Environmental Health & Safety

Department of Physical Education and Athletics

January 2010

Public Access Defibrillator Program (PAD)

Scope:

THE AMHERST COLLEGE DEPARTMENT OF PHYSICAL EDUCATION AND ATHLETICS PAD
Defibrillator Program for Coaches and Trainers meets the requirements of the Massachusetts Department of Public Health (MDPH) (Title XVI Chapter 112 12V, 12V, 1/2), Cooley Dickinson Hospital, and the Amherst Fire Department. 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 MDPH in order for the Amherst College Coaches and Trainers to prepare, use and maintain an Automatic External Defibrillator (AED). The policy includes a memorandum of understanding with the AED Medical Director and the Emergency Department at Cooley Dickinson as well as letters of notification to Amherst College Campus Policy, Amherst College Health Services, Amherst Fire and Police Departments and American Medical Response (AMR) of Northampton. The policy must identify the area Medical Director, the Amherst Fire Department Liaison, the Amherst College Health Services, the Amherst College AED Service Coordinator and the Amherst College Department of Physical Education and Athletics Defibrillator (PAD) Coordinator, all regulatory and paperwork requirements, appropriate maintenance, storage and use and training, periodically.

Applicability:

THE DEFIBRILLATOR POLICY AND APPLICABLE STANDARD OPERATING GUIDELINES
have been developed, implemented, and maintained by the Amherst College Environmental Health and Safety Manager. The AED will be available to the “trained” faculty, staff and students in case of cardiac arrest. It is the program’s intention to provide the best resources available to assist an individual in cardiac arrest providing that there is the necessary equipment and properly trained AED providers available at the time of the cardiac arrest. Additionally, the Defibrillator Policy will include the roles and responsibilities of those predetermined AED providers who are Cardiopulmonary Resuscitator (CPR) and Automatic External Defibrillator (AED) Certified, the Amherst Fire Department, the Emergency Department and Medical Director at Cooley Dickinson Hospital.

Personnel and Agency Definitions:

  • AED Provider Agency: Amherst College
  • AED Medical Director: Dr. Raymond Conway

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 (V-Fib)- 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.
Defibrillator – the machine used to perform the function of defibrillation
Department- a member of the police or fire department qualified at the first responder level or its equivalent.
First Responder- a member of the police or fire department qualified at the first responder level or its equivalent.
Medical Control- the physician responsible for Emergency Department operation at Cooley Dickinson Hospital.
Predetermined AED Provider- that person who is CPR and AED certified and has a copy of his/her certification on record with Amherst College who holds accountability for the retrieval, use, and return of the AED when it is used. This person is responsible for being familiar with the Amherst College AED policies and procedures and the Life Pak 500 AED.
Paramedic- the highest level Emergency Medical Technician (EMT) in the Commonwealth of Massachusetts. This person can administer medication and to provide the most advanced medical treatment available outside of the hospital. The AED provider is required to request a paramedic level staffed ambulance for all cardiac patients and AED required events.

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;
    • Early Notification of the EMS System by dialing 2111 at Amherst College or 911 other Off-Campus locations
    • Early intervention of Cardiopulmonary Resuscitation (CPR) by a Coach, Trainer, bystander or Amherst College Police Officer
    • Early Defibrillation by trained AED providers
    • Early arrival of Advanced Cardiac Life Support (Paramedic Level Ambulance) Paramedic/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, the Amherst College Campus Police, the Amherst Fire Department Ambulance or other requested ambulance service.

Defibrillator Location

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 - 4 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.

The AED units shall be available for athletic events as well as various intramural events.

The Amherst College Department of Physical Education and Athletics PAD Coordinator in coordination with defibrillator trained coaches and trainers will make the determination as to where the defibrillators will be used if multiple events are occurring simultaneously. The Amherst College Head Trainer or their designee will determine the best place to have the defibrillator should more than one event be taking place at the same time. Examples include:

  • Schools without defibrillators
  • Student with increased risk of heart trouble
  • Sport with greatest potential risk of heart attack
    • An AED may not always be available at all venues of athletic events.
    • At events where AED’s are available they will be accessible for bystanders as well as athletes, for use by trained individuals.

Responsibility for Operation and Placement

It shall be the responsibility of The Amherst College Department of Physical Education and Athletics PAD Coordinator (Head Athletic Trainer) or their designee to check the Automatic External Defibrillators weekly. This person will verify that the units are in their proper location, that each has all the appropriate supplies and equipment and that they are ready for use. Inventory list under vinyl cover to left of display. Each unit will have testing information downloaded monthly.

  • The Physio-Control Life-Pak 500 will perform its own diagnostic evaluation, daily. If the defibrillator has identified a problem, a red wrench will appear on the top surface of the unit and an alarm will sound and continue until serviced.
  • If the red wrench on the top of any of the defibrillators is illuminated, the unit is experiencing some type of malfunction. The unit is still operational, but requires service.
  • The problem should be immediately reported to the PAD coordinator. If the red wrench is lit, and “flashing”, the unit must be removed from service.
  • After completing the inspection of all AEDs, the Amherst College Department of Physical Education and Athletics PAD Coordinator shall make a note on the maintenance checklist indicating that the units have been inspected and they were found to be “In-Service” or “Out-of-Service”.
  • The inspecting ATC shall identify themselves on the maintenance checklist with the time and date of inspection, and note and deficiencies identified during the inspection.
The Amherst College AED Service Coordinator shall be responsible for the following:
  • The prompt replacement of equipment and supplies.
  • The repair and service of the Physio-Control Life-Pak 500.
  • All record keeping for the equipment.
  • Training records.
    • CPR/AED
    • Skills Evaluations
  • Incident record keeping
  • The memorandum of understanding and the policies and procedures which are included.
  • CPR/AED rectification of all Certified Athletic Coaches and Trainers, both full and part time.

AED Use

Amherst College AED providers, in each instance of responding to a request for emergency care or treatment, must contact emergency medical services in the town in which they are located and provide a report to its medical director.

Follow up After Incident

In the event of an incident where an AED is used the following people should be contacted in the following order:
Rick Mears (413) 542-8189 or (413) 542-2291
- Amherst College AED Service Coordinator
Stan Zieja (413) 542-8188 or (413) 584-7521
- Amherst College Department of Physical Education and Athletics PAD Coordinator
Raymond Conway, MD (413) 582-2947 fax
- Emergency Department Director CDH
Jen Sell, Fire Captain (413) 256-4086
- Amherst Fire Department
Warren Morgan , MD (413) 542-2266
- Amherst College, Team Physician

After the Amherst College Department of Physical Education and Athletics PAD Coordinator or their designee has been notified, the responder should complete a copy of the defibrillator incident report. The PAD Coordinator will forward the report to Cooley Dickinson Hospital. The fax number is 582-2947 for CDH.

Contraindications for Defibrillator Use

  1. Person with a PULSE
  2. CHILD UNDER AGE 1

If the defibrillator unit is infant/child adaptable, the infant/child pads with the pink plug can be used with the Life-Pak 500. These pads, in conjunction with an upgraded Life-Pak 500, will deliver shocks of an appropriate number of joules. Do not use a non-adaptable Life-Pak 500 with the infant/child pads.

Do Not Start CPR or Initiate Defibrillation if…

  • Person has a pulse
  • There is a valid CC / DNR on the person in compliance with MDPH CC/DNR protocols
  • 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

Dispatch Protocols for Medical Emergencies

  • The AED is located in the Fitness Center at Alumni Gym, with Stan Zieja and in both Amherst College Campus Police Cars.
  • In the event that a Coach, Trainer or other Trained AED provider is notified or determines one of the medical emergencies listed below he or she shall or their designee shall automatically call the Amherst College Campus Police Dispatch Center at 2111.
  1. Cardiac Arrest
  2. Cardiac Distress
  3. Cardiac History
  4. Chest Pain
  5. Unresponsive/Unknown
  6. Respiratory Arrest
  7. Respiratory Distress

A wall-mounted Defibrillator Cabinet protects the Defibrillator in the Fitness Center, Main Level of Alumni Gym.

If the cabinet door is opened…

  • the Simplex Fire Alarm System will send a “Priority 2” alarm to the Amherst College Campus Police, which indicates that the defibrillator has been removed.
  • Amherst College Campus Police will then immediately summon the Amherst Fire Department Ambulance, in accordance with protocol.

Arrival on Scene

Bring in all necessary equipment, including;

  1. First Aid Kit with Bag Valve Mask and/or Pocket Mask
  2. Defibrillator
    • Use Universal/Standard precautions/Body Substance
    • Determine Unresponsiveness (absence of breath & pulse)
    • Consider all potential non-cardiac causes of cardiac arrest (electrical shock, overdose or trauma)
    • Initiate CPR and assist with ventilations (if awaiting defibrillation) IF defibrillator is already on scene shock is priority
    • Make sure that the ambulance is in route to the scene and provide all necessary, additional information regarding the person’s condition and care.

Patient Preparation for Defibrillation

After determining that the patient warrants CPR and Defibrillation, the officer(s) should...
  1. Verify Ambulance Intercept as soon as possible p
  2. prepare the chest to receive the QUIK-COMBO electrodes with the REDI-PAK preconnect system.
  • 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 it
    • If Nitropatch or other similar item-Remove it
  1. Turn the Defibrillator ON
    • follow the verbal instruction
  2. Attach defibrillator electrodes to patient while verbalizing procedures
    • place the anterior electrode on the patient's right upper torso (right of their sternum and below the clavicle).
    • place the (heart) electrode to the patients left nipple (see attached set-up)
      - firmly press the electrodes onto the patient’s chest to eliminate air pockets between the gel surface and the skin.
  3. PRESS ANALYZE
  4. Determine if Defibrillation (shock) is indicated or not

After the patient has been turned over to the ambulance or higher level of medical care...

  • Contact the Amherst College AED Service Coordinator or their designee in the following order;
  1. Richard A. Mears - Environmental Health & Safety 542-8189 (work), 549-0898 (home),(413) 263-7894(pager), or cell phone (413)530-8782.
  2. Capt. Jen Sell - Amherst Fire Department 256-4080
  3. After the patient has been turned over to the ambulance or higher level of medical care… After the Amherst College AED Service Coordinator or their designee has been notified, the coach or trainer should complete a copy of defibrillator incident report found in Appendix D of this policy. The report will be forwarded to Cooley Dickinson Hospital by the AED Service Coordinator. The fax number is 582-2947 for CDH and 586-0947 for WMEMS.

Shock Advised

1. Verify that no one is touching the patient.
2. Administer shicok by "Pushing" Red Flashing Button.
3. Check for a pulse

  • If no pulse begin CPR
  • 2 minutes

4. Follow directions of Defibrillator

No Shock Advised

1. Check for a pulse.

  • If no pulse, begin CPR
  • 2 minutes

2. Analyze patient with Defibrillator
3. Follow direction of Defibrillator

If a patient has been successfully defibrillated, then…
  1. maintain an open airway
  2. administer oxygen with a non-rebreather mask at 15 lpm
  3. monitor vital signs, including;
    • Blood Pressure
    • Pulse
    • Respiration’s
Oxygen Tank
 

Batteries

The Physio- Control Life-Pak 500 Defibrillator comes with two (2) batteries;

  1. Rechargeable Sealed Lead Acid (SLA) Battery
  2. Non-Rechargeable Lithium Battery

The Rechargeable Sealed Lead Acid Battery is capable of;

  1. delivering 60 shocks at 360 joules or
  2. lasting approximately 2 years with proper charging
  3. it must be charged after each use or at least once per month.
    • On the last day of each month the battery should be given to the Service coordinator ( Environmental Health & Safety) for recharging.
      • EH&S will keep track of charging dates in Microsoft Schedule

The Non-Rechargeable Lithium Battery can;

  1. deliver 300 shocks or
  2. have a shelf life of 5 years
    • Neither battery should be exposed to temperatures in excess of 120 degrees Fahrenheit.

Maintenance for the Life-Pak 500

Maintenance of the defibrillator shall be the responsibility of the Service Coordinator (Environmental Health and Safety). The Life-Pak 500 performs its own daily diagnostic evaluation. Whenever service is needed, the Service Icon on the top of the defibrillator unit will illuminate. When the red wrench “glows”, service is required and EH&S must be notified, immediately.

Training

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

The class was 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 – included Comfort Care and Do Not Resuscitate (CC / DNR) and will take approximately 6 hours.
Class #2 – completed the training requirements and will take approximately 4 hours

Quarterly Skill Evaluation – Each full time member of the police department as well as all Amherst College Coaches and Trainers 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 each year it shall be a hands-on practical.