Environmental Health and SafetyHealth and Sanitation

Amherst College Campus Police
Defibrillator Policy

Scope
Purpose
Applicability

  1. Definitions
  2. Chain of Survival
  3. Defibrillator Location
  4. Responsibility for Operation and Placement
  5. Contraindications of Defibrillator Use
  6. Do Not Start CPR or Initiate Defibrillation if...
  7. Dispatch Protocol
  8. Arrival on Scene
  9. Patient Preparation for Defibrillation
  10. Batteries
  11. Maintenance
  12. Training
  13. Start Date

Scope:

The Amherst College Defibrillator Program has been prepared in accordance with the requirements of Western Massachusetts Department of Emergency Medical Services, Cooley Dickinson Hospital, the Amherst Fire Department and the Amherst College Environmental Health and Safety Committee.  This policy and applicable standard operating guidelines and appendixes shall conform to those rules and regulations utilized by the agencies referenced above.


Purpose:

The purpose of this policy is to establish and formalize the standard operating guidelines that are required by the Office of Emergency Medical Services in order for Amherst College Campus Police Department to have, maintain and utilize an Automatic External Defibrillator (AED). The policy includes a memorandum of understanding with both the Amherst Fire Department and the Emergency Department at Cooley Dickinson Hospital, Northampton.  The policy must identify the area Medical Director, the Amherst Fire Department Liaison, the Amherst College Service Provider Director, all regulatory and paperwork requirements appropriate maintenance, storage and use and training, both quarterly and annually.


Applicability:

The Defibrillator Policy and applicable Standard Operating Guidelines shall be developed, implemented and maintained by the Amherst College Campus Police and the Office of Environmental Health and Safety.  The AED will be available to the faculty, staff and students twenty-four (24) hours a day in case of cardiac arrest.  Additionally, the Defibrillator Policy will include the roles and responsibilities of those Amherst College employees and students who are Cardio-Pulmonary Resuscitator (CPR) Certified, the Amherst Fire Department, the Emergency Room and Medical Director at Cooley Dickinson Hospital and the Western Massachusetts Office of Emergency Medical Services


I.  Definitions:

 
Cardiac Arrest – A condition that results when the heart stops beating. It is caused by life threatening abnormalities in the hearts electrical system. These abnormalities are most often referred to as arrhythmias.
  • Ventricular Fibrillation is the most common arrhythmia. With this condition, the heart starts beating so uncontrollably that it is unable to pump blood to the rest of the body or brain. Also known as V-Fib, this state of totally disorganized electrical activity produces a quivering of the ventricles. Because the pumping of the heart in this situation is inadequate, there is no detectable pulse.
  • Ventricular Tachycardia means a fast heart. It is a very rapid contraction of the ventricles that prohibits the heart from pumping blood properly, consequently there is no pulse detected with this patient either.
    • Cardiopulmonary Resuscitation (CPR) – is the administration of chest compressions and rescue breathing to circulate oxygenated blood through the body.
    Comfort Care/Do Not Resuscitate (CC/DNR) – an order written by a physician that states when a patients breathing and heartbeat have stopped, they shall not be resuscitated.
    Defibrillation – is the definitive treatment used for patients in cardiac arrest (ventricular fibrillation). It is a brief, powerful electrical shock applied to a person’s chest, interrupting the abnormal heartbeat and allowing the hearts natural rhythm to regain control.
    Defibrillator – the machine used to perform the function of defibrillation
    Department – means the Department of Public Health for the Commonwealth of Massachusetts (M.G.L. c. 17)
    Emergency Medical Technician (EMT) – the person who has successfully completed a Massachusetts approved Emergency Medical Training program. The EMT can be one of three (3) levels basic, intermediate or paramedic (B, I or P).
    First Responder – is a member of the police or fire department, the Metropolitan District Commission (MDC), the Capital Police Department, the uniformed branch of the Massachusetts State Police and other similar organizations.
  • Exception persons primarily responsible for the clerical or administrative work for the above referenced departments or organizations.
    • Medical Control – The Physician responsible for Emergency Room operations at Cooley Dickinson Hospital.
    Paramedic – The highest level EMT in the Commonwealth of Massachusetts. Training at this intensity allows the EMT-P to administer medication and to provide the most advanced medical treatment available outside of the hospital. A paramedic intercept is required for all cardiac patients.
    II. Chain of Survival
    1. The “Chain of Survival” is the four-step procedure that is to be followed for any incident that requires an ambulance, including a heart attack and cardiac arrest. The “Chain of Survival” includes;
      1. Early Notification of the EMS System by dialing 2111 at Amherst College
      2. Early intervention of Cardiopulmonary Resuscitation (CPR) by bystander or police officer
      3. Early Defibrillation by trained AED providers
      4. Early arrival of Advanced Cardiac Life Support (Paramedic Level Ambulance)
    2. Amherst College has embarked upon a program of training faculty, staff and students in both CPR and First Aid. By providing this training we hope to increase early recognition of a heart attack or other medical emergency and to take action immediately by summoning advance medical care as soon as it is warranted. In addition, through CPR training, Amherst College hopes to be able to initiate Cardiopulmonary Resuscitation at the very onset of a cardiac arrest, providing the patient with the best chance of support until the arrival of the defibrillator and the Amherst Fire Department Ambulance Service.
      1. Amherst College Physical Plant and Dining Services have staff on duty that are currently able to provide both CPR and First Aid until the arrival of the Amherst College Campus Police and the Amherst Fire Department Ambulance.
    III. Defibrillator Location

    The Amherst College Campus Police Defibrillators shall be located in the two primary response police cars. The defibrillator will be located on the cage in the front seat of the above referenced vehicle and shall be protected from damage.

    IV. Responsibility for Operation and Placement

    1. It shall be the responsibility of the A1 and A2 officers on the first shift (0700-1500) to check the Automatic External Defibrillator daily.
    2. The Physio-Control Life-Pak CR Plus will perform its own diagnostic evaluation daily. If the defibrillator has identified a problem, the "OK" on the defibrillator will disappear and a battery or a triangle will appear, indicating an abnormality.
    3. The defibrillator will be checked at the beginning of the first shift (0700). It will be that police officer's responsibility to verify that the unit is in the proper location, that it has all of the appropriate equipment and that it is ready for use. Any problem should be immediately reported to the office of Environmental Health & Safety.
    4. After completing the inspection of the AED, the above referenced police officer shall make a note in the shift log indicating that the unit has been inspected and that it was found to be “In-Service” or “Out-of-Service”
    5. The Office of Environmental Health and Safety (Service Director) shall be responsible for the following;
      1. the prompt replacement of equipment and supplies
      2. the repair and service of the Physio-Control Life-Pak CR Plus
      3. all record keeping for the equipment
      4. training records
        • CPR
        • First Responder / EMT
        • Quarterly and Annual Skills Evaluation
      5. incident record keeping
      6. the memorandum of understanding and the policies and procedures, which are included.
    6. The Amherst College Campus Police Chief or his/her designee shall be responsible for;
      1. the CPR and First Responder rectification of all police officers, both full and part-time.
      2. assisting the office of Environmental Health & Safety with quarterly in-house skills evaluations for the full time police officers.
    7. The four (4) Amherst College Physical Education and Athletics Defibrillators shall be located in the following areas
      1. Alumni Gymnasium Fitness Center, Main Level
      2. Orr Rink - Main Corridor
      3. Head Athletic Trainer - 2 units
        • The Head Trainer shall, when necessary, provide a coach or trainer with the 2nd defibrillator for events or games (home or away) where there is the greatest potential risk for sudden cardiac death.
        • The 2nd Defibrillator unit shall be signed in and out by the Coach and or Trainer in a manner acceptable to the Medical Control Officer and the Head Athletic Trainer.
        • The 3rd defibrillator is in the Orr Rink Trainer's Room.

       

    V. Contraindications for Defibrillator Use
    1. Person with a pulse (Absolute Contraindication)
    2. Vehicle in motion (Stop CPR and Motion)
    3. Child under age 8 or less than 66 lbs (Contact Medical Control)

      4.  The LifePak CR Plus defibrillator units can be used on infants and children when the infant/child pads are used. These pads attach to the LifePack CR Plus with a pink cable connection, which reduces the number of joules delivered to an acceptable level.
    VI. Do Not Start CPR or Initiate Defibrillation if...
    1. person has a pulse
    2. there is a valid CC / DNR on Site
    3. one of the following conclusive signs of death are present:
      1. Body Decompartmentalization / Decapitation (Injuries Incompatible with Life)
      2. Body Putrification (i.e. maggots, etc.)
      3. Full Body Rigor with Dependant Lividity in the Absence of Hypothermia
        • not dead until warm and dead
    VII. Dispatch Protocols for Medical Emergencies
    1. The Automatic External Defibrillators are located in the primary response police cars.
    2. In the event an Amherst College Campus Police Dispatcher receives a report of following list of medical emergencies he or she shall automatically dispatch the most appropriate police officer. The officer closest to the scene of the emergency should be directed to respond first.
      1. Cardiac Arrest
      2. Cardiac Distress
      3. Cardiac History
      4. Chest Pain
      5. Unresponsive/Unknown
      6. Respiratory Arrest
      7. Respiratory Distress
    VIII. Arrival on Scene
    1. Bring in all necessary equipment, including;
      1. First Aid Kit
      2. Defibrillator
        1. Take appropriate Body Substance Isolating Precautions (aka Universal Precautions)
          • look for a mechanism of injury
        2. Determine Unresponsiveness (absence of breathing and pulse)
          • is there a DNR?
        3. Consider all potential non-cardiac causes of cardiac arrest (i.e. electrical shock, overdose or trauma)
        4. Initiate CPR and assist with ventilation's (if waiting defibrillator)
          • if defibrillator is already on scene (shock is priority
        5. Make sure that the ambulance is en route to the scene and provide all necessary, additional information regarding patient condition and care.
    2. If the police officer arrives on the scene of an incident for which an ambulance has not yet been requested, he or she should follow the guidelines referenced above.
    IX. Patient Preparation for Defibrillation
    1. After determining that the patient warrants CPR and Defibrillation, the officer(s) should...
      1. prepare the chest to receive the QUIK-COMBO electrodes with the REDI-PAK preconnect system.
        1. Remove clothing from patient's chest
          • If the Chest is Wet - Dry it
          • If the Chest is Hairy - Shave it
          • If Heart Electrical Devices are Implanted -  Work around it
          • If Necklaces or Jewelry is in place - Remove or cover with tape
    2. Turn the Defibrillator ON
    3. Attach defibrillator electrodes to patient while verbalizing procedures
    4. Analyze the Rhythm status
    5. Determine if Defibrillation (shock) is indicated or not
    6. Verify Ambulance Intercept as soon as possible
    7. If defibrillation is unsuccessful after the (9) consecutive shocks, the officer/ operator shall again continue ( or have someone else start) 5 minutes of CPR and then follow the same steps outlines above.
    Shock Advised

    If the Physio-Control Life Pak CR Plus determines that Shock Advised, then the Defibrillator will initially charge to 200 joules, and will then ask the operator to press SHOCK.

    After the shock has been delivered, the defibrillator will again Analyze on its own to determine if another shock is warranted. 

    If shock is again to be delivered, the unit defibrillator will charge to 300 joules and will then ask the operator to press SHOCK for a 2nd time. 

    This procedure can take place for a total of (3) consecutive shocks, the 3rd such shock being delivered automatically at 360 joules.

     
     
    After the (3) shocks:
    • Check Pulse
      • If there is no pulse, START CPR (60 seconds) as indicated on the defibrillator
        • Check Pulse, Again
          • If still no pulse the Physio-Control Life Pak 500 will prompt the operator to push Analyze

     
     
    If the Defibrillator indicates Shock, the unit will charge 360 joules and will tell the operator to press SHOCK for the 4th time (the 1st shock in the second set of (3) shocks) 

    Follow the same protocol for the 2nd set of (3) shocks

     
     
    After the 2nd set of (3) shocks...
    • Check Pulse
      • If there is no pulse, START CPR (60 seconds) as indicated on the defibrillator
        • Check Pulse, Again
          • If still no pulse the Physio-Control Life-Pak CR Plus will prompt the operator to push Analyze

     
    If the Defibrillator indicates Shock, the unit will again charge to 360 joules and will tell the operator to press SHOCK for the 7th time (the 1st shock in the third set of (3) shocks) 

    Follow the same protocol for the 3rd set of (3) shocks 
     

     
     
     
    If after 3 sets of (3) shocks that are unsuccessful, the officer / operator shall perform 5 minutes of CPR and then repeat the above sequence, or turn the patient over to more advanced medical care (i.e. Ambulance Staff or Advanced EMT B/I/P)

    NO SHOCK ADVISED
    If the Physio-Control Life-Pak CR Plus determines No Shock Advised, then… 
    • Check for a pulse
      • If there is no pulse, continue CPR for (1) minute, then…
          •  
          Reanalyze the patient by pressing the Analyze button on the AED 
          1. if shock is indicated, follow the shock protocol
          2. if no shock is indicated…

     
     
    • Check for a pulse
      • If there is still no pulse, continue CPR for another (1) minute, then…
          •  
          Reanalyze the patient by pressing the Analyze button on the AED 
          1. if shock is indicated, follow the shock protocol
          2. if no shock is indicated…
    • Check for a pulse
      • If still no pulse, continue CPR until the patient can be turned over to more advanced medical care (i.e. Ambulance Staff, Advanced EMT B/I/P
     
    If a patient has been successfully defibrillated, then… 
    1. maintain an open airway
    2. administer oxygen by nonrebreather mask at 15 lpm
    3. monitor vital signs, including;
      • Blood Pressure
      • Pulse
      • Respiration’s
    		 Oxygen Tank

    X. Batteries
    The Physio- Control Life-Pak CR Plus Defibrillator comes with an internal battery and a charging unit.

      EH&S will keep track of charging dates


    XI. Maintenance for the Life-Pak CR Plus

    Maintenance of the defibrillator shall be the responsibility of the Service Coordinator (Environmental Health and Safety). The Life-Pak CR Plus performs its own daily diagnostic evaluation. Whenever service is needed, the Service Icon on the top of the defibrillator unit will illuminate. If the "OK" symbol is not visible and either a battery or triangle with an exclamation point appear, the unit will need to be replaced or repaired. Contact EH&S and note the defibrillator malfunction in the police log.


    XII. Training

    The initial training for the Amherst College Campus Police will take place on Wednesday, October 13, 1999 and conclude on the following Wednesday, October 20, 1999.

    The class will be taught by Captain Gary Childs acting as the as an agent of Western Massachusetts EMS, who shall facilitate the program through the Amherst Fire Department in accordance with the rules and regulations of the Commonwealth of Massachusetts and the Western Massachusetts OEMS protocols.

    Class #1 – will include Comfort Care and Do Not Resuscitate (CC / DNR) and will take approximately 6 hours.
    Class #2 – will complete the training requirements and will take approximately 4 hours

    Quarterly Skill Evaluation – Each full time member of the police department shall attend (4) defibrillation in-services with Environmental Health & Safety (every 3 months) in accordance with the requirements of the Western Massachusetts Emergency Medical Services. The testing may be computer based, but at least twice annually, a hands on practical will be required with EH&S and/or Medical Control.


    XIII. Start Date:

    • The Amherst College Campus Police shall place the Physio-Control Life-Pak 500 Defibrillator into service on or just before midnight, Thursday October 21, 1999.
    • The Amherst College Campus Police shall place the Physio-Control Life-Pak CR Plus into service (both police cars) on Saturday, November 15, 2003.