardiac arrest described above and is treated the same. (b) Facilitate immediate access to professional medical help: Call 9-1-1 as soon as you suspect a sudden cardiac arrest. Provide the school address, cross streets, and patient condition. Remain on the phone with 9-1-1. (Bring your mobile phone to the patient s side, if possible.) Give the exact location and provide the recommended route for ambulances to enter and exit. Facilitate access to the victim for arriving Emergency Medical Service (EMS) personnel. Immediately contact the members of the Cardiac Emergency Response Team. Give the exact location of the emergency. Example: Mr. Smith, Classroom, Room #308, gym, football field, cafeteria, etc. Be sure to let EMS know which door to enter. Assign someone to go to that door to wait for and flag down EMS responders and escort them to the exact location of the patient. If you are a CERT member, proceed immediately to the scene of the cardiac emergency. The closest team member should retrieve the automated external defibrillator (AED) en route to the scene and leave the AED cabinet door open; the alarm typically signals the AED was taken for use. Acquire AED supplies such as scissors, a razor and a towel and consider an extra set of AED pads. 18
(c) Start CPR: Begin continuous chest compressions and have someone retrieve the AED. Here s how: Press hard and fast in center of chest. Goal is 100 compressions per minute. (Faster than once per second, but slower than twice per second.) Use 2 hands: The heel of one hand and the other hand on top (or one hand for children under 8 years old), pushing to a depth of 2 inches (or 1/3rd the depth of the chest for children under 8 years old. Follow the 9-1-1 dispatcher s instructions, if provided. (d) Use the nearest AED: When the AED is brought to the patient s side, press the power-on button, and attach the pads to the patient as shown in the diagram on the pads. Then follow the AED s audio and visual instructions. If the person needs to be shocked to restore a normal heart rhythm, the AED will deliver one or more shocks. Note: The AED will only deliver shocks if needed; if no shock is needed, no shock will be delivered. Continue CPR until the patient is responsive or a professional responder arrives and takes over. (e) Transition care to EMS: Transition care to EMS upon arrival so that they can provide advanced life support. (f) Action to be taken by Office / Administrative Staff: Confirm the exact location and the condition of the patient. Activate the Cardiac Emergency Response Team and give the exact location if not already done. Confirm that the Cardiac Emergency Response Team has responded. Confirm that 9-1-1 was called. If not, call 9-1-1 immediately. Assign a staff member to direct EMS to the scene. Perform Crowd Control directing others away from the scene. Notify other staff: school nurse, athletic trainer, athletic director, etc. Ensure that medical coverage continues to be provided at the athletic event if on-site medical staff accompanies the victim to the hospital. Consider delaying class dismissal, recess, or other changes to facilitate CPR and EMS functions. Designate people to cover the duties of the CPR responders. Copy the patient s emergency information for EMS. Notify the patient s emergency contact (parent/guardian, spouse, etc.). Notify staff and students when to return to the normal schedule. Contact school district administration. 19
Building Location Information School Name & Address: School Emergency Phone: Cross Streets: AED Location: AED Location: AED Location: AED Location: AED Location: AED Location: Cardiac Emergency Repsonse PLAN Heart safe schools info: www.projectadam.com updated cerp: www.heart.org/cerp 20
Cardiac Emergency Response Team PROTOCOL Simplified Adult BLS Unresponsive No breathing or no normal breathing (only gasping) Activate emergency response Get defibrillator Start CPR Push Hard Push Fast Check rhythm/ shock if indicated Repeat every 2 miuntes American Heart Association, 2010 21
2Cardiac Emergency Response DRILLS 22
About: Cardiac Emergency Response Drills Doing regular Cardiac Emergency Response Drills is the best way to find out if your Cardiac Emergency Response Plan works. Drills are beneficial for testing your communication system and your response team s readiness. Use the steps below to execute a basic School-Based Cardiac Emergency Response Drill. Advanced practice scenarios are available upon request. Utilize the Drill Summary Checklist for an objective post-drill review. Drills should be performed at least 2 times annually to assure optimal performance during an actual emergency. You should consider multiple drills if you have more than one response team. 1. Planning the Drill: When: Inform your team that you will be doing a Cardiac Emergency Response Drill in the next few weeks so they have time to review the Cardiac Emergency Response Plan in advance. Do not tell them exactly when you will do the drill. It is important once the drill is underway that it be clearly communicated to all involved that this is only a drill. Who: The drill will involve your Site Champion, Cardiac Emergency Response Team, office staff and an objective observer (to record times on the Drill Summary Checklist). It is recommended a Site Champion be identified at each school to set up the drills. Determine the manner in which classes will be covered during a drill or true cardiac emergency if classroom teachers are on the Cardiac Emergency Response Team. All other team members should be responsible for making sure CPR and the AED are initiated promptly. What: You will need: AED Training Unit Manikin (must be compatible with AED Training Unit) Cell Phone or Telephone Drill Summary Checklist on clipboard with pen or pencil Stopwatch Where: Location of drills should be anywhere on campus so all staff consider what they will be looking for (unresponsiveness and abnormal or no breathing) and what they will do. If students are on campus be sure they are informed beforehand about what the drill may look like and that it is only a drill. Establish a Code: This code name will be used to initiate a response to a cardiac emergency by the Cardiac Emergency Response Team. The code should be communicated on the drill day and in a real cardiac emergency as defined in your communication plan. Encourage team members to be descriptive in addition to a code name and state there is a medical emergency in room #, teacher s name and geographic location. Establish a Communication System: How will the Cardiac Emergency Response Team know the drill has been initiated? Choose a method of mass communication to the team (i.e. overhead announcements, intercoms, walkie-talkies, cell phones, etc.). 23
2. The Day of the Drill: The Site Champion should place a manikin on the floor along with the AED Training Unit. Have the finder call the front office advising them that this is only a drill. Tell them you have an unresponsive victim and give the location. Your plan now goes into effect. The school s Cardiac Emergency Response Team should be notified using the established Code (i.e. Code Blue) using the teams established Communication System (i.e. overhead announcements, intercoms, walkie-talkies, cell phones, etc.). Your designated observer should record the times each step happens using the Drill Summary Checklist. The Site Champion gives the first rescuer to arrive (Rescuer 1) the short scenario if applicable. The AED Training Unit is already placed at the drill location ready to be swapped out with the real school AED brought to the scene. Never use the real AED pads for drills. Proceed as if this was a real cardiac arrest situation. 3. After the Drill: Thank everyone for responding. Spend a few minutes reviewing the checklist together, noting times and duration of different steps of the response. Ask the responders for feedback and discuss suggestions and concerns. Consider whether there are any action steps needed. Were there specific communication problems? If the drill points to changes to the plan and protocol, discuss these with your Cardiac Emergency Response Team and administrator. Be sure to make the changes and communicate the changes clearly to your team. Plan another drill to test the revised plan. 24
Tool: Drill Summary Checklist Name of School: Date: Drill: Location of the Victim: Time from Victim down to found (min/sec): Time from Victim down to shock (min/sec): Goal: Complete the drill in under 3 minutes Y N N/A Communication of emergency is clear and without delay? Team responded with urgency? Scene checked for safety? Victim checked for responsiveness? Someone directed to call 9-1-1? Staff sent to wait for EMS? Victim checked for breathing 5-10 seconds? CPR started with chest compressions? Compressions at least 2 inches deep and at a rate of approx. 30 compressions in 18 seconds? 2 breaths given with just enough air to make the chest rise? Nose was pinched while giving breaths? Compressions resumed immediately after 2 breaths administered? AED arrived at scene within 3 minutes? AED pads applied immediately and without pause in compressions except to apply pads? Team members communicated with each other throughout drill? Shift of roles completed smoothly? Questions for post-drill review: What did the Cardiac Emergency Response Team do right? What could the Cardiac Emergency Response Team do better? What was easy to remember? What was difficult to remember? 25
3 Sudden cardiac arrest all staff Awareness 26
Script: Sudden Cardiac Arrest (SCA) and AED Staff Awareness A program script and power point presentations are available upon request. Project ADAM Wisconsin can additionally train staff and volunteers to administer this training. Please contact Allison Thompson, Project ADAM Administrator, ajthompson@chw.org OR 414-266-1666 to plan or schedule a training. This presentation lasts approximately 20 minutes. You will need a computer, internet access and a projector or screen. An all staff meeting is the best venue for this presentation. Main Objectives for Project ADAM All Staff SCA and AED Training: 1. Identify Adam Lemel s Story 2. Identify Sudden Cardiac Arrest signs and possible treatment 3. Explain why schools need to be prepared for cardiac emergencies After this brief presentation, a cardiac emergency response drill demonstration supported by Project ADAM staff can be coordinated. 27
Handout: Sudden Cardiac Arrest (SCA) There are over 420,000 sudden cardiac deaths (SCD) in the US each year. These victims could be on your staff or visitors to your school. During sudden cardiac arrest (SCA) the heart goes into ventricular fibrillation or ineffective quivering and no longer pumps blood to the brain and other vital organs. Most victims have no history of heart disease. Early CPR and early defibrillation with an automated external defibrillator (AED) are required to save the victim s life. Time is the critical element in saving these victims. Three to five minutes is the optimum time for emergency response, much shorter than the average EMS response time. Someone on the staff needs to call 911, while a responder initiates CPR and someone else brings the AED to the scene if there is one in the school. Survival rates decrease by 10% with each minute of delay. A shock delivered by an AED within 3-5 minutes can save a life. The AED, when applied, will look for a shockable heart rhythm and will only deliver a shock if it is needed. A victim of sudden cardiac arrest will either just collapse for no known reason, or may briefly complain of feeling faint or dizzy before collapsing. There may be seizure-like activity, gasping or ineffective breathing for a very short time. A core first responder team of at least 5 staff members (or 10% of staff) should have current training in CPR and AED use. Practice drills are recommended at least annually. Regular, documented maintenance of the AEDs is also necessary. Since anyone might be the witness, it is important for all staff members to have some general awareness of these facts: what a sudden cardiac arrest looks like, warning signs, importance of a rapid response, basic AED information (such as where it is and what it is), the school communication plan and how they can help in the emergency response. 28
Handout: SCA What Coaches, Athletic Trainers and Athletic Directors Need to Know Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, affecting an estimated 9,500 children each year, according to the American Heart Association. To date, at least 29 lives in Wisconsin schools have been saved after a sudden cardiac arrest. 12 students and 17 adults are alive today because their schools were prepared for a cardiac emergency by having CPR-AED trained staff, a communicated cardiac emergency response plan. Catastrophic injuries can occur: During any physical activity, at any age At any level of participation During team and individual practices, as well as at games Unpredictably and without warning Early recognition is critical The single greatest factor affecting survival is the time interval from arrest to defibrillation. Survival rates decrease by 10% with each minute of delayed response. The goal is to start CPR immediately and administer the AED within 3-5 minutes after collapse. Sudden unresponsiveness should be considered sudden cardiac arrest until proven otherwise (with an AED). Anyone who is unresponsive and not breathing normally, needs CPR and the AED. A sudden cardiac arrest victim may have some seizure-like jerking also. The response should be handled by the best-trained personnel available. Do not wait for EMS to arrive-- average EMS response time is 6-12 minutes; brain damage begins after only 3-5 minutes. Hands Only CPR Any arrest, especially one that is witnessed by another person, can be treated with Hands Only CPR until the AED arrives. This is because the victim was breathing just before collapsing, so he can survive without breathing assistance for several minutes. To administer Hands Only CPR: Send someone to call 911, or call yourself if no one else is there Start continuous chest compressions: - Hard and fast - In the center of the chest, 2 inches down and 2 inches up - To the beat of Stayin Alive, or a rate of 100-120 beats per minute 29
4Youth CPR-AED Awareness Project ADAM Wisconsin www.projectadam.com 30
Lesson plan: Compression Competitions Lesson : Hands Only CPR and AED Education for Kids Grades 4-5 (this lesson can be adapted for any age group, elementary, middle or high school) Purpose: Teach elementary school children the signs of sudden cardiac arrest, describe the emergency response steps for sudden cardiac arrest, and have them perform Hands Only CPR-Compressions for 2 minutes (in a fun, competitive, and instructional atmosphere). This can be part of a school health fair, after school activity or part of an existing health unit. Location is best in a gym or open area. Preparation: Send classroom teachers basic information on Hands Only CPR and AED use prior to competition day listed below under resources. Do a brief introduction of the material at any point without taking up a lot of class time. CPR and AED steps are demonstrated on a manikin in front of the class. Ask the student s to prompt you in the steps needed to perform the rescue/compressions. Request a list of names of students who are participating. Use the certificate template included in this kit to print certificates for students. The certificates are given to the classroom teacher to hand out to students when they return to their classroom after learning CPR and how to use an AED If you have other staff who are CPR-AED trained or CPR instructor s, ask for their assistance in spot checking hand placement and compression depth as the kids are practicing on the manikins. Allow a practice session for each group. Wear comfortable clothing on the day of the competition sessions as you will spend a lot of time on the floor. Equipment: Manikins to accommodate the groups participating. Don t insert lung bags into the manikins because of cost and the fact we were not teaching rescue breathing Wipes to clean manikins Stop watch to time the sessions Resources: Project ADAM Responding to Cardiac Emergencies - http://www.chw.org/childrens-and-the-community/resources-for-schools/cardiac-arrest-project-adam/videooverview/ Hands-Only CPR - http://www.heart.org/heartorg/cprandecc/handsonlycpr/hands-only-cpr_ucm_440559_ SubHomePage.jsp Competition Session: Each student is asked to finally get into a position to do compressions. They are given the instruction to start compressions. Time each group for 2 minutes and check hand positions. Cheer them on to the end of a full 2 minutes of chest compressions. At the end we all CHEER!! The students asked us to bring this back to their Health Fair Day, after the first year we presented it!! We also show all other students how to do CPR when they visit our corner of the gym. It is wonderful day and they often know more about CPR than we assume. Take this chance to show them how an AED works using an AED Training Unit. 31
5Getting the word Out Project ADAM Wisconsin www.projectadam.com 32
Tool: Sample press release Sample Project ADAM Wisconsin Heart Safe School News Release [SCHOOL NAME] ANNOUNCES PROJECT ADAM WISCONSIN HEART SAFE SCHOOL RECOGNITION [SCHOOL NAME] Recognized as a Project ADAM Wisconsin Heart Safe School (City and date) Beginning [recognition date] the students, visitors and staff of [school name] will have a better chance of surviving a cardiac arrest because they have been recognized as a Heart Safe School. According to the American Heart Association, over 424,000 people die of sudden cardiac death every year. A Sudden Cardiac Arrest is a condition in which abnormal heart rhythms cause the heart s electrical impulses to suddenly become chaotic. Defibrillation, which delivers an electric shock to the heart, is the only known treatment to stop this chaotic electrical activity. For every minute defibrillation is delayed, the victim s chances of survival decreases by 7 to10 percent. This school worked with Project ADAM (Automated Defibrillators in Adam s Memory), a program of the Children s Hospital of Wisconsin and Herma Heart Center, to implement a comprehensive plan to prevent sudden cardiac death. This Heart Safe Schools program includes placement of AEDs within schools, implementation of cardiac emergency response plans and drills, and education of school staff on the warning signs and treatment of sudden cardiac death. Schools that complete this program are recognized as Project ADAM Wisconsin Heart Safe Schools. This is a new program in Wisconsin and we are excited to watch it grow. AEDs are safe and easy to use, making it possible for non-medical personnel to provide rapid defibrillation for victims of all ages. Please contact: for more information regarding [school name] program. For more information about Project ADAM and prevention of sudden cardiac death in schools, please contact Allison Thompson, Project ADAM Administrator at Children s Hospital of Wisconsin, 414-266-1666. 33
6Additional resources Project ADAM Wisconsin www.projectadam.com 34
CPR-AED Training Needs assessment Project ADAM is a program of Children s Hospital of Wisconsin and the Herma Heart Center, and is dedicated to helping schools in Wisconsin implement quality CPR-AED programs to prevent sudden cardiac death. As part of the program, grants may be available to assist schools with CPR-AED training. It is required the school be recognized or working towards recognition as a Project ADAM Wisconsin Heart Safe School. To apply please complete this application and return to Allison Thompson, ajthompson@chw.org or fax: 414-266-6248. School: County /District Pvt: Name: Position: Phone: Fax: Email: Date: Please check as many boxes as appropriate and we will also send any supporting documents below requested: Just beginning to implement a school CPR-AED program Want to be a Project ADAM Wisconsin Heart Safe School Need the script for Project ADAM awareness training Need to update training for current First Responders Already a Project ADAM Heart Safe School Other need, please specify Please indicate here, how you anticipate using the funds: Pay for CPR-AED training for first responders at the school Send staff member(s) to a CPR-AED instructor course Purchase manikins to use for CPR classes for staff or students Purchase other training materials for CPR/AED classes Other, please specify your need: Project ADAM staff will contact you within 5 days to let you know we received your application. Our Project ADAM Advisory Board will review all applications and allocate training resources as funds may bcome available. All applicants will receive follow up by December of each calendar year. Please call Allison Thompson, Project ADAM Administrator at 414-266-1666 if you have questions about this process. Thank you for your interest in saving lives in schools. 35
AED placement Since 1999 and the tragic death of Adam Lemel, The Wisconsin Masonic Foundation and Project ADAM (Automated Defibrillators in Adam s Memory), have been working together to place AEDs throughout Wisconsin to save lives in schools and communities. 1. School makes initial contact with Project ADAM Wisconsin > www.projectadam.com > 414-266-1666 > ajthompson@chw.org 2. School will be connected with Erika Miller and the Wisconsin Masonic Foundation, 262-965-2200, ext. 831, who will then connect you with a local Masonic lodge in your area. 3. Once connected with a lodge in your area, lodges work with schools to fundraise for the cost of an AED and matching grants from the Wisconsin Masonic Foundation are available for up to $800 for placement of AEDs in schools and communities. 4. Help us spread the word! Once grants are approved, we will be in touch to schedule a placement ceremony and send an AED partnership sticker. 36
About: Project ADAM Champion AwardFor Excellence in School CPR-AED Program Coordination Project ADAM is seeking nominations of individuals who have demonstrated passion, innovation, and excellence in serving as a champion for their school s CPR-AED program. This award is being presented in honor and memory of Karen Smith. Karen Smith was a pioneer and leader in school health and safety. Karen served for over 20 years as the Nursing Services Coordinator for the Pewaukee School District in Pewaukee, Wisc. Karen annually trained more than 500 people in CPR and automated external defibrillator (AED) use, including students, teachers, coaches, administration and many more in the community. She made it her mission to train every student of Pewaukee schools in CPR-AED use throughout their education. She served on the Project ADAM Advisory Board since its inception in 1999. Through her charismatic work with Project ADAM, Karen tested new ideas to pave the way for easier CPR-AED training in schools, rallied the support of legislators and community leaders and established a national model for the implementation of public access defibrillation programs in schools. When Karen died at the age of 62 on January 26, 2010 due to pancreatic cancer, she still had many plans and ideas to be carried-out to make school communities even safer. Through this award we strive to honor Karen s memory and continue her good work by recognizing individuals who reflect her passion and commitment to creating safer school communities by championing cardiac emergency preparedness. Application Process 1. Applicants must be recognized as a Project ADAM Wisconsin Heart Safe School 2. Complete Contact information 3. Complete Letter of support and program description (from individual other than nominee). 4. Applications submitted by fax, mail or email to: Attn: Alli Thompson, Project ADAM Administrator MS B550A, PO Box 1997 Milwaukee, WI 53201-1997 Fax: 414-266-6248 ajthompson@chw.org 5. Applications must be received by June 1st each calendar year 6. Applications will be reviewed and voted upon during 3rd Quarter Project ADAM Advisory Board Meeting, and announced by the end of September 7. Award recipient will receive a framed certificate and school presentation from Project ADAM staff 37