Project ADAM Tennessee Information Packet

Project ADAM Tennessee

saves lives

Form No. 30943 (05/16)

EAST TENNESSEE CHILDREN’S HOSPITAL

WWW.ETCH.COM/PROJECTADAM

Project ADAM Tennessee Information Packet

1. Contents 2. General Information Project ADAM Tennessee Project ADAM Manual

3. PAD (Public Access to Defibrillation) Program Checklists A Comprehensive School Program for Prevention of Sudden Cardiac Death Implementation Checklist Sample: CPR/AED Emergency Response Plan for Schools 4. Protocols and Awareness PAD Program Policy and Procedure Template Sample: Notification letter to all parents and students Sample: Notification letter to local Emergency Medical Service Sample: Notification letter to community groups Sample: Program News Release Staff Awareness for SCA and AED Notes for Presentation Awareness for Athletic Directors and Coaches Awareness for Administrators Awareness Form for students Prevent Sudden Cardiac Death

5. Skill Drills AED/CPR Skill Drill Skill Drill scenarios Article: AED Drills Drill Recording

6. Tennessee Laws TCA:Tennessee AED Law & Good Samaritan Law

7. Additional Information and Forms AED Placement and Vandalism AED Overview/Comparison Sheet AED Readiness Inventory PA Event Summary Form Organizational Links Budget Worksheet Periodic Maintenance Checklist CPR/AED Training Log

IntroductionIn 2011, Project ADAM Tennessee was launched by East Tennessee Children’s Hospital as an affiliate of Project ADAM, a national public access defibrillation (PAD) program for schools. Through Project ADAM Tennessee, schools are provided with individual consultation on the prevention of sudden cardiac death (SCD) in the school setting. Project ADAM Tennessee works with schools in the following ways:

• Identifying a project coordinator and emergency response team at your school to recognize and respond efficiently to sudden cardiac arrest (SCA)

• Implementing a PAD program, including CPR and AED training for selected faculty, staff and volunteer first-responders

• Assistance in obtaining a new AED and/or managing an existing one • Consultation regarding maintenance of equipment, training updates and

practice drills • Providing information to staff, students and parents about risk factors and symptoms of

sudden cardiac arrest • Connecting participating schools so they may share best practices • Working with local emergency responders to coordinate efforts and offer

the best chance of success • Providing materials with step-by-step instructions in the development of a PAD • A comprehensive planning manual is provided to each participating school, complete with templates. All consultation is provided free of charge to schools in Tennessee thanks to the generous support of East Tennessee Children’s Hospital.

Project ADAM Heart Safe SchoolsTennessee schools who complete the Project ADAM Tennessee checklist indicating theirimplementation of a quality AED program will receive a framed certificate of recognition as a Heart Safe School. Door stickers and directional signs to identify location of AEDs and warning signs for school clinics and physical education/sports areas will be provided.

Project ADAM TennesseeProject ADAM Tennessee’s mission is to serve children and adolescents through education and the deployment of life saving programs that help prevent sudden cardiac arrest and sudden cardiac death in schools. Adults at work or visiting in schools will also benefit from the program. Our goal is to engage the participation of all schools in Tennessee.

For more information on how your school can become Heart Safe, please contact:

Karen Dean Smith, APRN-BC East Tennessee Children’s HospitalProject ADAM Tennessee Coordinator 2018 Clinch Avenue, Koppel [email protected] Knoxville, TN 37916865-384-1676 or 865-541-8137


saves lives

Implementation ChecklistName of School and District:___________________________________ o ES o MS o HS o Pvt. AED Coordinator:_______________________________Contact phone number:_______________________________Email:______________________________ Medical Director:____________________________________________ How long have you had an AED program?_______________ What AED(s) do you use? _________________________ Number of staff trained as CPR /AED rescuers?_______ Training: o Am. Heart o Red Cross o Other __________We have______________ or have not ______________ had to use our AED.Location(s) of AEDs _______________________________________________________________________________ Please complete this checklist for the current program in your school (one form per school):

Program Quality Not In In Need Comments Place Place HelpA program coordinator is identified, who oversees the overall program.School has _______ (#) AEDs. We have buildings,mobile units, students, staff.The placement of the AED(s) makes it accessible from any partof the building or campus within 2-3 minutes (either by fastround-trip walk or by staff transporting to victim).There is a designated emergency response team andCPR/AED training is updated: annually every 2 years , or (list)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 trainingon sudden cardiac death (warning signs, recognition,communication procedures, other staff roles, etc.)We have a communication code (overhead page or other)to notify responders and others in the area thatan incident is occurring. Teachers outside with studentscarry a communication device.The device is checked monthly ________, or per manufacturer’s directionsThis maintenance check is documented each time in writing andreported to:___________________________________.We keep a CPR barrier device, scissors, gloves, razor,and towel in a case or pack near or attached to the AED.

Project ADAM TennesseeA Comprehensive School Program for

Prevention of Sudden Cardiac Death

Program Quality Not In In Need Comments Place Place HelpWe hold at least an annual AED practice drill to test our emergency plan,communication and emergency responders.We have a written policy, procedure or guideline forAED use in the school. Local EMS has been notified about the specifics of our program,has a copy of our plan, and is familiar with school entrances andbuilding layout.Student athletes must have completed the TSSAA pre-participation physical form. (If another form is used, please include a copy. Not required for ES or MS)If our device has been used, an incident debrief and AED maintenance occurred within 24 hours.If a device is used for sports events, there is a written emergency action 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).We have a physician medical director (Check one: local____________ or with AED company________________)This school has a certified CPR instructor on staff (this is not necessary, but helps maintain the program more inexpensively.)Students in our school (MS/HS) are taught CPR in the ______________ grade or class. Other community groups that use the school building regularly have been made aware of our AED program, location of devices, etc.Other comments about your program:

Please send or fax this checklist to: Karen Dean Smith, APRN, PNP, Project ADAM Tennessee Coordinator, East Tennessee Children’s Hospital, Community Benefits Dept., 2018 Clinch Ave., Knoxville, TN 37916 Cell: 865-384-1676, Office: 865-541-8137, [email protected]. Please call or email any questions regarding your PAD program or these requirements to become a Project ADAM Tennessee Heart-Safe School. When your program has been evaluated as complete, we will arrange for the presentation of a certificate and add your school to the community of Project ADAM Tennessee Heart-Safe Schools. Thank you for your participation in this important initiative.

Sample: CPR/AED Emergency Response Plan for SchoolsLocation of AED Unit(s),__________________________________________________________________________

Method to Announce Alert: “Code AED (or Code Blue or Code ADAM) in Mr./Ms. __________Room. AED Team report to Mr/Ms._____________________ room immediately. All staff should contain their students in current classroom until further notice.”

Upon transport by EMS, front office should announce. “Code AED now clear. Staff may resume normal schedules.”

CPR/AED Team Member Extension CPR Expiration Date

1.

2.

3.

4.

5.

6.

7. Because possible scenarios requiring CPR/AED use may vary greatly, any of the CPR/AED team members may be called upon to assist in any steps of the response plan. In the event classroom teachers are team members, they will need backup to cover their classrooms. All staff and particularly office staff should have a basic understanding of the response plan to presumed Sudden Cardiac Arrest.

It is assumed that teachers will have means to communicate, either by intercom, cell phone, or walkie talkie no matter where on school grounds they may be.

RESPONSE PLAN1. Teacher/Staff closest to victim alerts front office of “Code ADAM or Code AED” in Room_____, If student is unresponsive, instruct front office or appropriate designee to bring AED, call EMS, & begin CPR

simultaneously. Front office or 1st responder should notify EMS.2. All AED team members will report immediately to victim. The AED team member closest to the AED will grab

the AED, leaving the AED box door open so the alarm will signal other team members that the AED has been taken.

3. If CPR has not been initiated, then the closest CPR certified person begins CPR. When the rest of team arrives, 2 person CPR may begin.

4. One responder brings walkie-talkie to communicate with office and document events. It should be noted the time event occurred, when CPR started, when EMS called, when EMS arrives. (See attached Page 2).

5. One responder should wait for EMS and direct them to scene.6. Front office staff should contact parents/family; copy victim’s emergency card and send with EMS. AED should

be sent with EMS to emergency room physicians.7. Crowd control is maintained.


PublicAccessDefibrillationProgram(school)POLICY AND PROCEDURE TEMPLATEThis template provided is a guide for developing Automated External Defibrillator (AED) guidelines for a school setting. It is recommended that AED guidelines be developed through consultation with the program medical director and local EMS and must include and complement the school’s emergency medical response plan. If a specific plan does not already exist, one must be developed and may be added as an attachment to this policy or created as a separate policy. Specific AED use protocols should be attached, as well as a floor plan indicating exact location of the AEDs. This template is not to be interpreted as medically or legally binding. Your medical director and school administration will approve your final policy and procedure.

Policy:

1. An Automatic External Defibrillator (AED) will be maintained on the premises of (school name, address and AED location).2. The AED shall be used in emergency situations warranting its use by individuals specifically trained in the use of the device. This should include an emergency response plan and specific protocols for the use of the AED. If trained individuals are not on school grounds during an emergency, a member of the general public who is present at an emergency situation on school grounds may use the AED.3. Program coordinator (Include contact information):4. Program coordinator responsibilities (Planning, CPR/AED training coordination, maintenance, etc.):5. Medical directorship information (Name, credentials, professional affiliations, etc.):

• The medical director is responsible for medical oversight of the PAD program. This includes writing a prescription for the AED device, approval of school PAD program guidelines, analysis of post-sudden cardiac arrest event forms and data.

6. Local EMS information (Contact person, address, etc.):7. Supporting documents (e.g., state AED laws and guidelines, infection control procedures, medical emergency response plan, etc.):8. Attach list of trained responders.9. Trained responder responsibilities (includes activating emergency response system, performing CPR/AED duties as assigned, compliance with CPR certification):

Procedure:

Location, maintenance and testing of AED(s)

1. The AED shall be located __________________ (include floor plan and location of AED) .

The type of device, intended use area, plan for maintenance and testing and location of the device on the premises shall be confirmed in writing to: __________________ (local Emergency Medical Service provider name, address, telephone).__________________ (program medical director name, address, telephone, pager).

2. Maintenance and testing are conducted as recommended by the manufacturer.o Documentation of the maintenance and testing is maintained <list location> for a period of _________ years.3

o Documentation shall record the date and type of maintenance/testing and the signature of the person performing the maintenance/testing.

1 If there is more than one AED, then each location should be listed. 2 Check the requirements of your state. Project ADAM authors highly recommend that each school identify a medical director. 3 Legal advisors for the schools should be consulted regarding types of program documentation required and maintenance of the documentation.


Readiness status will be assured consistently (i.e. weekly).o Records of readiness verification shall be kept <<list location>>

3. Equipment (include AED manufacturer, sales contact information, AED model, etc.)4. Ancillary equipment:5. Trained responders: CPR/AED renewal certification information.6. Post-event assessment (include procedure for handling of data card):7. Use of the AED: a) Determine unresponsiveness of victim and activate emergency response plan. b) If victim is unresponsive, call 9-1-1 and retrieve AED from ____________________. c) Assess the victim: airway, breathing, circulation d) Initiate CPR (if required) while AED is being retrieved. e) Public address system: used to activate responders and indicate location of emergency. f) Designate an individual to wait at facility entrance to direct EMS to victim location.

8. Upon arrival, place AED near head of victim and close to AED operator.9. Prepare to use the AED: a) Turn power ON. b) Bare and prepare the chest for AED use. c) Attach AED pads to victim. d) Stop CPR while the AED detects heart rhythm. e) Follow AED device prompts for further action; if shock is indicated, be sure all rescuers are “clear” before shock is administered.

10. Upon arrival, EMS shall take charge of emergency situation. a) Provide victim information to EMS: name, age, known medical problems, time of incident. b) Provide information as to current condition/number of shocks administered.

11. Data card: following AED use, the data card shall be delivered to: _____________________ for downloading and analysis.

12. Following AED retrieval and/or use: a) A critical incident debriefing session will be held within <<time frame>> for all responders. b) The medical director shall be notified of AED use. o Complete follow-up report if deemed necessary by medical director. o Arrange for quality improvement review.

13. The AED will be checked and placed back in readiness state: a) Remove data card from unit; label with victim data; deliver to appropriate personnel according to program protocol. b) Replace data card. c) Restock AED per inventory list. d) Clean AED if needed according to manufacturer recommendations. e) Document AED readiness.

14. Place AED back in service after use: a) Readiness status will be assured following any AED use. b) Records of readiness verification shall be kept <<list location>>.

Medical director

Name___________________________ Signature______________________________ Date _________________________Program coordinator

Name___________________________ Signature______________________________ Date _________________________Building principal

Name___________________________ Signature______________________________ Date _________________________© 2005 Children’s Hospital and Health System. All rights reserved.

Notificationlettertoallparentsandstudents

SAMPLE

Dear <<parents, guardians and/or students>>,

(Name of your school) is pleased to inform you we have joined a community effort to place automated external defibrillators (AEDs) in our school building. This decision is the result of our wish to make our schools safe for our students, visitors and employees.

The latest national statistics indicate that more than 350,000 children and adults in the U.S. die from sudden cardiac arrest every year, most of them outside of the hospital. We also are being made aware of the documented numbers of young athletes who suffer sudden cardiac arrest while participating in sports. Through our cooperative efforts with Project ADAM Tennessee and East Tennessee Children’s Hospital we have joined hundreds of schools throughout the state of Tennessee and beyond in preparing our school for a life-threatening emergency. This program enables us to offer any person who may experience a sudden cardiac arrest the best chance for survival.

We have placed AEDs in the following locations: <<locations>>. The AEDs are in alarmed cabinets. When the cabinet doors are opened a loud alarm will sound. This alerts everyone that there is a potential emergency. Our school has a maintenance plan in place for the unit(s); the AEDs are designed to work effectively unless they are tampered with. Additionally, the unit will not shock a person unless it detects a shockable rhythm (ventricular fibrillation). As with any emergency device, please be reminded that tampering with such a unit may result in disciplinary action for the person involved.

Staff has been trained to assist with an emergency during regular school hours. After school hours this is a public access defibrillation (PAD) program. If you suspect someone is experiencing a sudden cardiac arrest please feel free to use the equipment at our school. Good Samaritan laws protect the layperson in a life-saving attempt, although we recommend becoming trained in CPR/AED use as an investment in your health and the health of others. Our local EMS is aware of our policies and procedures for the program; we have been provided medical oversight by <<physician name/healthcare facility>>.

To call 911 during school hours (describe the process). To call 911 after school hours (describe the process). If the AED is used please contact (name/phone number) so that we may follow-up on and replace materials used in the resuscitation effort.

Sincerely,

<<School PAD coordinator>>


NotificationlettertolocalEmergencyMedicalService(EMS)

SAMPLE

Dear Chief (EMS contact person),

As part of our commitment to the health and well-being of our students, families and visitors, (name of school) has acquired Automatic External Defibrillators (AEDs).

The intended usage areas of the defibrillators have been defined with consideration of accessibility to our staff and lay rescuers. We have attached a map indicating these locations.

We have implemented the following protocols in affiliation with (training organization-if applicable) and Project ADAM (Automated Defibrillators in Adam’s Memory).

• A (name the brand of AED, i.e.: Lifepak 500) has been purchased through (vendor’s name). • The AEDs were placed with the assistance of (list those sources here i.e.: training organization, Project

ADAM, defibrillator vendor or EMS). • All employees in our facility know the location of the AEDs.• Personnel have been identified to conduct appropriate maintenance and testing of the AEDs according to the

manufacturer’s directions and company policy. • Our lay rescuers have been trained by: (list the training organization here). • A plan for refresher courses and on-going maintenance of the equipment has been implemented. • We will/will not be implementing the pediatric component of the program. • Our program was implemented in compliance with <<statewide laws/guidelines>>. • (Name of physician) has agreed to provide medical direction and control. He/she will be utilized as needed at

the discretion of our staff and in the debriefing of any life rescue event.

Please be advised that (school name) is proud to be a participant in our city’s “Chain of Survival”.

Please feel free to contact me if you have any questions or concerns.

Sincerely,

Program coordinatorSchool name

© 2005 Children’s Hospital and Health System. All rights reserved.


Community Groups Letter

SAMPLE

This letter to community groups may be provided on an as-needed basis. Please check with your school legal counsel to ensure it may be used. It may also serve as an addendum to your school liability waiver already in place. Feel free to copy any or all of the following key points.

<Name of company or civic group>

<Date of building/room use>

<Name of your facility> is committed to provide our students, visitors and employees with a safe environment. We have joined a community effort to implement a Public Access Defibrillation (PAD) program in our facility. Automated External Defibrillators (AEDs) have been placed in the following locations:

*Describe these locations. You may want to indicate whether wall-mounted cabinets are used and if so, inform the user that they are unlocked and alarmed; the alarm will stop when the cabinet door is closed.

We have trained staff available during regular school hours should a sudden cardiac arrest or other emergency occur. However, please be advised that trained staff MAY NOT be readily available to assist you in the event of an emergency outside of regular school hours. If you are CPR/AED certified and feel you can effectively use the AED please feel free to use it. We encourage everyone to participate in our community “Chain of Survival” (early 911, early CPR, early defibrillation, early medical care).

If a life rescue event occurs please be advised that to activate 911 you must: (describe the procedure for doing this at your facility). If you use the AED, please contact the appropriate school officials immediately. <Include where list of names and numbers can be found>.

We would encourage everyone to learn CPR and how to use an AED; it could be the difference between life and death. For information on CPR/AED training classes scheduled for our area please call <school representative or any accredited training organization in your area >.


Sample Program News ReleaseDate:

FOR IMMEDIATE RELEASE:

(School name) announces life-saving defibrillation program.

(City and date) Starting (your school’s implementation date) the students, visitors and employees of (school name) will have a better chance of surviving a cardiac arrest because of newly installed Automated External Defibrillators (AEDs). The AEDs are part of our school’s new public access defibrillation program that trains staff and students to recognize a cardiac emergency, perform CPR and use the device to administer a shock to the heart. “We want to be sure we can effectively respond to any medical emergency that occurs on our property”, says (school spokesperson).

Every year almost 350,000 people suffer cardiac arrest and only about 5 percent of them survive. Since 1999, in southeastern Wisconsin alone, 25 adolescents under the age of 18 have also suffered sudden cardiac arrest. Only 8 of those students survived. While our program will allow us to respond to any person who collapses we certainly want to offer our young people every chance to survive, since cardiac arrest in this age group is so unexpected. Cardiac arrest is a condition in which abnormal heart rhythms cause the heart’s electrical impulses to suddenly become chaotic. When this happens, the heart stops abruptly, and the victim collapses and quickly loses consciousness. Death usually follows unless a normal heart rhythm is restored within a few minutes. Defibrillation, which delivers an electric shock to the heart, is the only known treatment to stop this chaotic electrical activity. This allows the heart to restart itself. For every minute defibrillation is delayed, the victim’s chances of survival go down by 7 to 10 percent.

When Adam Lemel collapsed and died while playing basketball in January of 1999 it spurred the efforts to establish a program to help schools across Wisconsin to place AEDs in all locations. The program, Project ADAM, was a joint effort of friends of Adam and Children’s Hospital of Wisconsin and has been a resource for many schools not only in Wisconsin but also across the nation. Senator Russ Feingold introduced the Adam Act, a bill that will establish a national clearinghouse, modeled after Project ADAM, for AED programs in schools across the country. In July of 2003 President Bush signed this bill into law. In 2016, Tennessee requires all schools to provide annual SCA, CPR and AED awareness training and perform at least one AED/CPR practice drill.

According to a school spokesperson, concern about being able to ensure quick defibrillation caused them to set up the AED program. “We have a large campus and sometimes EMS response times are delayed due to weather, traffic problems and location of the victim, so we worked with local EMS and the Project ADAM staff to set up our program...<<or insert other quote>>.”

AEDs now on the market are safe and easy to use, making it possible for non-medical personnel to be trained to provide rapid defibrillation for victims of all ages. More and more schools are taking this step since legislation supporting the Good Samaritan law was passed in this state. This allows non-medical lay rescuers to use the AED. The American Heart Association, Project ADAM and OSHA recommend that any facility inwhich large groups of people congregate consider establishing a defibrillation program. Itis estimated that establishing these programs could save as many as 50,000 lives per year.

For more information regarding our program you may contact (contact person). For information about Project ADAM and public access defibrillation programs in your school please call (414) 266-3889.



StaffAwarenessTrainingforSuddenCardiacArrestandAED


This is just a template and may be modified. This presentation lasts approximately 20 minutes. You will need a DVD player, projector, and speakers. You will need to have internet access and be ready to play 2 chapters of the Project ADAM training videos, located at http://www.chw.org/childrens-and-the-community/resources-for-schools/cardiac-arrest-project-adam/video-overview/. After this presentation, the staff should return to their normal locations for the drill. Following the drill, you may reconvene to discuss the drill with entire staff.

INTRODUCTIONSay: This material is from Project ADAM Tennessee, an outreach program of East Tennessee Children’s Hospi-tal which helps schools obtain AEDs, create a response plan, and implement CPR and AED training for staff. Our school is properly equipped with an AED(s), or Automated External Defibrillators. We have a protocol for making sure they are maintained properly. State law now requires that all school personnel undergo Sud-den Cardiac Arrest (SCA) awareness training and perform an annual AED drill with students present. Doing these two things will ensure any victim of SCA on our campus will have the best chance of survival.

The practice drill is not a test, but rather an exercise that helps us to measure our preparedness and tweak any possible weaknesses. We will do the drill in just a minute. First, we’re going to watch a short video from Project ADAM that will help us understand Sudden Cardiac Arrest.

PLAY CHAPTER 2 of Project ADAM video - http://www.chw.org/childrens-and-the-community/resourc-es-for-schools/cardiac-arrest-project-adam/video-overview/.

Say: There’s usually not much warning with Sudden Cardiac Arrest. These often are the people who are the picture of health, out for their daily run or in the middle of a ball game and suddenly drop. In SCA, the heart is no longer pushing blood to the brain and other vital organs. Unless immediate action is taken, there will be damage to these organs and the victim will likely die. There is a general plan that every school should follow and that is the American Heart Assocation’s Chain of Survival. It is very simple and easy to remember: 1. Early recognition of SCA (unresponsive & not breathing normally; may have seizure-like activity) 2. Early call to 9-1-1 3. Early CPR 4. Early AED 5. Early Advanced Care

Let’s talk about our schools AED or Automated External Defibrillator.Our AED here at(this school) is a (Zoll? Cardiac Science? Phillips?–check to be sure) model and is located ______________. It is state law that these devices are stored in an unlocked case that is easily accessed and close to where the most activity occurs during the day. Most AED cases have an alarm. The alarm is not connected to EMS, but is for your notification. If the AED is retrieved in an emergency, we recommend letting the alarm sound until the team has secured the situation. The AED is very simple to use. (Demonstrate briefly how to turn it on, where the pads for adult and peds are located, explain that we

leave adult pads attached since they are most likely going to be ones using it, but ped pads are available for anyone under 55 lbs. or 8 years old. If in doubt about victim’s size or age, go with adult. Explain how this AED delivers shock – either automatic or will flash and direct responder to deliver a shock).

Most AEDs have a CPR instruction feature such as voice directions and/or a metronome. (Demonstrate if theirs has this feature). The AED will not hurt anyone. It will analyze the victim’s heart and will only shock a shockable rhythm. The AED is not to be feared. It may make a hero out of you!

We are going to watch one more video that will help us understand why we need a Public Access to Defibrillation Program and give us an idea of what this looks like.

PLAY Chapter 3 of Project ADAM Video - http://www.chw.org/childrens-and-the-community/resources-for-schools/cardiac-arrest-project-adam/video-overview/.

SAY: At (our school), we have established a Medical Emergency Response Team and a plan.

(Ask response team to stand). These people have agreed to serve as our response team. They have been trained in CPR and AED use (or they will be shortly) and will come to your aid when needed.

Whether or not you are on the “team,” you are responsible in some way:

If you find the victim or are the first adult on the scene:

You will call for the response team if you find a child or adult who is: 1. Unresponsive, and 2. Not breathing normally (not breathing at all, gurgling, shallow ineffective gasps are NOT NORMAL)These are the only 2 criteria you are looking for. You do not need to check for a pulse.

You will assess the scene to make sure it is safe for you to approach the victim. You will tap on the victim and shout to see if there is a response. If the victim is unresponsive and not breathing normally, you will call the office by intercom, ask them to send the AED team to your location. If you do not get a response from the office, it is OK to yell for help or send a student next door to get another teacher. It is crucial to contact the office in the calmest way possible so that the response plan will be immediately initiated.

You will stay with the victim until team members arrive. If you know CPR, begin compressions at a rate of 100/minute, 2 inches deep, in the center of the chest on the lower half of the sternum (think “Stayin’ Alive”). If you do not know CPR, and you know there’s a staff member close by who does, get them! If you know CPR but are not on the team, it is OK to start CPR until team members take over.

The team’s response:

The front office will call (on your school’s most efficient mass-communication device, usually the intercom, in some cases walkie-talkie or phone): “There is a medical emergency in (Ms. _____’s room/ Room #____, _____hallway – identify location clearly). AED/CPR team should report immediately to (repeat location). All other staff should contain their classrooms, and stay clear of hallways until further notice.”

The front office will call 9-1-1.

Someone from the front office or response team will await arrival of EMS and direct them to location of victim.

All other team members will immediately go to the location of the victim.

If you are not a team member, you will keep your students in their classroom and stay out of the hallways. If your classroom is near a team member, you will make sure their students are supervised so the team member can attend to the victim. All staff should make every effort to protect the privacy and dignity of the victim, while also protecting their students from the drama and trauma of such an incident.

When the team arrives, they will continue or begin CPR, attach the AED to the victim, and listen to the instructions of the AED. They will continue to perform CPR and listen to the AED directions until EMS arrives. All other personnel should clear the area and should take care to keep students away from the victim and out of the hallways.

When EMS has left the premises, the front office should notify the staff with an overhead announcement: “Staff may resume normal activities at this time.”

Ask someone to remain and serve as timekeeper.

Questions?

(If conducting a drill, instruct participants to return to their normal location during the school day and await notification from the office). Once we have completed the drill, we’ll return here for a quick debriefing.

Upon completion of drill, ask front office to announce, “All Clear.” If you have time, ask staff to return to library for review of drill performance and to address additional questions. The most common trouble spots involve communication and accessibility issues and it is helpful to consider alternatives.

SuddenCardiacArrest(SCA)InformationforAthleticDirectorsandCoaches


Catastrophic injuries can occur and you can respond: • During any physical activity, at any age - not just with athletes • At any level of participation • During team and individual practices, as well as at games • Unpredictably and without warning • They are Low Incidence, but High Risk • SCA is the leading cause of death in young athletes: 1,000 - 7,000 children, adolescents and

young adults each year • Early recognition is critical. Sudden unresponsiveness means sudden cardiac arrest until proven

otherwise with AED • An SCA may look like a seizure in the beginning • Anyone who is unresponsive and not breathing normally, needs CPR and the AED • Should be handled by the best trained personnel available - and you cannot wait for EMS to arrive • Average EMS response time is 6-12 minutes. The brain can only wail3- 5 minutes • Training in CPR and on-site AED programs are likely the only means of achieving early defibrillation

and improving survival from sudden cardiac arrest in athletes • Any adult (or teen) witnessed arrest, can be treated with Hands Only CPR until the AED arrives:

Send someone to call 911 Start continuous chest compressions, hard and fast, in the center of the chest, 2 inches down, and to

the beat of “Stayin Alive” (rate of 100/minute) Rationale: the victim you observe go down was breathing just before collapsing, so does not need

breathing assistance for several minutes -just great compressions. • The single greatest factor affecting survival is the time interval from arrest to defibrillation. So

recognition of the emergency is critical. Target goal: under 5 minutes from collapse to first shock (and effective CPR immediately and until AED arrives).

• Survival rates decrease by 10% with each minute of delayed response • In a recent national survey of 36 SCA events in high schools, 97% SCA events were witnessed, 94% received bystander CPR, and AED deployed a shock in 83% (12 required multiple shocks), 67% of those victims survived! • As of June 2013, at least 39 lives have been saved in Georgia schools after a sudden cardiac arrest. These children and adults are alive today because their schools were prepared and practiced for this emergency, where school personnel provided CPR and used the school’s AED.

Emergency Action Plans for SportsGoal: to provide the highest possible quality health care to athletes and others (not just for cardiacemergencies, but more commonly for fractures, spine injuries, healinjuries, asthma and allergic reactions

• Develop in consult with local EMS, administration, school health personnel • Should be venue-specific (i.e. how would you communicate and/or retrieve AED from any

practice field or game site?) • Communication access to phone and back-up communication - 911 availability- know where the call goes (is nearest cell tower in next county?) - clearly communicate to EMS “victim is unconscious and not breathing” • Personnel: Identify first responders and keep training current. Consider training all coaches

in CPRIAED • Educate all members of emergency response team in: - recognition of emergency - CPR,AED, First Aid - disease prevention - the Emergency Action Plan • Roles: immediate care of victim (CPR if needed), emergency equipment retrieval, activation of EMS,

direction of EMS to scene • Other roles:crowd control, attention to other students, contacting parents (are emergency numbers

with you), get medical records of athlete • Emergency equipment should be on site, easily accessible, in good operating condition, checked

at least monthly for pad dates, battery life. Build quality into your plan by reviewing regularly and rehearsing the plan with an AED practice drill, annually or before every season

• Communicate the plan to parents and athletes

NATA Position Statement (March 2002) see complete statement at www.nata.org)1. All personnel involved with the organization or sponsorship of athletic activities share a professional

responsibility to provide for the emergency care of an injured person.2. Must have a written emergency plan, accounting for athletes, game officials, fans, sideline participants.

(comprehensive, practical, flexible)3. All personnel share a legal duty to develop, implement and evaluate emergency plans for all sponsored

athletic activities.

Tennessee Sudden Cardiac Prevention Act (see Tennessee Law, TCA Chapter 68)

These emergencies are always devastating to the school community. Awareness, planning, education andadvocacy can and will save lives.

For assistance with your planning, contact:

Karen Dean Smith, APRN-BCProject ADAM Tennessee CoordinatorEast Tennessee Children’s Hospital2018 Clinch Ave. Knoxville, TN 37916 [email protected]: (865) -541-8137 Cell: (865) 384-1676 Fax: (865) 541-8285

• There are about 350,000 sudden cardiac deaths (SCD) in the U.S.each year, almost 1,000/day. These victims could be on your staff or visitors to your school. • At least 600 - 1,000 of these occur in children and adolescents each year, so we can expect there might be 10-25 student deaths in Tennessee each year. • There have been at least 7 probable sudden cardiac arrest in Tennessee schools in the last 2 years: there has been 5 lives saved by an AED1 in Knoxville1 Emanuel Negedu was a lucky victim of SCA as was Hunter Helton. • During Sudden Cardiac Arrest (SCA) the heart goes into ventricular fibrillation or “ineffective quivering” and can no longer pump blood to the brain and other vital organs. • Early CPR and early defibrillation are required to save the victim’s life. • Time is the critical element. Three to five minutes is the optimum time for emergency response. Don’t waste precious time trying to figure out what may have happened- some on the staff needs to call 911, while a first 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 automated external defibrillator (AED) within 3 - 5 minutes can safe a life. We cannot wait for Emergency Medical Services. • The AED will look for a “shockable” heart rhythm and will only deliver a shock if it is needed. All rescuers are covered by the Good Samaritan Law. • A student victim of sudden cardiac arrest may just complain of feeling “faint” or dizzy, usually during or just after exercise. They will rapidly become unconscious. There may be irregular and ineffective breathing for a short time. • A core group of staff members (at least 5) should be trained in CPR and AED use. It is advisable for all coaches and PE teachers to have this training also. • AED practice drills are also recommended at least annually. • Since anyone might be the one to witness the event, it is important for all staff members to have some general awareness of these facts: what a sudden cardiac event 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 initiate and help in the emergency response.

The early warning signs of sudden cardiac arrest risk include: • Fainting or dizziness during or right after exercise • Excessive fatigue or shortness of breath with exercise • Chest pain or discomfort with exercise • Family history of a sudden, unexplained death before age 50

For more information on recognition as a Project ADAM Tennessee Heart-safe school or for consultation for your school please contact:

Karen Dean Smith, APRN-BC, Project ADAM Tennessee CoordinatorEast Tennessee Children’s Hospital,2018 Clinch Ave. Knoxville, TN [email protected] (o) 865-541-8137 (c) 865-384-1676 (f ) 865-541-8285

AwarenessforAdministrators


SuddenCardiacArrestAwarenessFormName of Student:___________________________________________ What is Sudden Cardiac Arrest? • Occurssuddenlyandoftenwithoutwarning. • Anelectricalmalfunction(short-circuit)causesthebottomchambersoftheheart(ventricles)tobeat

dangerouslyfast(ventriculartachycardiaorfibrillation)anddisruptsthepumpingabilityoftheheart. • Theheartcannotpumpbloodtothebrain,lungsandotherorgansofthebody. • Thepersonlosesconsciousness(passesout)andhasnopulse. • Deathoccurswithinminutesifnottreatedimmediately.

What causes Sudden Cardiac Arrest? • Conditions present at birth G Inherited (passed on from parents/relatives) conditions of the heart muscle: s Hypertrophic Cardiomyopathy–hypertrophy(thickening)oftheleftventricle;themost

commoncauseofsuddencardiacarrestinathletesintheU.S. s Arrhythmogenic Right Ventricular Cardiomyopathy–replacementofpartoftherightventricle

byfatandscar;themostcommoncauseofsuddencardiacarrestinItaly. s Marfan Syndrome–adisorderofthestructureofbloodvesselsthatmakesthem pronetorupture;oftenassociatedwithverylongarmsandunusuallyflexiblejoints. G Inherited conditions of the electrical system: s Long QT Syndrome–abnormalityintheionchannels(electricalsystem)oftheheart. s Catecholaminergic Polymorphic Ventricular Tachycardia and Brugada Syndrome –othertypesofelectricalabnormalitiesthatarerarebutareinherited. G NonInherited(notpassedonfromthefamily,butstillpresentatbirth)conditions: s Coronary Artery Abnormalities–abnormalityofthebloodvesselsthatsupplybloodtothe

heartmuscle.ThesecondmostcommoncauseofsuddencardiacarrestinathletesintheU.S. s Aortic valve abnormalities–failureoftheaorticvalve(thevalvebetweentheheart andtheaorta)todevelopproperly;usuallycausesaloudheartmurmur. s Non‐compactionCardiomyopathy–aconditionwheretheheartmuscledoesnot developnormally. s Wolff‐Parkinson‐WhiteSyndrome–anextraconductingfiberispresentintheheart’s electricalsystemandcanincreasetheriskofarrhythmias. • Conditions not present at birth but acquired later in life: s Commotio Cordis–concussionoftheheartthatcanoccurfrombeinghitinthechest byaball,puck,orfist. s Myocarditis–infection/inflammationoftheheart,usuallycausedbyavirus. s Recreational/Performance‐Enhancingdruguse. • Idiopathic:SometimestheunderlyingcauseoftheSuddenCardiacArrestisunknown,evenafter autopsy.


What are the symptoms/warning signs of Sudden Cardiac Arrest? • Fainting/blackouts(especiallyduringexercise) • Dizziness • Unusualfatigue/weakness • Chestpain • Shortnessofbreath • Nausea/vomiting • Palpitations(heartisbeatingunusuallyfastorskippingbeats) • Familyhistoryofsuddencardiacarrestatage<50 ANY of these symptoms/warning signs that occur while exercising may necessitate further evaluation from your physician before returning to practice or a game.

What is the treatment for Sudden Cardiac Arrest? • Timeiscriticalandanimmediateresponseisvital. • CALL 911 • Begin CPR • UseanAutomatedExternalDefibrillator(AED)

What are ways to screen for Sudden Cardiac Arrest? • TheAmericanHeartAssociationrecommendsapre-participationhistoryandphysicalincluding 12importantcardiacelements. • TheUILPre‐ParticipationPhysicalEvaluation–MedicalHistory form includes ALL 12 of these important cardiac elements and is mandatory annually. • Additionalscreeningusinganelectrocardiogramand/oranechocardiogramisreadilyavailableto allathletes,butisnotmandatory.

Where can one find information on additional screening? • ChecktheHealth&SafetypageoftheUILwebsite(http://www.uiltexas.org/health)ordoan internetsearchfor“SuddenCardiacArrest”.

_________________________________________ ____________________________________________Parent/GuardianSignature Date

____________________________________________ Parent/GuardianName(Print)

_________________________________________ ____________________________________________StudentSignature Date

____________________________________________ StudentName(Print)

3 Simple Steps to Protect Your Family1: Learn the Early Warning Signs

If you or your child has had one or more of these signs, see your primary care physician:

• Fainting suddenly and without warning, especially during exercise or in response to loud sounds like doorbells, alarm clocks or ringing phones • Unusual chest pain or shortness of breath during exercise • Family members who had sudden, unexplained and unexpected death before age 50 • Family members who have been diagnosed with a condition that can cause sudden cardiac death, such as hypertrophic cardiomyopathy (HCM) or Long QT syndrome. • A seizure suddenly and without warning, especially during exercise or in response to loud sounds like doorbells, alarm clocks or ringing phones

2: Learn to Recognize Sudden Cardiac Arrest

If you see someone collapse, assume he has experienced sudden cardiac arrest and respond quickly. This victim will be unresponsive, gasping or not breathing normally, and may have some jerking. Send for help and start CPR. You cannot hurt him.

3: Learn Hands-Only CPR

Effective CPR saves lives by circulating blood to the brain and other vital organs until rescue teams arrive. It is one of the most important life skills you can learn--and it’s easier than ever.

• Call 911 (or ask bystanders to call 911 and get an AED)

• Push hard and fast in the center of the chest. Kneel at the victim’s side, place your hands on the lower half of the breastbone, one on top of the other, elbows straight and locked. Push down 2 inches, then up 2 inches, at a rate of 100 times/minute, to the beat of the song “Stayin’ Alive.”

• If an Automated External Defibrillator (AED) is available, open it and follow the voice prompts. It will lead you step-by-step through the process, and will never shock a victim that does not need a shock.

Project ADAM Tennessee works to ensure that schools in East Tennessee are trained and prepared to handle a sudden cardiac arrest. Make sure that wherever your child plays, practices, or goes to school is heart-safe. Learn more at etch.com or email [email protected].

Learn more about hands-only CPR at www.heart.org/handsonlyCPR.

PreventSuddenCardiacDeathProject ADAM Tennessee

AED / CPR Skill DrillPreparation

1. Instruct team members to go to http://www.projectadam.com.html. On the home page, there is an icon for Project ADAM video on lower right side. Click on this arrow. Go to Chapter 3 and watch. This will take less than 4 minutes and is excellent preparation.

2. Inform all staff that a drill will be run in the next two weeks at a time when few, if any, students are present. It will be announced as, “This is a DRILL.” Code Blue in the ______. Emergency Response Team report immediately to the ______.” Repeat.

3. Select a time and place for the drill. If front office staff are not part of Team, inform them of their role and of drill time. Inform teachers who are team members to assign backup to cover their classrooms.

4. Inform team members that though they may be assigned a specific task , they will need to be aware of all responses.

5. Assign members to: Initiate response and alert team to victim’s location; Call 9-1-1; Assess victim & situation; Bring AED; Begin CPR; Provide crowd control; Assist with CPR; Gather information on emergency card and contact parents.

6. Select Drill from examples in Project ADAM notebook or make up your own.

7. Assign two people to document.

The Drill

1. Place manikin on floor near one of your team members. This team member will: Assess and determine that victim is unresponsive, call for help, alert office to emergency location and to contact 9-1-1, and bring AED. This member will assure that victim is on firm surface, scene is safe, check for pulse for at least 5 seconds and no more than 10 seconds, and begin CPR.

2. Designated team members will: Bring AED to site, leaving AED case open so alarm will sound and others will know it has been retrieved; Front office will call 9-1-1 and announce “This is a DRILL. Code Blue on the playground. Emergency Response Team members please report to your assigned locations.” (Repeat). One member will await arrival of EMS, one will remain in office to maintain communication, find emergency card, alert guardians. Others will go to scene. Person bringing AED may assist with CPR. One person will maintain crowd control.

3. When AED arrives, substitute AED Trainer for your real AED. Apply appropriate pads and follow prompts. Continue CPR while attaching pads.

4. When EMS arrives, direct them to scene. Send AED and emergency card with EMS.

5. Review and correct any problems.


The following scenarios may be utilized to make practice of CPR and AED skills more realistic for the responders within a school public access defibrillation program. They are useful for both initial training and periodic “skill drills.”

What are “skill drills?”

This is a system of role-play that provides periodic practice of skills rarely preformed but which are, at the same time, essential. Periodic skill practice is necessary to the overall quality of a program. Without opportunity to practice, responders may not be able to perform at an optimal level when an emergency happens. In addition, planned drills allow for review to assure that the essential elements of optimal response are operational such as prompt notification of the EMS, knowledge of AED location and time required to deploy AED to the scene both proper sequence and timely implementation of efforts to maintain airway, breathing and circulation.

Many schools have systems for periodic practice of evacuation procedures already in place. Skill drills for public access defibrillation programs may follow a similar process as longs as they provide for hands-on practice by responders. For example, a drill for staff responders may be planned on a scheduled in-service day with CPR mannequins as victims.

As an alternative to planned drills, specific times for review sessions may be designated that allow for practice. It is highly recommended that all trained responders have hands-on practice at an interval of not less than every six months. This requires merely the amount of time required for a responder to work through a practice scenario. In groups of four, trained responders may work through each role of a scenario quickly.

Skill Drill Scenarios


Public Access Defibrillation in a School SettingPurpose:

In this scenario, the learners practice the following AED scenario: victim collapse witnessed in the gymnasium. Persistent ventricular fibrillation (VF), as determined by the AED, will require three shocks, one minute of CPR, a fourth shock and the rhythm will convert to a non-shockable rhythm.

After VF is converted, breathing and pulse will be present.

Critical thinking: Seizure type activity due to hypoxia may precede sudden cardiac death.

Materials Required: • AED trainer device (or training card to safely use AED for training). • Mannequin for CPR (and appropriate barrier device/ decontamination supplies). • Telephone (unconnected phone set or play phone). • Stop watch.

Rhythm sequence for AED training unit:

Start with shockable rhythm � 3 shocks delivered � CPR for 1 minute � shockable rhythm continues � fourth shock � convert to non-shockable rhythm; pulse returns; breathing returns.

Scenario role assignments:

Rescuer 1 – AED rescuer Rescuer 2 – 9-1-1 callerRescuer 3 – CPR rescuer Rescuer 4 – observer/time keeper (this person should record amount of time taken for entire drill to be completed as well as should serve as an observer to provide feedback to the group.) Scenario:

It is a big game. John leaves the house early to head to school for practice. As he goes out the door, he tells his mom that he has never felt this good in all his life. While practicing, John feels a little short of breath and thinks, “I’m probably just a little nervous” but does not mention it to the coach. Near the end of the game, John’s team is up by 10 points. Suddenly, John has another episode of shortness of breath. He collapses and begins to have some seizure activity. You (Rescuer 1) are attending the ball game. You and a coach (Rescuer 2) are the first people to reach the fallen player. Begin to assess and manage this victim now.

Instructor actions and victim information:

• The victim has what appears to be a seizure. The seizure has stopped. There is no breathing. • There is no pulse. (Note: seizures have often been noted in actual events and are related to hypoxia. This is an important point to make with the learners). • Rescuer 2 returns with AED. Before attaching AED, remind students that a teen who has been playing basketball may be sweaty (wet chest). Chest may need to be dried before pads are attached.

Skill Drill Scenarios 1


Expected Learner Actions

Rescuer 1 – AED Rescuer • Assess victim: check responsiveness, open airway, assess breathing. Simultaneously ask Rescuer 2 – 9-1-1 caller to notify the EMS and obtain the AED.

Rescuer 2 – 9-1-1 Caller • Notifies the local EMS of the emergency; obtains AED.

Rescuer 1 – AED Rescuer • Initiate CPR until AED arrives. • When AED arrives, attach leads and begin use. • Clear and analyze.

Instructor actions and victim information: • Initial rhythm in VF. • Rhythm remains VF for 3 shocks. After 3 shocks, the victim has no pulse. The victim is not breathing.

• Rescuer 3 now is available. • After 3 shocks, victim has no pulse. • Victim is not breathing.

• After 1 minute CPR, the rhythm is VF. • After fourth shock, rhythm converts to “no shock advised” non-shockable rhythm. • Victim now is breathing. • Victim now has a pulse.

Taking time immediately after implementing the scenario to review actions taken will provide a richer learning experience.

1. What did we do well? 2. What could we do better? If needed, discuss with students how the time from delivery of the AED to delivery of the first shock might be made shorter. 3. What was easy to remember to do? 4. What was hard to remember to do?

RECAP:Rescuer 1 – AED rescuer • Clear and shock one time. Follow with two more shocks

Rescuer 3 – CPR rescuer • Check pulse. • Perform CPR for one minute.

Rescuer 1 – AED rescuer • After one minute of CPR; clear & analyze • Clear and give fourth shock. • Clear and analyze. ‘No shock advised.’

Rescuer 3 – CPR rescuer • Check pulse; check breathing. • Monitor victim.

Public Access Defibrillation in a School Setting Purpose

In this scenario, the learners practice the following AED scenario: victim collapse witnessed in the gymnasium. VF will require two shocks and then the rhythm will be converted to a non-shockable rhythm. After VF is converted, breathing and pulse will be present briefly and then the rhythm will revert to VF. One additional shock will be re-quired.

Critical thinking: maintaining the AED in operation since ventricular fibrillation (VF) may reoccur.

Materials required:

• AED trainer device (or training card to safely use AED for training). • Mannequin for CPR (and appropriate barrier device/ decontamination supplies). • Telephone (unconnected phone set or play phone). • Stop Watch.

Rhythm sequence for AED training unit

Start with shockable rhythm � 2 shocks delivered � convert to non-shockable rhythm; pulse returns; breathing ab-sent � continue monitoring with AED � reverts to shockable rhythm � 1 shock delivered � convert to non-shock-able rhythm with pulse and breathing present.Scenario role assignmentsRescuer 1 – AED rescuer Rescuer 2 – 9-1-1 callerRescuer 3 – CPR rescuer Rescuer 4 – observer/time keeper

Scenario

Robert’s soccer game is tonight. Robert’s parents and grandparents are all attending. Arriving at the field, the family finds a vantage point that will give them a great view of the game. During the first half of the game, Robert’s grand-father suddenly sits down and states, “I don’t feel very well.” He collapses almost immediately. You (Rescuer 1) are a part of the coaching staff for the soccer team and hear someone call for assistance. You look around and see Rob-ert’s mother (Rescuer 3) beginning CPR. There is a cellular phone and AED on the sidelines at the game. Begin to assess and manage the victim now.

Instructor actions and victim information: • CPR is in progress by Rescuer 3



Expected Learner Actions

Rescuer 1 – AED Rescuer • Ask Rescuer 2 – 9-1-1 caller to use the cellular phone to notify the EMS. (NOTE: Cellular phone should be at least 10 feet away from the victim). • Take the AED with you as you go to the victim.

Rescuer 3 – CPR Rescuer • Continue CPR in progress.

Rescuer 2 –9-1-1 Caller • Uses the cellular phone to notify the local EMS of the emergency. Responds to assist at the scene.

Instructor actions and victim information • Initial rhythm is VF • Rhythm remains VF for 2 shocks. Rhythm converts to non-shockable rhythm with pulse present, breathing absent. • Victim lapses back into VF rhythm. • After third shock, rhythm converts to ‘no shock advised’ non-shockable rhythm. • Victim again is breathing and has a pulse.

immediately after implementing the scenario to review actions taken will provide a richer learning experience.

1. What did we do well? 2. What could we do better? If needed, discuss with students how the time for delivery of the AED to delivery of the first shock might be made shorter. 3. What was easy to remember to do? 4. What was hard to remember to do?

RECAP:Rescuer 1 –AED Rescuer • Set up AED. Attach leads. • Clear and analyze. • Clear and shock one time. Follow with one more shock. Clear and analyze. ‘No shock advised.’Rescuer 3 – CPR Rescuer • Check pulse • Check breathingRescuer 1 – AED Rescuer • Continue to have AED monitor heart rhythm. • Clear and give third shock. • Clear and analyze. ‘No shock advised.’Rescuer 3 – CPR Rescuer • Check pulse; check breathing. • Monitor victim.

Public Access Defibrillation in a School SettingPurpose

In this scenario, the learners practice the following AED scenario: victim collapse witness in the area of swimming pool. Persistent VF will require two shocks and then the rhythm will convert to non-shockable rhythm. After VF is converted, breathing and a pulse will be present.

Critical thinking: using the device safely due to water being present in environment.

Materials required:

• AED trainer device (or training card to safely use AED for training). • Mannequin for CPR (and appropriate barrier device/ decontamination supplies). • Telephone (unconnected phone set or play phone). • Stop watch.

Rhythm sequence for AED Trainer:

Start with shockable rhythm � 2 shocks delivered � convert to non-shockable rhythm; pulse returns; breathing returns. Scenario role assignments:Rescuer 1 – AED rescuer Rescuer 2 – 9-1-1 callerRescuer 3 – CPR rescuer Rescuer 4 – observer/time keeper

Scenario:The swim team is competing today. Sue has not been feeling well during the week but is ready to compete. Sue prepares for her race with a few laps and then gets out of the pool. She suddenly sits down and appears to have a hard time breathing. As you (Rescuer 1) go to assist her, she slumps over. Rescuer 2 and Rescuer 3 are present. Begin to assess and manage the victim now. Instructor actions and victim information • Upon arriving at victim’s side, there is no breathing or pulse present. • Initial rhythm is VF. • Rhythm remains VF for two shocks. Rhythm converts to non-shockable rhythm with pulse and breathing present.

Expected learner actionsRescuer 3 – CPR Rescuer • Assess victim for pulse and breathing. • Initiate CPR.Rescuer 1 –AED Rescuer • Ask Rescuer 2- 9-1-1 Caller to notify the EMS. • Obtain AED.Rescuer 2 – 9-1-1 Caller • Appropriately notifies local EMS of the emergency.Rescuer 1- AED Rescuer • Assure victim is in dry location. • Use towel to dry victim’s chest. • Set up AED. Attach leads. • Clear and analyze.Clear and shock 1 time. Follow with 1 more shock. Clear and analyze. “No shock advised.”

Taking time immediately after implementing the scenario to review actions taken will

provide a richer learning experience.

1. What did we do right?2. What could we do better? If needed, discuss with students how the time for delivery of the AED to delivery of the first shock might be made shorter.3. What was easy to remember to do?4. What was hard to remember to do?



Taking time immediately after implementing the scenario to review

actions taken will provide a richer learning experience.

1. What did we do right?2. What could we do better? If needed, discuss with students how the time for delivery of the AED to delivery of the first shock might be made shorter.3. What was easy to remember to do?4. What was hard to remember to do?



Public Access Defibrillation in a School SettingPurpose

In this scenario, the learners practice the following AED scenario: victim collapse witnessed in the gymnasium. VF will require two shocks.

Critical thinking: before the electrodes are applied, tell the rescuer the victim is wearing a medication patch.

Materials required


Scenario role assignmentsRescuer 1 – AED rescuer Rescuer 2 – 9-1-1 callerRescuer 3 – CPR rescuer Rescuer 4 – observer/time keeper

Scenario:The school day is almost over and the custodian is fixing the gym doors while the basketball team practices. You (Rescuer 1) hear a sound as if someone has fallen. As you look over, you see the custodian lying on the floor. An AED is located in the gymnasium. Begin to assess and manage the victim now.

Instructor actions and victim information • Upon arriving at the victim’s side, there is no breathing or pulse present. • Victim has medication patch on chest. • Initial rhythm is VF. • Rhythm remains VF for two shocks. Rhythm converts to non-shockable rhythm with pulse and breathing present.’

Expected learner actionsRescuer 3 -- CPR Rescuer • Assess victim for pulse and breathing. • Initiate CPR.Rescuer 1 -- AED Rescuer • Ask Rescuer 2 – 9-1-1 Caller to notify the EMS. • Obtain AED.Rescuer 2 -- 9-1-1 Caller • Appropriately notifies local EMS of the emergency.Rescuer 1 – AED Rescuer • Remove medication patch. Use towel to dry victim’s chest. • Set up AED. Attach leads. • Clear and analyze.Clear and shock one time. Follow with one more shock. Clear and analyze. “No shock advised.”

SKILL DRILL 5 – One person rescue

PurposeIn this scenario, the learners practice the following AED scenario: victim collapse discovered on the playground. VF will require one shock.

Critical thinking: One-person rescue requires clear thinking and forethought. Remember the chain of survival.

Materials required


Scenario role assignment

Rescuer 1 – 9-1-1 caller/CPR Rescuer/AED Rescuer Observer/timekeeper

Scenario:

You are the last person to leave an after-school event. The door still is unlocked, although you have not seen the custodian in some time. As you exit the school, you see a teenager lying on the ground. An AED is located in the gymnasium. You are carrying a cellular phone. Begin to assess and manage the victim now.

Instructor actions and victim information

• Upon arriving at the victim’s side, there is no breathing or pulse present. • Victim seems to be having a seizure. • Initial rhythm is VF. • Rhythm remains VF for one shock. Rhythm converts to non-shockable rhythm with pulse and breathing present.

Expected learner actions

Rescuer 1 – CPR Rescuer • Assess victim for pulse and breathing. • Initiate CPR (one minute).

Rescuer 1 – 9-1-1 caller • Call 9-1-1 to notify the EMS. • Appropriately notifies local EMS of the emergency.

Rescuer 1 – AED Rescuer • Set up AED and pads. • Clear and analyze. • Clear and shock one time. Clear and analyze. “No shock advised.”

Taking time immediately afterimplementing the scenario to review

actions taken will provide a richer learning experience.

1. What did I do right?2. What could I do better? If needed, discuss with students how the time for delivery of the AED to delivery of the first shock might be made shorter.3. What was easy to remember to do?4. What was hard to remember to do?




346 NASN School Nurse | November 2011

Healthy Lifestyles

Automated External Defibrillator Drills

Martha Anderson, RN, Texas

Brenda Clarke, RN, MSN, NCSN, Texas

Chrissy R. Hester, Texas

Jeff Mann, MS, ATC, LAT, Texas

Keywords: automated external defibrillator; AED; AED team; skill drill

T he automated external defibrillator (AED) is commonplace in community settings such as airports,

malls, and churches. Public access defi-brillation came to the forefront in the United States in 1994 by the American Heart Association Task Force on Early Defibrillation. Placement of AEDs in locations easily accessible by trained lay-persons may improve the survival of sud-den cardiac arrest by quick identification of arrhythmia and defibrillation. In 2004, the American Academy of Pediatrics and the American Heart Association issued guidelines on medical emergency plans for schools. An emergency response plan includes placement of AEDs (Gregory, 2007). Many state legislatures have enacted laws requiring AED placement in all school facilities.

The Real Deal

September 15, 2006, was the night that started legislation that would affect all Texas public schools. A&M Consolidated High School (AMCHS) was hosting Austin Westlake High School in a varsity football game. There were 4,500 fans in attendance watching the two state-ranked top 10 teams. The

temperature was in the high 80s, and it was just before 8:00 p.m. The game was two minutes into the second quarter, and Westlake had just driven the field to tie the game 7 to 7.

A 6-foot, 6-inches, 300-pound offensive tackle for Westlake had just left the field to sit on the bench. He was discussing

the successful scoring drive with his teammates when he fell backward onto the track. His body began to go into what looked like a seizure. The football players yelled for help, and the athletic trainer for Westlake responded. He determined the player was still breathing, so he monitored him during the seizure.

DOI: 10.1177/1942602X11409418For reprints and permission queries visit SAGE’s Web site, http://www.sagepub.com/journalsPermissions.nav.

2011 The Author(s)

Figure 1. Current and Pending AED Legislation in the United States (as of September 3, 2009)

Source: Map provided by Zoll Medical Corporation (2009). Reprinted with permission.

at East Tennessee State University on January 20, 2015nas.sagepub.comDownloaded from

347November 2011 | NASN School Nurse

Figure 2. School-Based AED Program



After the seizure ended, the student did not regain consciousness.

Doctors from the sideline and from the stands (including the player’s parents, both physicians) came to his aid. As CPR was being performed by the player’s parents, the referees yelled for the athletic trainers and team doctors from AMCHS to assist. Meanwhile, the Westlake AED was retrieved from the splint bag and applied to the player’s

chest. Within a matter of seconds, the AED delivered a life-saving shock. The student’s eyes opened up, and he began to speak and ask how he did in the previous drive. He was loaded into the ambulance and taken to the hospital. Today, this athlete has an internal defibrillator, and with the exception of refraining from contact sports, he has been able to resume an active lifestyle (Robbins & Cantu, 2006).

At the time, AMCHS had two AEDs: one for athletics and one for the band. College Station Independent School District (CSISD) experienced firsthand the importance of having an AED on site, and the decision was made to purchase AEDs for all of the athletic venues at the high school and the middle schools. An AED was purchased for each of the two middle schools, and two more AEDs were purchased for the high school athletic department.

AEDs in the School Setting

CSISD was well ahead of the game with the decision to require AEDs in the school setting. By the spring of 2007, all schools in the district had at least one AED. Texas State Representative Rob Eissler sponsored Senate Bill 7, dedicating it to “all parents who have lost children because AEDs weren’t available” (Elliott, 2007, p. 1). After approval by the Texas House, every school was required to have an AED by September 1, 2007 (Elliott, 2007).

The head athletic trainer at AMCHS, was given the responsibility of developing the policy and procedure for our district—College Station Independent School District. In addition, a team of first responders (an AED team) was established on each campus. The AED teams continue to this day and are composed of coaches, teachers, administrators, resource officers, and school nurses. The rationale for establishing the AED team is to have a designated group of CPR/AED-trained individuals to respond on campus when an AED is needed during school hours. By having a varied representation of all personnel, it is CSISD’s goal that at least one of the AED team members will be present prior to or after school should an AED emergency occur.

What Now?

With policies and procedures for AED use and response put into place and campus teams of AED first responders certified by the American Heart Association in the standards for CPR/AED training, specific implementation

Figure 3. AED Drill Roles

Rescuer 1 (finds victim)

Identifies the victim in need

Calls the front office

Begins CPR

AED arrives—continues CPR

Continues CPR until AED monitors the victim

Continues CPR after first shock

Repeats with shock and CPR until emergency medical services (EMS) arrives

If shock is successful, places victim in recovery position

Rescuer 2 (AED arrival)

Opens AED

Places electrodes on victim

AED monitors victim

Shock delivered

Assists with CPR as needed

Repeats with shock and CPR until EMS arrives

If shock is successful, places victim in recovery position

Rescuer 3 (remaining AED team members)

Calls 911 if needed/directed

Assists with CPR if needed

Opens doors and gates as needed

Crowd control

Meets the ambulance

Calls the front office to confirm communication with principal and administrative staff



Figure 4. AED Skill Drill Checklist



readiness details followed. How would the AED team and campus nurse create an effective plan? First, the idea of having a practice AED drill was proposed. A task force was subsequently established with the head athletic trainer, the two middle school nurses, and the director of student services, who also serves as the nurse administrative

liaison. The goal was to develop an AED drill to help team members practice regularly and reinforce more realistic CPR and AED use. After about 6 months of planning, the drills began to take shape. The basic format for the drill was adapted from information found online (CPR/AED Pamphlet, 2008). It was decided by the task force that

both middle schools would pilot the drills and then meet to finalize the AED drill format before presenting the drill recommendations to the entire CSISD school nurse group.

Piloting the AED Drill

Piloting the AED drill involved two major components. First, the nurse at A&M Consolidated Middle School created a video utilizing student interviews that focused on students’ knowledge of an AED and informed students of the AED drill procedure and upcoming drill. The video was shown schoolwide during announcement time.

The nurse at College Station Middle School (CSMS) enlisted the help of science teachers to prepare students for the drill. The student preparation was a three-day process. Science teachers first showed a PowerPoint presentation that focused on compressions-only CPR and how an AED works. Next, students viewed a video showing CSMS AED team members performing CPR and using the AED on a manikin. Students were also shown what to expect during an AED drill. On the third day, advisory teachers presented an oral review. The actual drills followed within one week and were unannounced. Both schools held the drill during the school day when students were in the classroom.

The drill utilized three rescuer roles, and the remaining 4 to 10 team members provided support with crowd control, communication, or anything else that the rescuers needed. Each drill was videotaped, and the AED skill drill checklist was recorded by a someone not on the team.

At each school, the school nurses led a debriefing session with the team immediately after the practice drill. The ability to practice the scenario was given high marks by both AED teams. In fact, the team members were rather impressed by their knowledge and skills! It was very beneficial to have the videotape for team members to watch their performance and be able to recognize where communication was not clear or

Figure 6. Members of the A&M Consolidated Middle School AED Team During a Skill Drill

Figure 5. Members of the College Station Middle School AED Team During a Skills Drill



duplicated and how they could improve upon those skills.

Conclusion

Skill drills should be a part of any school-based AED program. There are many drills that are practiced yearly to remind students and staff how to handle fires, tornados (duck and cover), safe shelter in place, and site evacuation. Adding a yearly AED drill, with a debriefing session, helps to keep first responders and rescuers in the school setting competent and familiar with CPR and the use of the AED should these skills ever be needed in the school setting. ■

Resources

Berg, R. A., et al. (2010). Part 5: Adult basic life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122(18), S685-S705.

Markenson, D., et al. (2010). Part 17: First aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Circulation, 122(19), S934-S946.

References

CPR/AED Use Drill Pamphlet. (2008). Retrieved January 21, 2011 from http://aeddrill.com

Elliott, J. (2007). Texas House OKs bill for defibrillation at schools. Chron. Retrieved December 9, 2010, from http://www.chron .com/disp/story.mpl/special/o7/legislature/4822964.html

Gregory, A. (2007). Schools should have emergency response plans, AEDs. American Academy of Pediatric News, 28(3).

Robbins, K., & Cantu, R. (2006). High school football: Saving Matt: How many people saved a life on the sidelines. The Statesman. Retrieved March 24, 2010, from http://www.statesman.com/sports/content/sports/stories/highschool/09/22/22Nader .html

Zoll Medical Corporation. (2009). AED legislation. Retrieved February 10, 2010, from http://www.zoll.com/medical-products/automated-external-defibrillation

Martha Anderson, RNSchool NurseA&M Consolidated Middle SchoolCollege Station, TXMartha is a school nurse for 7th and 8th grades. She is also the president of the Region VI Texas School Nurse Association.

Brenda Clarke, RN, MSN, NCSNSchool NurseCollege Station Middle SchoolCollege Station, TX

Brenda is a school nurse for 7th and 8th grades. She is also the president-elect of the Region VI Texas School Nurse Association.

Chrissy R. HesterDirector of Student ServicesCollege Station Independent School DistrictCollege Station, TXChrissy is the administrative liaison for the 13 school nurses in the College Station Independent School District.

Jeff Mann, MS, ATC, LATHead Athletic TrainerA&M Consolidated High SchoolCollege Station, TXJeff is the head athletic trainer for the College Station Independent School District. Jeff also serves as the Texas State Athletic Trainers’ Association Secondary Schools Committee Chairman as well as a committee member on the Southwest Athletic Trainers’ Association Secondary Schools Athletic Training Committee.


DrillRecordSchool:_____________________________________________Date: ________________________________________TIME DRILL BEGINS:_______________________TIME DRILL ENDS: _______________________________________ 1. Time victim is discovered and front office called ____________________________________________ 2. Time “Code” called by front office staff ___________________________________________________ 3. First Rescuer responds(check all that apply) __ Time arrived __Called for help(vocal) __ Called for help (phone) __ Started CPR __ Ran for help __ Called for AED __ Other___________________ 4. Second Rescuer arrives on scene _______________________________________________________ 5. Time CPR begins ____________________________________________________________________ 6. CPR started by _____________________________________________________________________ 7. Did rescuers switch off CPR role every 2 minutes? __________________________________________ 8. Number of responders ________________________________________________________________ 9. Time AED arrives ____________________________________________________________________ 10. Time AED fully attached to victim _______________________________________________________ 11. Time of first shock __________________________________________________________________ 12. Staff member communicates identity of victim to front office __________________________________ 13. Front office notifies parent/guardian if necessary __________________________________________ 14. Staff member awaits EMS arrival _______________________________________________________ 15. Staff members perform crowd control ___________________________________________________

What did rescuers do correctly?

What could have been done better?

What was easy to remember?

What was hard to remember?

What will you do differently next time?

Team Members: ___________________________________________________________________________________ _____________________________________________________________________________________


TennesseeCodeAnnotatedTENNESSEE AED LAW Tennessee Code Annotated

68-140-401. Legislative intent. lt is the intent of the general assembly that an automated external defibrillator (AEO) may be used in accordance with the provisions of § 68-140-401 for the purpose of saving the life of another person in cardiac arrest. 68-140-402. Partdefinitions. As used in this part, unless the context otherwise requires: (1) “AED” or “defibrillator” means an automated external defibrillator: and (2) “Automated external defibrillator (AED)” means a medical device heart monitor and defibrillator that: (A) Has received approval of its premarket notification, filed pursuant to 2, U.S.C. §360(R), from the United States Food and Drug Administration; (B) ls capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia, and is capable of determining, without intervention by an operator, whether defibrillation should be performed; and (C) Upon determining that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to an individual’s heart. 68-140-403. Use of AED devices-Training-Maintenance- Registration encouraged. ln order to ensure public health and safety:

(1) A person or entity who acquires an automated external defibrillator (AED) shall ensure that: (A) Expected defibrillator users receive American Heart Association CPR and AED or an equivalent nationally recognized course in defibrillator use and cardiopulmonary resuscitation, (B) The defibrillator is maintained and tested according to the manufacturer’s operational guidelines; and (C) Any person who renders emergency care or treatment on a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible. (2) Any person or entity who acquires an AED shall, within reasonable time after the placement of an AED, register the existence and location of the defibrillator with the emergency communications district or the ambulance dispatch center of the primary provider of the emergency medica¡ services where the AED is to be located. 68-140-404. Program for use of AEDs. ln order for an entity to use or allow the use of an automated external defibrillator, the entity shall: (1) Establish a program for the use of an AED that includes a written plan that complies with subdivisions (2)-(6) and the rules adopted by the department of health. The plan must specify: (A) Where the AED will be placed; (B) The individual who are authorized to operate the AED:


(C) How the AED will be coordinated with an emergency medical service providing services in the area where the AED is located; (D) The maintenance and testing that will be performed on the AED; (E) Records that will be kept by the program; (F) Reports that will be made of AED use; (G) Other matters as specified by the department; and (H) A plan of action for proper usage of the AED; (2) Adhere to the written plan required by subdivision (l ); (3) Ensure that before using the AED, expected users receive appropriate training approved by the department in cardiopulmonary resuscitation and the proper use of an AED; (4) Maintain, test, and operate the AED according to the manufacturer’s guidelines and maintain written records of all maintenance and testing performed on the AED; (5) Each time an AED is used for an individual in cardiac arrest, require that an emergency medical service is summoned to provide assistance as soon as possible and that the AED use is reported to the supervising physician or the person designated by the physician and to the department as required by the written plan; and (6) Before allowing any use of an AED, provide to the emergency communications district or the primary provider of emergency medical services where the defibrillator is located: (A) A copy of the plan prepared pursuant to this section: and (B) Written notice, in a format prescribed by department rules, stating: (I) That an AED program is established by the entity; (II) Where the AED is located; and (III) How the use of the AED is to be coordinated with the local emergency medical service system. 68-140-405. Rules relating to AEDs - Adoption - Scope and contents. The department of health shall adopt rules specifying the following: (1) The contents of the written notice required by § 68-140-704; (2) Reporting requirements for each use of an AED;

(3) The contents of a plan prepared in accordance with § 68-140-704 and requirements applicable to the subject matter of the plan; (4) Training requirements in cardiopulmonary resuscitation and AED use that are consistent with the scientific guidelines of the American Heart Association for any individual authorized by an AED program plan to use an AED: (5) Requirements for medical supervision of an AED program, (6) Performance requirements for an AED in order for the AED to be used in an AED program; and (7) A list of the AED training programs approved by the department.

68-140-406. Limitation on liability of entity responsible program. The entity responsible for the AED program shall not be liable for any civil liability for any personal injury that results from an act or omission that does not amount to willful or wanton misconduct or gross negligence if the applicable provisions and program established under § 68-140-704 and the rules adopted by the department pursuant to $ 68- T 40-705 have been met by the entity and have been followed by the individuals using the AED 68-140-407. Limitation on liability of trainers. An individual providing training to others in an approved program on the use of an AED shall be held harmless by the employer of the trainer for damages caused by training that was negligent.

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68-140-408. Training and demonstration competence use of in CPR and of AED.

For purposes of § § 68-140-704-68-140-710, expected AED users shall complete training and demonstrate competence in CPR and the use of an AED through a course of instruction approved by the Tennessee emergency medical services board. 68-140-409. Applicability of § § 68-140-401, 68-140-404- 68-140-409. The provisions of § § 68-140-704 - 68-,140-710, shall only apply to situations involving emergency use of an AED and in no case shall it apply where there is a duty to provide care. Nor shall it apply where a doctor has prescribed use of an AED for a patient’s use in the patient’s private home. 68-140-410. [Transferred]

HB0032 000436TCA 49-2-122.HOUSE BILL 32 by ToddAN ACT to amend Tennessee Code Annotated, Title 68, relative to sudden cardiac arrest prevention.BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:SECTION 1. Tennessee Code Annotated, Title 68, is amended by adding the following language as a new chapter 54:

68-54-101. This act shall be known and may be cited as the “Sudden Cardiac Arrest Prevention Act.”

68-54-102.As used in this chapter, unless the context otherwise requires: (1) “Community-based youth athletic activity” or “youth athletic activity” means an athletic activity organized by a city, county, business, or nonprofit organization when the majority of the participants are under eighteen (18) years of age, and are engaging in an organized athletic game or competition against another team, club, or entity or in practice or preparation for an organized game or competition against another team, club, or entity. “Community-based youth athletic activity” does not include college or university activities or an activity which is entered into for instructional purposes only, an athletic activity that is incidental to a nonathletic program, or a lesson; (2) “Department” means the department of health; (3) “Health care provider” means a Tennessee licensed medical doctor (M.D.) or an osteopathic physician (D.O.); (4) “Person” means any individual or governmental entity, corporation, association, organization, nonprofit institution, or other entity or such entities’ representatives; and (5) “School youth athletic activity” means a school or a local education agency organized athletic activity when the majority of the participants are under eighteen (18) years of age, and are engaging in an organized athletic game or competition against another team, club, or entity or in practice or preparation for an organized game or competition against another team, club, or entity. “School youth athletic activity” does not include college or university activities, an activity which is entered into for instructional purposes only, or an athletic activity that is incidental to a nonathletic program, or a lesson.

68-54-103. (a) This section applies to school youth athletic activity. (b) (1) The governing authority of each public and non-public elementary school, middle school, junior high school, and high school, working through guidance approved by the department of health and communicated through the department of education, shall at a minimum: (A) Adopt guidelines and other pertinent information and forms as approved by the department of health to inform and educate coaches, school administrators, youth athletes, and their parents or guardians of the nature, risk, and symptoms of sudden cardiac arrest, including the risks associated with continuing to play or practice after experiencing any of the following symptoms: (i) Fainting or seizures during exercise; (ii) Unexplained shortness of breath; (iii) Chest pains; (iv) Racing heart rate; or

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(v) Extreme fatigue; (B) Require annual completion by all coaches, whether the coach is employed or a volunteer, and by school athletic directors of a sudden cardiac arrest education program approved by the department. In developing the program, the department may use, at no cost to the state, materials and resources created by organizations, such as Simon’s Fund, for the purpose of educating coaches about sudden cardiac arrest. The department shall make the sudden cardiac arrest education course program available on its web site for any school to access free of charge; (C) Require that, on a yearly basis, a sudden cardiac arrest information sheet be signed and returned by each coach and athletic director and, if appointed, a licensed health care professional, to the lead administrator of a non-public school or, for a public school, the local education agency’s director of schools prior to initiating practice or competition for the year; (D) Require that, on a yearly basis, a sudden cardiac arrest information sheet be reviewed by each youth athlete and the athlete’s parent or guardian. The information sheet shall be signed and returned by the youth athlete, if the youth athlete is eighteen (18) years of age or older, otherwise by the athlete’s parent or guardian, prior to the youth athlete’s initiating practice or competition, to confirm that both the parent or guardian and the youth athlete have reviewed the information and understand its contents; (E) Maintain all documentation of the completion of a sudden cardiac arrest education course program and signed sudden cardiac arrest information sheets for a period of three (3) years; (F) Establish as policy the immediate removal of any youth athlete who passes out or faints while participating in an athletic activity, or who exhibits any of the following symptoms: (i) Unexplained shortness of breath; (ii) Chest pains; (iii) Racing heart rate; or (iv) Extreme fatigue; and (G) Establish as policy that a youth athlete who has been removed from play shall not return to the practice or competition during which the youth athlete experienced symptoms consistent with sudden cardiac arrest and not return to play or participate in any supervised team activities involving physical exertion, including games, competitions, or practices, until the youth athlete is evaluated by a health care provider and receives written clearance from the health care provider for a full or graduated return to play. (2) After a youth athlete who has experienced symptoms consistent with sudden cardiac arrest has been evaluated and received clearance for a graduated return to play from a health care provider, then a school may allow a licensed health care professional, if available, with specific knowledge of the youth athlete’s condition to manage the youth athlete’s graduated return to play based upon the health care provider’s recommendations. The licensed health care professional, if not the youth athlete’s health care provider, shall provide updates to the health care provider on the progress of the youth athlete, if requested. (3) No licensed health care professional or other person acting in good faith within the authority prescribed under this act shall be liable on account of any act or omission in good faith while so engaged; provided, that “good faith,” as used in this act, shall not include willful misconduct, gross negligence, or reckless disregard. (c) The local education agency, in consultation with the head of the school youth athletic activity, may establish the following minimum penalties for a coach found in violation of ignoring a youth athlete’s sudden cardiac arrest symptoms or allowing the youth to return to the practice or competition during which the youth athlete experienced the symptoms without written clearance from the health care provider for a full or graduated return to play: (1) For a first violation, suspension from coaching any school youth athletic activity for the remainder of the season; (2) For a second violation, suspension from coaching any school youth athletic activity for the remainder of the season and the next season; and (3) For a third violation, permanent suspension from coaching any school youth athletic activity.

68-54-104. (a) This section applies to community-based youth athletic activity. (b) (1) Any city, county, business, or nonprofit organization that organizes a community-based youth athletic activity for which an activity fee is charged, working through guidance from the department of health, shall at a minimum: (A) Adopt guidelines and other pertinent information and forms as developed by the department of health to inform and educate the director of the youth athletic activity, coaches, youth athletes, and their parents or guardians of the nature, risk, and symptoms of sudden cardiac arrest, including the risks associated with continuing to play or practice after experiencing any of the following symptoms:

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(i) Fainting or seizures during exercise; (ii) Unexplained shortness of breath; (iii) Chest pains; (iv) Racing heart rate; or (v) Extreme fatigue; (B) Require annual completion by all coaches, whether the coach is employed or a volunteer, and, if appointed, the licensed health care professional of a sudden cardiac arrest education program approved by the department. In developing the program, the department may use, at no cost to the state, materials and resources created by organizations, such as Simon’s Fund, for the purpose of educating coaches about sudden cardiac arrest. The department shall make the sudden cardiac arrest education course program available on its web site for any youth athletic activity operated by a city, county, business, or nonprofit organization to access free of charge; (C) Require that, on a yearly basis, a sudden cardiac arrest information sheet be signed and returned by each coach to the head of the youth athletic activity prior to initiating practice or competition for the year; (D) Require that, on a yearly basis, a sudden cardiac arrest information sheet be reviewed by each youth athlete and the athlete’s parent or guardian. The information sheet shall be signed and returned by the youth athlete, if the youth athlete is eighteen (18) years of age or older, otherwise by the athlete’s parent or guardian, prior to the youth athlete’s initiating practice or competition, to confirm that both the parent or guardian and the youth athlete have reviewed the information and understand its contents; (E) Maintain all documentation of the completion of a sudden cardiac arrest education course program and signed sudden cardiac arrest information sheets for a period of three (3) years; (F) Establish as policy the immediate removal of any youth athlete who passes out or faints while participating in an athletic activity, or who exhibits any of the following symptoms: (i) Unexplained shortness of breath; (ii) Chest pains; (iii) Racing heart rate; or (iv) Extreme fatigue; and (G) Establish as policy that a youth athlete who has been removed from play shall not return to the practice or competition during which the youth athlete experienced symptoms consistent with sudden cardiac arrest and not return to play or participate in any supervised team activities involving physical exertion, including games, competitions, or practices, until the youth athlete is evaluated by a health care provider and receives written clearance from the health care provider for a full or graduated return to play. (2) After a youth athlete who has experienced symptoms consistent with sudden cardiac arrest has been evaluated and received clearance for a graduated return to play from a health care provider, then the organizer of the community-based youth athletic activity may allow a licensed health care professional, if available, with specific knowledge of the youth athlete’s condition to manage the youth athlete’s graduated return to play based upon the health care provider’s recommendations. The licensed health care professional, if not the youth athlete’s health care provider, shall provide updates to the health care provider on the progress of the youth athlete, if requested. (3) No coach, head of any athletic activity, licensed health care professional, or other person acting in good faith within the authority prescribed under this act shall be liable on account of any act or omission in good faith while so engaged; provided, that “good faith,” as used in this act, shall not include willful misconduct, gross negligence, or reckless disregard. (c) The head of the community-based youth athletic activity may establish the following minimum penalties for a coach found in violation of ignoring a youth athlete’s sudden cardiac arrest symptoms or allowing the youth to return to the practice or competition during which the youth athlete experienced the symptoms without written clearance from the health care provider for a full or graduated return to play: (1) For a first violation, suspension from coaching any community-based youth athletic activity for the remainder of the season; (2) For a second violation, suspension from coaching any community-based youth athletic activity for the remainder of the season and the next season; and (3) For a third violation, permanent suspension from coaching any community-based youth athletic activity.SECTION 2. This act shall take effect July 1, 2015, the public welfare requiring it.

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TENNESSEE GOOD SAMARITAN LAW Tennessee Code Annotated 63-6-2l8. (a) This section shall be known and cited as the “Good Samaritan law.” (b) Any person, including those licensed to practice medicine and surgery and including any person licensed or certified to render service ancillary there to, or any member of a volunteer first aid, rescue or emergency squad that provides emergency public first aid and rescue services, who in good faith: (1) Renders emergency care at the scene of an accident, medical emergency and/or disaster, while en route from such scene to a medical facility and while assisting medical personnel at the receiving medical facility, including use of an automated external defibrillator, to the victim or victims thereof without making any direct charge for the emergency care; or (2) Participates or assists in rendering emergency care, including use of an automated external defibrillator, to persons attending or participating in performances, exhibitions, banquets, sporting events, religious or other gatherings open to the general public, with or without an admission charge, whether or not such emergency care is made available as a service, planned in advance by the promoter of the event and/or any other person or association, shall not be liable to such victims or persons receiving emergency care for any civil damages as a result of any act or omission by such person in rendering the emergency care, or as a result of any act or failure to act to provide or arrange for further medical treatment or care for the injured person, except such damages as may result from the gross negligence of the person rendering such emergency care.

(c) A receiving medical facility shall not be liable for any civil damages as a result of any act or omission on the part of any member of a volunteer first aid, rescue or emergency squad that provides emergency public first aid and rescue services while such person is assisting medical personnel at the receiving medical facility. (d) lf: (1) A volunteer fire squad is organized by a private company for the protection of the plant and grounds of such company, (2) Such squad is willing to respond and does respond to calls to provide fire protection for residents living within a six (6) mile radius of the county surrounding such plant: and (3) The plant is located in a county that does not otherwise provide fire protection to such residents: then the members of such volunteer fire squad, while providing fire protection within such area outside the plant, shall be liable to suit under the provisions of the Governmental Tort Liability Act, complied in title 29, chapter 20, part 2.

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Tenn. Code Ann. § 49-2-122 (Copy w/ Cite)Tenn. Code Ann. § 49-2-122

TENNESSEE CODE ANNOTATED© 2015 by The State of Tennessee

All rights reserved

*** Current through the 2014 Regular Session and amendments approved at the November 4, 2014 General Election ***

Title 49 Education Chapter 2 Local Administration Part 1 General Provisions

Tenn. Code Ann. § 49-2-122 (2014)

49-2-122. Placement of automated external defibrillator (AED) devices in schools.

(a) LEAs are encouraged, within existing budgetary limits, to place automated external defibrillator (AED) devices in schools.

(b) Any school that receives an AED shall comply with all provisions of title 68, chapter 140, part 4 relative to training, __ establishment of a written plan that complies with § 68-140-404, notification and other requirements. Any LEA that __ places AEDs in schools shall comply with § 68-140-404 as to the maintenance and testing of the AEDs to ensure that the devices are in optimal operating condition.

(c) Each placement of an AED shall be supervised and endorsed by a physician with an unrestricted license to practice medicine or osteopathy in this state. When a school receives its first AED, it shall place the AED in a location that may be accessed readily from any area of the school, which may include those areas of the school that are used for physical education or activity. Subsequently, additional AEDs shall be placed in locations that are accessible during emergency situations. AEDs shall not be placed in an office that is not accessible to any person who might need to use the AED or in any location that is locked during times that students, parents or school employees are present at school or school events.

(d) AEDs placed in schools shall be registered with local emergency medical services providers as required by §§ 68-140-403(2) and 68-140-404(6).

(e) LEAs and schools responsible for an AED program pursuant to § 68-140-404(1) shall not be liable for any civil liability for any personal injury that results from an act or omission that does not amount to willful or wanton misconduct or gross negligence if the applicable provisions and program established under § 68-140-404 and the rules adopted by the department pursuant to § 68-140-405 have been met by the LEA and school and have been followed by the individuals using the AED.

(f) A teacher, school employee or other person employed by the LEA responsible for an AED program pursuant to § 68-140-404(1) shall not be liable for any civil liability for any personal injury that results from an act or omission that does not amount to willful or wanton misconduct or gross negligence if the applicable provisions and program established under § 68-140-404 and the rules adopted by the department pursuant to § 68-140-405 have been met by the LEA and school and have been followed by the individuals using the AED.

(g) Misuse or abuse of any AED device on school property by a student is disorderly conduct and the student shall be subject to disciplinary action.

HISTORY: Acts 2008, ch. 795, §§ 2, 4; 2010, ch. 819, § 2; 2011, ch. 179, § 1.

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SENATE BILL 2088By Overbey

HOUSE BILL 2974By Ramsey

AN ACT to amend Tennessee Code Annotated, Title 49, relative to emergency life saving measures in schools.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE

SECTION 1 Tennessee Code Annotated, Section 49-1-122(b), is amended by designating the existing language as subdivision (1) and by adding the following language as subdivision (2):

(2) (A) A public school having one (1) or more AEDs shall schedule annual AED training for all school personnel. Staff meetings or in-service days allocated under § 49-5-414 for training programs in emergency first aid and cardiopulmonary resuscitation (CPR) may be used, in whole or in part for the purposes of this subdivision (b)(2). (B) The annual AED training shall: (i) Teach the use of AEDs; (ii) Inform school personnel of the locations of AEDs; (iii) Inform school personnel of the school’s response plan; and (iv) Inform school personnel of the members of the school response team. (C) A school having one (1) or more AEDs shall also conduct an annual cardiopulmonary resuscitation (CPR) and AED drill for school personnel to practice the use of these life saving measures and to evaluate the school’s preparedness in the event of a sudden cardiac arrest. (D) In planning the annual training in the use of AEDs and the annual CPR/AED drills, LEAs and schools may contact other schools with training programs in existence and Project ADAM Tennessee for recommendations as to the development of appropriate programs or for guidance in using existing programs. The training shall be aligned with Project ADAM guidelines for Heart Safe Schools, and the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

SECTION 2 Tennessee Code Annotated, Section 49-61-208, is amended by adding the following language as a new subsection:

The program of instruction on CPR shall include instruction on the use of an automatic external defibrillator (AED) and location of any AED in the school, if the school has an AED or AEDs. If the school has an AED, the school shall conduct a CPR and AED drill so that the students are aware of the steps that must be taken if an event should occur that requires the use of an AED

SECTION 3 This act shall take effect July 1, 2016, the public welfare requiring it.

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Consider the following scenarios:

1. A student collapses on the gym floor during basketball practice. The coach asks a student to run to the nurse’s office to retrieve the AED. The student rushes to the office, only to discover the door is locked and the nurse is nowhere to be found. Struggling to find someone to help, the student runs back to the gym after five minutes without the AED. 911 has been called, CPR had been started…but it has been 6 minutes since the student collapsed and the EMS has not arrived…

2. Three students, while horsing around, remove an AED from its case in the gym. They are caught just as they begin to play around with plugging the pads into the unit. The teacher places the unit back in its case and escorts the students to the office for disciplinary action. The AED is not checked for damage after the incident.

Frequently asked questions about public access defibrillation (PAD) programs often pertain to the above scenarios. Where should the defibrillator be placed? Can it be locked? What if a student vandalizes an AED or its cabinet?

Here are some important things to consider:

1. An AED is not useful unless access is easy. Keeping an AED in a locked office or cabinet does little during a crisis. Schools serve as a community resource as well – there may be many after-hours events in which an AED is called to the scene. If you have implemented a public access defibrillation program at your school, the AED should be mounted on a wall within 1-2 minutes of any given area. If the school is large enough, 2-3 AEDs are needed to ensure access within 1-2 minutes. Signs clearly pointing in the direction of the AED should be posted throughout the school.

2. Many AED wall cabinets are equipped with an alarm. Rather than running the risk of the key being unavailable in an emergency, an alarmed device (such as the one that sounds when the fire alarm is pulled) is the best indicator that the case has been opened. Some automatically generate a 911 call.

3. If your AED has been tampered with in any manner, it must be thoroughly checked for damages and effectiveness. Any time the AED is used, the case is vandalized, or the unit is tampered with, the AED program coordinator must conduct a thorough check (see your AED unit manual for the proper procedure) to ensure the unit is still working properly. A call to the AED distributor is also an excellent way to ensure its effectiveness after any incident.

AEDplacementandvandalism


AED

Ov

erv

iew

Device

Dust/Water Resistance

Size / W

eight

Battery Life

Pads Life

CPR Supp

ort

Energy Delivery

Warranty

Shock Delivery

Self Test

IP 21

* more suscep

tible to

2.8 x 7.4 x 8.3

4 years

2 years (A)

CPR Prom

pts

150‐15

0‐15

08 years

semi‐a

utom

atic

yes

damage from

dust a

nd

3.3lbs

2 years (P)

Info button will

fixed

(button to push)

Daily/W

eekly

water. (id

eal in controlled

walk rescue

r throu

ghMon

thly

environm

ents)

CPR

3 compo

nents

Philips ‐ Onsite

Visual/Aud

ible Alerts

IP 24

3.3 x 10

.6 x 12.4

4 years

2 years (A)

CPR Prom

pts

200‐30

0‐351

7 years

semi‐a

utom

atic

Yes

6.6lbs

*date of installatio

n2 years (P)

Ope

n Lid, AED

will walk rescue

rvaria

ble

full automatic

Daily/W

eekly

4 year ope

ratio

nal w

arranty

through CP

R process a

nd

Mon

thly

operation of AED

3 compo

nents

Visual/Aud

ible Alerts

Cardiac Science

IP X4

4.2 x 8 x 9.5

2 years

2 years (A)

NONE

200‐30

0‐360

8 years

semi‐a

utom

atic

Yes

4.5 lbs.

*com

bine

d with

pads

2 years (P)

Instructs rescuer to

begin

varia

ble

full automatic

If pads used/ne

ed

CPR

*internal non

replaceable

Batteries /

Circuitry

battery (app

rox. 2 yrs.)

Visual Alerts o

nly

Physio CR +

IP 55

5.25

x .5

x 11.5

5 years

5 Years (A)

CPR He

lp with

Adu

lt CP

R‐D pads

120 ‐150

‐ 20

0 5 years (7)

semi‐a

utom

atic

Weekly / Mon

thly

6.7 lbs.

*10 Lithium 123

batterie

s2 years (P)

additio

nal 2

full automatic

if registered

with

Zoll

Batteries /

Circuitry

Visual/Aud

ible Alerts

Zoll AE

D Plus

IP 54

8.5 x 11

.8 x 2.7

5 yr. or 7

yr. op

tion

2 yrs. (A

)Non

e15

0 ‐150

‐ 150

5 years

semi‐a

utom

atic

Daily/W

eekly

4.2 lbs.

*has a 9 volt b

attery fo

r self

2 yrs. (P

)fixed

full automatic

Mon

thly

check (ann

ual)

*9V pe

rforms self test

Visual alerts

Defib

tech Life

line

IP 55

2.4 x 7.1 x 8.9

4 years

2 yrs. (A

)CP

R prom

pts

150‐15

0‐150

8 years

semi‐autom

atic

3.5 lbs.

Pediatric

Info button will

fixed

Daily/W

eekly

key

walk rescue

r throu

ghMon

thly

CPR

3 compo

nents

Visual/Aud

ible Alerts

Philips FRx

Impo

rtan

t Criteria:

1Ease of U

se2Self‐Testing

3Who

are re

spon

ders/ whe

re will AED

be located

Apprendix4

Project ADAM® AED Readiness Inventory

*If your school has more than one device, list location or other means of identifying specific device inventoried.

Directions:

Determine intervals at which AED is checked (bi-weekly, monthly, bi-monthly, etc). Insert date. Initial each check performed and any corrective action to ensure readiness.

Record initials and signature below. Example:

Device location: Date: 9/1/05 Time: 1300

R= Routine P= Post-use

R

AED stored in proper location John Doe (JD)

Storage unit intact JD AED exterior intact JD User’s guide present JD Three sets electrodes (pads): (2) Adult and (1) Pediatric

JD

Battery installed and functional JD Spare battery available (if recommended)

JD

Data card installed JD Spare data card on-hand JD Mouth barrier device JD Razor JD Towel JD Scissors (clothing removal) JD Non-latex gloves JD Other: Other:

Corrective action required/completed:

Date Details Signature


ProjectADAMTennesseeAEDReadinessInventory

*If your school has more than one device, list location or other means of identifying specific device inventoried.

Directions: Determine intervals at which AED is checked (bi-weekly, monthly, bi-monthly, etc). Insert date. Initial each check performed and any corrective action to ensure readiness. Record initials and signature below.

ProjectADAMTennesseeEventSummaryFormThis form is to be completed for EVERY event in which an AED was retrieved.

Date of event:_______________________________________________ Time: ____________________________

Location of event: _____________________________________________________________________________

Age of victim (if known): ______________________________________ Sex: o M o F

Was the event witnessed? o Yes o No

If yes, by whom? ______________________________________________________________________________

Time of victim assessment: _____________________________________________________________________

Assessment of victim: Responsive: o Yes o No

Airway opened: o Yes o No

Breathing: o Yes o No

Signs of circulation: o Yes o No

Was CPR started? o Yes o No

Time CPR was started: ___________________

Time 911 was called: ___________________

Was AED used: o Yes o No

If no, why not? _______________________________________________________________________

If yes, number of shocks given? __________________________________________________________

Time of EMS arrival to victim: ____________________________________________________________________

Ambulance service responding to event: ___________________________________________________________

Hospital to which patient was transported: __________________________________________________________

Did the patient survive? o Yes o No

Indicate any problems encountered: ______________________________________________________________

Please attach a short description including any other important details of what occurred.

School PAD coordinator: ________________________________________________________________________

Medical Director for school PAD program: __________________________________________________________

Signature of person completing this form: _________________________________________________________

ProjectADAMoffersdebriefingafterasuddencardiacarrestevent.If interested call: 865-541-8137

Please fax to 865-541-8137Attn: Project ADAM Tennessee Administrator

Organizational LinksCPR/AED Training Courses: American Heart Association www.americanheart.org American Red Cross www.redcross.org American Safety & Health Institute (ASHI) www.ashinstitute.org EMP America www.medicfirstaid.com National Safety Council www.nsc.org

AED Manufacturers: Cardiac Science www.cardiacscience.com Debiftech www.defibtech.com Medtronic Physio-Control www.medtronicphysiocontrol.com Philips Medical Systems/Heartstream www.philips.com Welch Allyn www.welchallyn.com Zoll Medical Corporation www.zoll.com

For more information on SCA, AEDs: East Tennessee Children’s Hospital: etch.com

• The National Center for Early Defibrillation: www.early-defib.org • The US Department of Education: www.ed.gov • Citizen CPR, a grassroots advocacy group: www.citizencpr.org • Heart Rhythm Society: www.hrsonline.org • National Association of School Nurses: www.nasn.org • Center for Disease Control: www.cdc.gov • Basic Emergency Lifesaving Skills in Schools (BELSS): www.uwlax.edu/BELSS


AutomatedExternalDefibrillator(AED)DecisionGuideWorksheetTo determine the specific AED to purchase for your school PAD program, answer the following questions and summarize information gathered from specific devices (information from completed AED purchasing data worksheets).

1. Does your local EMS have a recommendation for the type of AED to purchase? ___Yes ___No If yes, list: _______________________________________________________

2. Does the medical director for the program have a recommendation for the type of AED to purchase? ___Yes ___No If yes, list: _______________________________________________________

Summary of basic information about AED devices:

BRAND Sales Rep. Model/Price Features Name: Model: Weight: Battery type: Price: Battery life: Phone: Service/resources: Self-check feature Y N How?: E-mail: Notes: Service alert capability: Y N How?

Name: Model: Weight: Battery type: Price: Battery life: Phone: Service/resources: Self-check feature Y N How?: E-mail: Notes: Service alert capability: Y N How?

Name: Model: Weight: Battery type: Price: Battery life: Phone: Service/resources: Self-check feature Y N How?: E-mail: Notes: Service alert capability: Y N How?


PeriodicMaintenanceChecklist**Done by AED Site Champion or trained designee

Defibrillator Location: ________________________________________________________________Defibrillator Model#: __________________________________ Serial #: _______________________

Daily: Status Indicator; Flashing black hourglass or blinking green Ready light. Self-test passedWeekly: Condition; No dirt/damage/contamination Supplies; 2 sets adult pads and one set pediatric pads, sealed, undamaged, unexpired Ancillary supplies (hand towel, scissors, gloves, pocket mask) Spare battery; within “Install Before” date __________________________

Month/Week Monday Tuesday Wednesday Thursday Friday (Weekly)

Signature/Initial Signature/Initial


CPR / AED Training Log School: ________________________________________________________________________________

Trainee Training Recognition Renewal Copy of card Date of additional name organization date date onfile? skillreview Example: Example: Example: Example: Example: Judy Smith AHA, Red 09/01/2005 09/01/2007 o Yes 10/30/05 (Custodian) Cross, etc. o No Skill Drill completed

o Yes o No

o Yes o No

o Yes o No

o Yes o No

o Yes o No

o Yes o No


Project ADAM Tennessee Information Packet

Healthcare

Transcript of Project ADAM Tennessee Information Packet