Key Steps to Implementing an AED Program
- John Mack
- John’s Foundation
- Help Available
Key Steps to Implementing an AED Program
Cardiac arrest is a leading cause of death in the United States. Each year, emergency medical services (EMS) treat about 360,000 victims of cardiac arrest before they reach the hospital. Cardiac arrest can happen to anyone at any time. It is important to implement AED programs so people are prepared to respond to a cardiac arrest emergency. Performing CPR (cardiopulmonary resuscitation) and using an AED before EMS arrives can increase the chance of survival upwards of 70%.
Here are the key steps to implementing an AED program. The steps may vary depending on your state, county and local laws, so please consult the laws as they apply to your locality.
1. GET MEDICAL OVERSIGHT
The U.S. Food and Drug Administration (FDA) requires a physician’s prescription to purchase an AED. It may be necessary to establish a collaborative relationship with an Emergency Health Care Provider (also referred to as the AED Medical Director or Physician) and complete a “collaborative agreement”.
The responsibilities of the physician may include overseeing or making recommendations on training, reviewing policies and procedures, evaluating data recorded on the AED during a medical emergency and helping assess each use of an AED to recommend any program improvements.
The collaborative agreement may require a written agreement that incorporates policies and procedures that assure compliance with local, county and state laws. The organization may need to file a copy of the collaborative agreement at the state, county or local level and/or with the appropriate regional EMS council.
Changes to your collaborative agreement will likely require resubmission; review annually to determine if necessary.
2. WORK WITH LOCAL EMS TO REGISTER YOUR AED
Working with your local EMS system is a key step to implementing an AED program. Most states require you to coordinate your AED program with local EMS and to provide follow-up data to EMS after any use of the AED.
Check whether your local or state laws governing AED programs require you to register your program at the town, county or state level. If registration is required, verify whether the physician or program coordinator completes this process.
Changes to your registration will likely require resubmission; review annually to determine if necessary.
3. SELECT YOUR AED
There are many different types of AEDs and a number of manufacturers to choose from. We don’t recommend one device over another; here’s a list of some well-known manufacturers in alphabetical order.
Cardiac Science – (800) 426-0337 – www.cardiacscience.com
Defibtech – (866) 333-4248 – www.defibtech.com
HeartSine Technologies – (866) 478-7463 – www.heartsine.com
Philips Healthcare – (800) 225-0230 – http://www.usa.philips.com
Physio-Control – (800) 442-1142 – www.physio-control.com
ZOLL Medical Corporation – (800) 348-9011 – www.zoll.com
Considerations when purchasing your AED:
- Research the history of the manufacturer; do they have many maintenance incidents or recalls on their AEDs?
- Can the manufacturer provide references from other purchasers?
- What is the manufacturer’s warranty for the AED?
- What after-sales support does the manufacturer offer?
- Does the manufacturer offer technical support?
- Does the manufacturer provide help with program implementation? Can they assist with placement, medical authorization, registration, training and supplies?
- What options are available for pediatric/child (under eight years old) needs?
- What maintenance is required?
- What is the battery life? Are batteries under warranty? What are the replacement costs?
- How often must pads be replaced? What is the cost?
- How much does an AED cost?
- Is it easy to use? Does it offer visual instruction in addition to verbal commands?
- Do you need an AED that offers bilingual instructions?
- How complex is data downloading?
AED cost considerations:
- Initial costs:
- Adult and pediatric pads
- Wall-mounted storage cabinet and/or portable case
- Resuscitation kit (i.e., scissors, razor, gloves and mask)
- Software to facilitate downloading data
- Long-term costs (consult your manufacturer for specific timeframes):
- AED pads must be replaced once used
- Unused AED pads need to be replaced every 2 to 5 years
- AED batteries need to be replaced every 2 to 7 years; their lifespan is affected by AED usage
4. INSTALL YOUR AED
Place your AED(s) in a visible and accessible location for optimal emergency response time. Effective AED programs are designed to deliver a shock to a victim within 3 to 5 minutes after the person collapses. Use a 3-minute response time as a guideline to help you determine how many AEDs you need and where to place them.
There are several elements that should be considered to appropriate place and access your AED:
- Response time: optimal response time is 3 minutes or less.
- Use a stopwatch and walk for 1 1/2 minutes — enough time for a responder to walk to the AED and return with it OR use average walking speed (300 feet per minute) to calculate the appropriate distance (450 feet) to an AED location.
- If your planned AED locations do not meet the 3 minute guideline, you should consider adding additional AEDs.
- Physical layout of the location: response time should be based on how long it will take for a responder walking at a rapid pace with an AED to reach a victim, taking into consideration areas with difficult access (i.e., locked entrances, secured areas within a building, stairs, elevators, crowd congestion, etc.).
- Number of visitors or types of visitors: areas with a high number of visitors or high-risk visitors may be more likely to experience a sudden cardiac arrest event.
- Specialty activities: areas that accommodate strenuous physical activities may be more likely to experience a sudden cardiac arrest event.
- Refer to your AED manufacturer’s user manual for more information about AED placement such as whether there are considerations with respect to temperature (if using/locating outside) or water.
Considerations for installing your AED:
- AEDs are best stored on a wall in a secure location. Wall-mounted AED cabinets are designed to protect and prominently display the AED. A door-activated audible alarm alerts everyone that the AED has been deployed.
- If a stationary AED location is not practical, portable cases can protect the AED from water, dust and accidental damage.
- AED wall signs clearly show the AED’s location. 3D signs are hung in the location of the AED cabinet, normally close to the ceiling. AED decals are also available to locate on entrance doors to notify visitors of an AED location.
Once you decide on a location for your AED, use this quick checklist to see if it’s readily accessible:
- Is it highly visible?
- Is it easily accessible to the public (i.e., not locked in a cabinet or behind a locked door)?
- Is it clearly visible in a well-travelled location that prevents or minimizes the potential for tampering, theft or misuse by unauthorized users?
- Is it in a wall-mounted cabinet at eye level with clear signage for quick identification?
- Has the AED location been made known to people that frequent the facility?
- Has the emergency response number been posted?
- Is a telephone nearby? Is it clear how to initiate an internal and external call?
- Is it near trained responders such as security guards, lifeguards, nurses station and first-aid stations?
5. DEVELOP A TRAINING PLAN
AED users should be trained in CPR and the use of an AED. People are more likely to use an AED if they are familiar with the device and realize how easy and safe it is to use. Training increases the comfort and confidence level of responders.
The objective of a training plan is to have an adequate number of CPR/AED trained organizational members at an event to handle an emergency incident in a safe and timely manner.
There are a number of places to seek training. Many EMS groups offer training. Check with American Heart Association and American Safety & Health Institute (ASHI) for training. Consult your medical director to determine which training programs are preferred.
6. PROMOTE YOUR AED
Once an AED is installed, it is important to let everyone know where the device is located. You can do this via an email blast, website, newsletter, social media, local media or newspaper, poster, signage or other means to promote your AED program. Encourage your members to get certified in CPR/AED instruction.
Signage can include a 3D sign to be mounted above the AED cabinet and decals to adhere to the door at the entrance to the facility.
If you have a map of your facility, mark the location of AEDs on it.
Remember to add relevant AED information to your staff training programs, facility tours and facility rental information.
If you relocate an AED for any reason, you must inform staff and visitors, and note the change to the organization that you registered your AED with.
7. MAINTAIN YOUR AED
AEDs must be regularly maintained.
It is important to do a weekly or monthly visual inspection of the AED to ensure it is in working order. This includes satisfactory condition of battery life and pads. Also, check the contents of the resuscitation kit to replenish as necessary. This task should be assigned to the program coordinator or another designated person and it should be noted in the organization’s policies and procedures.
Remember to also verify that sign are still posted noting the AED location.
The results of your inspections can be recorded on a system checklist to note the dates these tasks were completed.
Consult your AED manufacturer’s guidelines for proper weekly, monthly and annual maintenance procedures.
Be sure to check with your manufacturer regularly to get the latest information on recalls and software updates.
8. DEVELOP A MANAGEMENT PLAN
Utilize an AED Management plan (also referred to as Policies & Procedures) for your organization to define roles and responsibilities to ensure program readiness.
The plan should include:
- Coordination of CPR/AED training and the members who participated
- The location of all AEDs
- Maintenance requirements for the AEDs and accessories; who is responsible for maintenance checks and the frequency it should occur
- Reviewing AED paperwork (i.e., registration, collaborative agreement) for changes and resubmission
- Monitoring the effectiveness of the policies and procedures and revising as appropriate
- Proper procedures to follow if the AED is used
9. AFTER YOUR AED IS USED
There are some important steps to take after an AED has been used for a SCA incident. Medical personnel attending a patient may require access to the information from the AED recorded during its use. Also, the AED must be returned to a “ready state” for future incidents.
What to do after your AED has been used:
- Download event information
- AEDs store the information that they communicate during an emergency.
- Consult your instruction manual to determine how to download the data to a computer. This will probably require special software and a cable to connect the AED to the computer.
- You may need to send copies of the event information to your medical director and the EMS organization involved in the incident.
- NOTE: incident information is considered private medical information and should be treated as such.
- Perform post-event maintenance
- After an AED is used, it is important to replace the pads, clean the unit, replenish supplies in the resuscitation kit and return it to a “ready state” as quickly as possible. Consult your instruction manual to determine what additional steps this may require. New pads and other supplies can be obtained from the AED manufacturer.
- Facilitate incident debriefing
- Conduct a post-incident review to evaluate your policies and procedures and determine if adjustments are necessary.