ZOLL Fully Automatic AED Plus External Defibrillator · Chain of Survival - The Chain of Survival...

ZOLL Fully Automatic AED Plus

External Defibrillator

Catholic Schools Office - Diocese of Broken Bay

Operational Procedure and Guideline

Published by:

Catholic Schools Office – Diocese of Broken Bay

Caroline Chisholm Centre

Building 2, 423 Pennant Hills Rd

Pennant Hills NSW 2120

Telephone: 9847 0606

Document Control:

Date of Issue - 16 March 2015

Date of Review – January 2017

Acknowledgements:

The Diocesan Schools System (Catholic Schools Office Diocese of Broken Bay) acknowledges ZOLL Medical Corporation, the ZOLL AED Plus Administrator’s Guide, (REF 9650-0301-01 Rev V)

September, 2012, sections of which have been adapted in the development of this guideline.

ZOLL Medical Australia – Lisa Richardson, Senior National Manager – Public Resuscitation

Response for Life – Julia Zuza

Australian Resuscitation Council

Produced by:

Employee Wellbeing and Safety, Catholic Schools Office Diocese of Broken Bay – WHS Officer: Fiona Bell.

Copyright Diocesan Schools System (Catholic Schools Office (CSO) Diocese of Broken Bay) 2015. All rights reserved. The information contained in this Operational Procedure and Guideline is provided for the use of CSO staff in the performance of their duties. Apart from any use as permitted under the Copyright Act 1968 and Copyright Amendment Act 2006, no part of this Operational Procedure and Guideline may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Catholic Schools Office Diocese of Broken Bay.

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TABLE OF CONTENTS

INTRODUCTION AND SCOPE ................................................................................. 5

1. BACKGROUND ............................................................................................... 6

2. DEFINITIONS .................................................................................................. 7

3. PROCEDURE ................................................................................................ 10

EQUIPMENT INFORMATION ......................................................................................................... 11

FIGURE 2: THE ZOLL FULLY AUTOMATIC AED PLUS MAIN FEATURES .................................................. 11

TABLE 1: THE ZOLL AED PLUS FULLY AUTOMATIC DEFIBRILLATOR - MAIN FEATURES AND FUNCTIONS ..... 12

ZOLL FULLY AUTOMATIC AED PLUS - UNIT CONTENTS .................................................................... 13

FIGURE 3. RESCUE PACK AND CPR- D ADULT PADZ ELECTRODE PACK .................................................. 13

4. USING THE AED ............................................................................................ 14

4.1 HOW THE AED COMMUNICATES WITH YOU .............................................................................. 14

4.2 USE OF THE AUTOMATIC EXTERNAL DEFIBRILLATOR (AED) .......................................................... 15

4.3 STEPS TO FOLLOW IF AED IS REQUIRED .................................................................................... 15

4.4 PROMPTS ........................................................................................................................... 16

TABLE 2 AED VOICE AND LCD PROMPTS ........................................................................................ 17

4.5 PREPARING THE PATIENT ....................................................................................................... 18

The patient ................................................................................................................ 18

Eight year old children ............................................................................................... 18

Electrodes .................................................................................................................. 18

Applying CPR-D padz™ .............................................................................................. 19

FIGURE 4. ELECTRODES SHOWING CROSS-HAIRS ............................................................................... 19

FIGURE 5. FITTING ELECTRODES .................................................................................................... 20

FIGURE 6. ADJUST THE ELECTRODES FOR A LARGE PATIENT ................................................................. 20

Using the AED cover .................................................................................................. 20

FIGURE 7 USING THE AED COVER TO MAINTAIN THE AIRWAY ............................................................. 20

4.6 OPERATION ........................................................................................................................ 21

Starting without electrodes attached to the patient ................................................ 21

Starting with electrodes attached to the victim ........................................................ 21

BASIC LIFE SUPPORT ......................................................................................... 24

TABLE 3. CPR PROMPTS ............................................................................................................. 25

5. TRAINING .................................................................................................... 25

6. AFTER AN EVENT .......................................................................................... 26

7. WARNINGS AND PRECAUTIONS ....................................................................... 27

8. PURCHASE .................................................................................................. 27

9. INSTALLATION AND STORAGE OF AED UNITS...................................................... 27

10. SET UP AND MAINTENANCE OF THE AED UNIT .................................................. 28

10.1 SETTING UP THE AED ......................................................................................................... 28

10.2 MONTHLY CHECK ............................................................................................................... 28

TABLE 4. MONTHLY CHECK – CHECKLIST ........................................................................................ 29

11. SERVICING OF THE AED ................................................................................ 30

12. STORAGE ................................................................................................... 30

13. COUNSELLING ............................................................................................ 31

FREQUENTLY ASKED QUESTIONS (FAQ’S) ABOUT THE ZOLL FULLY AUTOMATIC AED PLUS®.

.................................................................................................................... 32

What is an AED? ............................................................................................................ 32

What is Sudden Cardiac Arrest (SCA)? .......................................................................... 32

Is SCA the same as a heart attack? ............................................................................... 32

Who is at risk of SCA? ................................................................................................... 32

What is VF? ................................................................................................................... 32

How is VF treated? ........................................................................................................ 32

If defibrillation is so important, why should I do CPR? ................................................. 33

Will I hurt the victim by using an AED? ......................................................................... 33

Can I accidentally shock another rescuer or myself? ................................................... 33

Should I use the AED if the victim has a pacemaker or is pregnant? ........................... 33

What is the shelf life of CPR D-Padz electrode? ........................................................... 33

How does the CPR D-Padz electrode measure the depth of compressions? ............... 33

After performing a manual self-test on the AED Plus, if it says "unit failed," what is the

NEXT thing that should be done? ................................................................................. 33

Do I have to wait for the entire picture LEDs to sequence before I can defibrillate? .. 33

Can I defibrillate on a Wet surface? ............................................................................. 34

Can I defibrillate on or near a metal surface? .............................................................. 34

Do I have to have an AED in my workplace? Is it law that you have to have an AED at

work? Why should I have an AED in my workplace? .................................................... 34

Can an AED be used when it is wet or raining? ............................................................ 34

What if I use an AED and make things worse by shocking someone that does not need

shocking? ...................................................................................................................... 34

Are AEDs dangerous unless used by a medical professional? ...................................... 34

Should an AED be kept in a locked cabinet? ................................................................. 34

Could I kill someone if I try to defibrillate? ................................................................... 35

Introduction and Scope

This procedure and guideline relates to the use, purchase and maintenance of the ZOLL fully automatic external defibrillator. It applies to all workplaces under the control of the Catholic Schools Office - Diocese of Broken Bay (DBB).

Figure 1. The ZOLL Fully Automatic AED Plus

Pouch at back of

carry bag

containing

support material

and Child Pedi

Padz II.

Tag with

electrodes

expiry dates

AED Inspection

card

AED

Carry Case

Carry Bag strap

Proof the AED

is Fully

Automatic

1. Background

The importance of timely defibrillation in conjunction with effective CPR is well documented as a key factor influencing the survival of patient’s suffering sudden cardiac arrest (SCA). An automated external defibrillator (AED) is a portable and easy-to-operate medical device that analyses an unconscious patient’s heart rhythm and automatically delivers a shock if they are having a sudden cardiac arrest (SCA). This is called defibrillation. An AED will not deliver a shock unless it detects a shockable heart rhythm. AED’s can significantly improve the chance of survival for a patient of sudden cardiac arrest. A patient’s chance of survival is reduced by ten percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after ten minutes. The use of an AED can be performed by the majority of our staff and students and need not be restricted to first aid trained personnel. Once turned on, the ZOLL fully automatic AED Plus defibrillator will use voice commands and screen messages while monitoring the heart rhythm. It will advise the operator if a problem is detected and provide guidance through the process of providing effective CPR and defibrillation (if required). Importantly; an AED cannot defibrillate a person that does not need it.

2. Definitions

AED - Automated External Defibrillator is a device that analyses and looks for shockable heart rhythms, advises the rescuer of the need for defibrillation and delivers a shock if needed. Australian Resuscitation Council - voluntary body that co-ordinates the practice and teaching of resuscitation and promotes uniformity and standardization of resuscitation. The ARC develops and publishes guidelines on resuscitation every five years. The last guidelines were published in 2010 and are due for update in 2015. Automated External Defibrillator (AED) means a portable electronic device that automatically diagnoses and treats sudden cardiac arrest (SCA). The treatment, known as defibrillation, consists of determining and delivering an appropriate level electric pulse to re-establish an effective heart rhythm.

Biphasic - Biphasic defibrillation alternates the direction of the current (joules), completing one cycle in approximately 10 milliseconds, meaning the current is delivered from one pad to the other and then reverses direction. Biphasic defibrillation, originally developed for implantable defibrillators, significantly decreases the energy level necessary for successful defibrillation, decreasing the risk of burns and myocardial damage. Cardiopulmonary Resuscitation (CPR) means an emergency procedure often employed after sudden cardiac arrest, combining external cardiac compression and expired air resuscitation to maintain circulation of oxygenated blood to the brain.

Chain of Survival - The Chain of Survival consists of the actions needed to treat a life--‐threatening emergency. With a strong chain of survival in every workplace and community, more lives can be saved. The chain has four links. Early Access - Recognising that an emergency exists and quickly calling for help, dialling 000 and requesting an ambulance. Early CPR - starting CPR immediately after cardiac arrest. CPR circulates oxygen‐rich blood to the brain and heart. It buys time for the patient until defibrillation can be performed. Early Defibrillation - Defibrillating the patient as soon as the AED arrives. This is most effective within 3‐5 minutes. This is the critical link in the chain. Early Advanced Care - Trained healthcare providers arriving quickly to give advanced care. CPR - Cardiopulmonary resuscitation (CPR) is the technique of chest compressions combined with rescue breathing. The purpose of cardiopulmonary resuscitation is to temporarily maintain a circulation sufficient to preserve brain function until specialized treatment is available.

Defibrillation - is a common treatment for life‐threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart using a defibrillator. This terminates the arrhythmia and allows normal sinus rhythm to be re-established by the body’s natural pacemaker. ECG - Electrocardiogram. An electrocardiogram is a test that records the electrical activity of the heart. ECG is used to measure the rate and regularity of heartbeats as well as the size and position of the chambers, the presence of any damage to the heart and the effects of drugs or devices used to regulate the heart. Fibrillation - Chaotic activity of the heart’s electrical system. This condition can occur in the atria or the ventricals. When it occurs in the ventricles, they quiver in a rapid, chaotic manner, preventing them from pumping blood to the body. First aider is a person who has successfully completed a nationally accredited training course or equivalent level of training that has given them the competencies to administer first aid. Good Samaritan - defined in legislation as a person acting without expecting financial or other reward for providing assistance. As a first aider or rescuer you should not fear litigation if you go to the aid of a fellow human in need. No ‘good samaritan’ or volunteer in Australia has ever been sued for consequences for rendering assistance to a person in need. See ‘Australian Resuscitation Council Guideline 10.5 Legal and Ethical issue related to Resuscitation’ for more information. Heart Attack – occurs when the flow of blood to the coronary arteries is blocked. If a heart attack is left untreated, a sudden cardiac arrest can occur. Impedance - resistance to the flow of electrical current through the body. Ingress Protection - A worldwide standard has been established by the International Electrotechnical Commission (IEC) for comparing the ability of electronic devices to withstand exposure to dust and liquids. The ratings established by the IEC for resistance to particulate and liquid matter are called ‘Ingress Protection’ or ‘IP ratings’ and are defined by IEC 60529. A full rating contains two digits. The first measures the ability of the instrument to resist the ingress of foreign objects or dust. The second measures the ability to resist the ingress of liquids. The first digit can have a value of 1 to 6, the second a value of 1 to 8. The higher the number is the better protection. Joule - the unit of energy delivered by a defibrillator. LED - light emitting diode. Myocardial Infarction - death of heart muscle resulting from an interruption of the blood supply to that area of myocardium.

Non - Shockable Rhythm - a heart rhythm that is detected by the defibrillator as not requiring a shock; but may require CPR. Passive airway support system (PASS) – the cover or lid of the ZOLL fully automatic AED Plus can be used by placing it under the shoulders of the patient to assist with head tilt to maintain patient’s airway open. Shockable Rhythm - a heart rhythm that is detected by the defibrillator as requiring a shock; ventricular fibrillation or ventricular tachycardia. Sudden Cardiac Arrest (SCA) - an electrical problem that causes the heart to beat chaotically, instead of beating rhythmically the heart quivers or fibrillates and it cannot pump oxygenated blood around the body. Within seconds the patient loses consciousness and becomes completely unresponsive. . It is a medical emergency that, if left untreated, invariably leads to death.

Ventricular Fibrillation (VF) - is an abnormal heart rhythm often seen in SCA. This rhythm is caused by an abnormal and very fast electrical activity in the heart. VF is chaotic, unorganized; the heart quivers and cannot pump blood. VF is short lived and can deteriorate to asystole (flat line) if not treated promptly. Ventricular Tachycardia (VT) - is a rapid heart rhythm originating in the ventricle.

3. Procedure

The ZOLL fully automatic AED Plus is the defibrillator selected by the Diocese of Broken Bay as appropriate for the needs of staff and students. The ZOLL fully automatic AED Plus has the lowest total cost of ownership. Unless used, there is nothing to replace or buy for five years, other than the Pedi Padz II which will be replaced after two years. The ZOLL fully automatic AED Plus supports the Australian Resuscitation Council’s full chain of survival through graphical and audible prompts. The unit is provided, complete with one piece CPR – D padz ‘adult’ and ‘child’ Pedi Padz II (electrodes) and a “Rescue Kit” containing gloves, barrier mask, scissors, razor, wet wipe and dry wipe. The AED is packaged in a soft carry case/ bag and is supported with a comprehensive ZOLL Fully Automatic AED Plus Administrator’s Guide and Operator’s guide, a basic life support flow chart, and A3 sized flow chart for the operation of the AED, an AED Wall sign and a DVD for training. The Unit also includes an alarmed AED wall cabinet in which to store the AED. The AED Plus is powered by ten commercially available consumer brand lithium-manganese dioxide batteries. You will not normally need to replace these. If there is a battery problem, please contact the CSO WHS Officer. The CSO has a strategy in place to replace batteries when that time falls due. The AED Plus includes a cover that can also be used as a passive airway support system (PASS) to support the patient’s neck and shoulders in a position that assists in maintaining an open airway. Workplaces are not to label or mark the AED or its case. All staff and students should familiarise themselves with the operation of the ZOLL fully automated AED Plus. A Trainer ZOLL AED Plus is available by contacting the WHS Officer. Training DVD’s are supplied with the AED. The ZOLL fully automatic AED Plus must be operated by all persons of the Diocese of Broken Bay in line with the manufacturer’s instructions and CSO guidelines.

Equipment Information

Figure 2: The ZOLL fully automatic AED Plus Main features

1.

2.

13.

12. 11.

10.

9.

8.

7.

6.

5.

4.

3.

14.

Table 1: The ZOLL AED Plus Fully Automatic Defibrillator - Main Features and functions 1. On / Off button Turns power On and Off.

When the power is Off, and has been off for at least 10 seconds, holding the button down for five seconds initiates the manual Self-Test.

2. Pictograms Icons that explain the series of steps needed for resuscitation and defibrillation.

3. Automatic Indicates the AED unit is ‘fully automatic’.

4. Shock button Lights when the AED is charged and ready to deliver a shock.

Will not light when the unit is not charged.

This AED delivers the shock (after a brief verbal countdown) without the need for the operator to press a button.

5. Indicator Lights Lights each pictogram to indicate to the rescuer which step must be taken.

6. Battery compartment Under the unit. Holds 10 x 123A size lithium manganese dioxide batteries.

7. LCD Display Displays- - Elapsed time - Shock count - User prompts - CPR compression depths.

8. Electrode connector Connect the electrodes to the AED here

9. IrDA comms port On the side of the unit. Provides a communications link between the defibrillator and a paramedics computer device to download collected data.

10. Adult / Child picture The unit incorporates the ZOLL Rectilinear Biphasic Defibrillation waveform and operates in either adult or paediatric mode.

11. Status Indicator Green tick indicates the unit has passed the Self- Test and is ready for use.

Red cross indicates the AED has failed the Self-Test. Check the Unit and contact the WHS Officer.

12. Carry handle Always use when transporting the AED

13. Speaker Underneath the Unit. Provides audio prompts and metronome beeps that direct rescuers on what to do; also provides voice prompts to indicate if service is required.

14.

AED Cover

The cover for the AED can be used as a passive airway support (PASS) under the shoulders to help maintain the patient’s airway. See Figure 7.

ZOLL Fully Automatic AED Plus - Unit Contents

Passive Airway Support cover

ZOLL AED Plus Operating Procedure Guide, Operator’s guide

Training DVD

CPR – D padz - Adult electrodes and Pedi Padz II child pads (0-8yrs / 25 kilos)

Rescue Kit: Gloves, barrier mask, scissors, razor, wet wipe and dry wipe.

Ten Lithium batteries Type 123A – 5 year shelf life – 300 shocks / 13 hrs monitoring,

redundant battery system backup battery

Soft Carry Case

Self- check – Weekly

Graphical user interface – picture prompts

Visual and audible rescuer prompts

LCD back lit display – written prompts

Chest compression display graph, gauge

Data download – Infra red port (for rescue paramedic report)

Paediatric treatment algorithm

Elapsed time display – for paramedics

Shock count display – for paramedics

Ingress rating – IP55 (dust and water protection)

AED Wall Sign

Alarmed AED Wall Cabinet

Figure 3. Rescue pack and CPR- D Adult padz electrode Pack

Electrode pack pre-

connected to the ZOLL Scissors Razor

Wet

Antibacterial

Wipe

Face shield

Paper Towel with Gloves

4. Using the AED

4.1 How the AED communicates with you

The ZOLL Fully Automatic AED Plus is an automated external defibrillator that uses voice prompts and visual indicators to guide the rescuer through the resuscitation sequence that may include defibrillation and / or cardiopulmonary resuscitation (CPR). The AED Plus supports both adult and paediatric defibrillation electrode pads, and automatically adjusts the defibrillation energy based on the type of electrode pads connected to it. Once turned on, the AED will use voice commands and screen messages to guide an operator through the defibrillation process. Following attachment of electrodes to a patient’s chest, the defibrillator monitors the electrocardiographic (ECG) rhythm of the patient’s heart, analyses that rhythm, and determines whether the rhythm is shockable or non-shockable. The AED will advise the operator if a problem is detected as well as indicating when a shock to the patient is required. When the unit detects a shockable rhythm, it automatically delivers a shock through the electrode padz. The rescuer will then be prompted to perform CPR for a period of 2 minutes, after which the unit automatically initiates a new ECG analysis.

The AED Plus can:

• Perform automated periodic self- tests to ensure its continual readiness.

• Use a one-piece electrode assembly (CPR•D-padz) that facilitates proper electrode placement and that is easy to apply to the victim.

• Analyse heart rhythm and inform the rescuer if the rhythm is shockable or non-shockable.

• Deliver defibrillation treatment to patients of cardiac arrest who exhibit shockable ECG rhythms.

• Provide voice prompts and graphics to guide the rescuer regarding what to do and when to do it during a cardiac emergency, such as calling for help or giving CPR to the victim.

• Provide audible beeps to encourage rescuers to provide CPR compressions at 100 CPM (requires the adult CPR-D•padz).

• Monitor the depth of chest compressions during CPR and provide voice prompts (i.e. ‘Push Harder’), if compression depth is inadequate (requires adult CPR-D•padz).

• Provide added support to ensure head tilt for opening the airway, via the unit’s cover / lid called a passive airway support system (PASS)). See Figure 7.

• Upload data from the defibrillator to an ambulance paramedic’s computer to store events or print event reports.

• Use commercially available batteries.

The AED tells you when a shock is required, and when to provide CPR. It then monitors the rate and depth of chest compressions and guides you as you provide CPR. To communicate these prompts to you, the AED uses a:

Speaker

Liquid crystal display (LCD)

Sequential graphic interface of pictograms signalled by light emitting diodes (LEDs)

4.2 Use of the Automatic External Defibrillator (AED)

An AED should be applied whenever sudden cardiac arrest (SCA) is suspected, regardless of the time frame involved as it may increase the survival rate. A SCA usually occurs without warning and without any signs or symptoms and should not be confused with someone who is having a heart attack. When somebody suddenly collapses a SCA should be immediately considered.

Signs that someone has suffered a SCA include:

• The person is unresponsive / unconscious • The person is not breathing normally and or they have no ‘signs of life’. If it is determined that an AED is required, someone should immediately send for an AED from the nearest location on the school premises. Prompt and effective CPR must still be undertaken whilst the AED is being retrieved to ensure the best possible chances of survival following a suspected cardiac arrest. The ZOLL fully automatic AED Plus will operate for all body sizes. The obesity level of a patient does not affect the AED’s operation, however if the patient is under 25 kilograms or 8 years of age, the child or (paediatric) Padz (electrodes) must be used instead of the adult Padz.

4.3 Steps to follow if AED is required

To provide the best opportunity for survival, these four steps must be put into motion within the first few minutes of a sudden cardiac arrest. If someone is unconscious or has stopped breathing you should immediately commence the ‘chain of survival’ as follows:

Early Access

In the event of a sudden cardiac arrest (SCA) on school premises the school reception administration staff should be notified immediately and requested to call an ambulance. A school first aider should also be contacted to assist with CPR. Alternatively, staff may call 000 using their mobile phone to seek an ambulance however, the school reception staff must be advised ASAP. A staff member should be in the location where the ambulance has been asked to attend so they can provide quick access to the patient.

Early CPR

CPR should be started as soon as possible.

Early Defibrillation

Get someone to bring an AED from the schools known location, attach the AED and turn it on. Follow the prompts given by the AED. All AEDs operate in a similar way and pad placement is the same regardless of the model used. Anyone is able to use the AED.

Early Advanced Care

Keep the AED connected to the patient until the ambulance arrives and advanced care is available, even if no shock is advised by the AED, or the patient regains consciousness.

4.4 Prompts

The AED issues the following voice and LCD prompts. These prompts and their definitions are discussed in Table 2.

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://sua.syr.edu/event.php?type%3Dcpr&ei=iPv4VKS8BoKE8gXQ9ICwDA&bvm=bv.87611401,d.dGc&psig=AFQjCNHSxawVcKv0j8-Rha5l1_nmtRAUNg&ust=1425689843889972

Table 2 AED voice and LCD prompts

Clinical Prompts Definition / Action

Unit OK AED Plus has successfully passed its power up self- tests.

Unit Failed AED Plus has failed its power up self- tests and is not usable for patient care.

Change Batteries AED Plus self- test has detected a low battery condition that is insufficient for the devices use for patient care. Replace batteries immediately.

Stay Calm Relax as much as possible and focus on the rescue effort.

Check Responsiveness

Check patient for responsiveness / consciousness by gently squeezing the patient and shouting “Are you all right?” “Open your eyes!”

Call for Help Send for help. Ask a bystander to call an ambulance.

Attach Defib Pads to Patient’s Bare Chest

Attach defibrillation pads to the patient’s bare chest.

Check electrode pads

Previously attached electrodes are not making good contact with the patient’s skin or the electrodes are defective.

Adult Pads AED Plus has detected adult electrode pads connected to it and adjusted defibrillation energy settings to adult levels.

Change the pads to the ‘Child Pedi Padz’ if victim is a child under 8 or

< 25 kilograms.

Paediatric Pads PAEDIATRIC PADS. AED Plus has detected paediatric electrode pads connected to it

Don’t touch patient, Analysing

DON’T TOUCH PATIENT. The AED Plus is checking the condition of the patient’s heart rhythm.

Shock Advised SHOCK ADVISED. ECG rhythm analysis has detected the presence of ventricular fibrillation or shockable ventricular tachycardia.

No Shock Advised. NO SHOCK ADVISED. ECG rhythm analysis has detected a rhythm that is not shockable.

Shock Delivered. SHOCK DELIVERED. A defibrillation shock has just been delivered to the patient.

Start CPR START CPR. Begin CPR.

Continue CPR. CONTINUE CPR. Continue providing CPR. This prompt may also be issued if

Real CPR Help fails to detect chest compressions at least ¾ of an inch deep.

Push Harder. PUSH HARDER. CPR compressions are consistently less than 2 inches deep.

Good Compressions. GOOD COMPRESSIONS. After prompting to Push Harder, rescuer has succeeded in delivering chest compressions at least 2 inches deep.

Stop CPR. STOP CPR. Stop CPR, the AED Plus is about to begin an ECG rhythm.

4.5 Preparing the patient

The patient

Indications for use:

• The patient has no signs of life: i.e., the patient is unconscious AND unresponsive AND not breathing normally AND not moving.

If the patient is unconscious but breathing, place the patient in the recovery position. Access an AED in case required.

Eight year old children

Children rarely develop Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (VT) heart rhythms that can be treated with a defibrillator. The main treatment is CPR, and the AED will prompt for CPR. The first responder will need to change to the Pedi Padz II child pads. • When equipped with CPR-D™ adult electrodes, the AED will prompt for depth of compressions suitable for adults. This is dangerous for small children. • When equipped with adult pads the AED delivers a shock suitable for adults. For these reasons, you must attach the Pedi Padz II child pads to treat children 0 - 8 years of age and / or less than 25 kilograms.

Electrodes

Check that electrodes are within the expiry date. To prepare the patient for the electrodes: a) Remove all clothing covering the patient’s chest. b) Ensure the patient’s chest is dry. c) If the patient has excessive chest hair, shave the hair, using the razor supplied. This aids in adhesion of the electrodes and helps prevent burning.

If the patient has an implanted defibrillator or pacemaker, in the upper right chest, angle the upper electrode so that it isn’t over either device, and then continue as normal. Damage to implanted defibrillators or pacemakers is of secondary concern.

NOTE

Implanted defibrillators and pacemakers can be recognised by a large square shaped

implant under the skin, particularly just below the collar bone.

Applying CPR-D padz™

To apply the electrodes: a) Open the package and unfold the electrodes. b) The central CPR sensor has cross-hairs. Locate the cross-hairs between the nipples and over the sternum. See Figure 4 below.

Figure 4. Electrodes showing cross-hairs

NOTE Electrodes must adhere cleanly to bare skin. The sensor must be over the sternum for the AED to correctly analyse CPR compressions. If the electrodes are not correctly attached to the patient, the unit issues the Check electrode pads or the Attach electrode pads prompt. If the electrodes are defective or aren’t making good contact with the patient, the AED prompts: Check electrode pads. c) Hold down the CPR sensor with your right hand. Pull the No 2 tab and pull the protective backing away from the upper electrode. Press the electrode down from the centre to the sides to ensure good adhesion. See Figure 5. d) Hold down the CPR sensor with your left hand. Pull the No 3 tab and peel away the protective backing from the lower electrode. Place the electrode below the patient’s left breast. Press the electrode from the centre out to ensure good adhesion. See Figure 5.

Cross

hairs

Figure 5. Fitting electrodes

Fitting the right electrode Fitting the left electrode

e) Maintain the position of the CPR sensor. If the patient is large, or the electrode’s position must be adjusted to fit underneath the patient’s breast, tear the electrode away from the CPR sensor along the dotted line and then fit the electrode. See Figure 6.

Figure 6. Adjust the electrodes for a large patient

→ →

Using the AED cover The AED’s cover can be used as a passive airway support wedge under the patient’s shoulders. This helps maintain the patient’s open airway.

Figure 7 Using the AED cover to maintain the airway

No 2 tab

No 3

tab

WARNING

If you suspect a head, neck or back injury, do not use the AED cover as a support.

4.6 Operation 4.6.1. The ZOLL Fully Automatic AED Plus will operate for both adult and child body sizes. The obesity level of a patient does not affect the AED’s operation. Child Pedi Padz II must be used for children less than 8 years of age or weighing less than 25 kilograms. 4.6.2. Ensure CPR, with effective compressions, is underway whilst the AED is being retrieved, and whilst the patient is being prepared for attaching the CPR Padz.

Starting without electrodes attached to the patient

4.6.3. Press On/Off to start the AED. The AED then conducts a Self -Test. Once complete, it

prompts you to follow your DRSABCD training. These prompts are:

a) “Stay calm”

b) “Check responsiveness”

c) “Call for help”

d) “Open airway”. “Check breathing”.

e) “Attach defib pads to patient’s bare chest”

4.6.4. Bare the casualty’s chest. This may require cutting through under garments to expose skin.

4.6.5. Open the CPR Padz and prepare the casualty (clean / dry the chest and/or shave chest hair if required).

Starting with electrodes attached to the victim

4.6.6. Press On/Off to start the AED. The AED then conducts a Self -Test. Once complete, it

prompts: Don’t touch patient. Analysing.

If the CPR Padz is not making good contact with the patient’s skin, the AED will prompt “Check Electrode Pads”. Ensure the CPR sensor (cross) is in the middle of the breastbone (in line with the nipples). If the casualty is of a larger build or there is a need to place the electrode under the casualty’s breast, the lower pad can be torn at the perforated line to extend the position of the lower pad. Place the lower pad slightly to the left of the centre of the chest and below the casualty’s breast.

4.6.7. Stop CPR whilst the AED analyses the casualty. Defibrillation shock is indicated if the AED detects VF or pulseless VT rhythms.

4.6.8. If a shock is advised the voice prompt will state: “Shock advised. Don’t touch patient”. When the AED issues the ‘Shock Advised’ prompt, the AED begins charging. The Operator will:

a) Warn bystanders and others to ‘stand clear’.

b) Ensure no one is touching the patient.

c) Lift bag valve mask away from the patient’s face and chest (if used).

4.6.9. When it is ready to deliver the shock, the AED prompts: “Don’t touch patient”. The

AED will then issue an audible countdown before it delivers the shock automatically and

when that happens the patient will be caused to exhibit a strong muscular contraction.

NOTE

The AED Plus automatically adjusts defibrillation energy to adult or paediatric levels based

on the type of electrodes attached to the unit. In its factory default configuration, the unit

delivers the first three shocks at 120J, 150J, and 200J respectively in adult mode, and at 50J,

70J, and 85J in paediatric mode.

4.6.10. After delivering the shock, the AED prompts: “Shock delivered”.

4.6.10.1. Dependent upon the heart rhythm analysed following the shock, the voice prompt will state “Start CPR” and CPR should be performed for another two minutes. 4.6.10.2. After two minutes, the voice prompt will state: “Stop CPR”, “Don’t touch patient, Analysing”. If the heart rhythm is not a shockable rhythm, the prompt will advise “No shock advised”, “Start CPR” and CPR should be performed for another two minutes. CPR is vital as it may assist with putting a patient into a shockable rhythm.

4.6.10.3. Alternatively, the shock provided by the AED may have brought the patient back to life and where the patient is conscious, breathing and / or shows signs of life, turn the casualty into the recovery position. If not, continue CPR. 4.6.11. After two minutes the AED will prompt “Stop CPR”, “Don’t touch patient”, “Analysing”. NOTE The AED may prompt the person performing compressions, “Push Harder” or “Good Compressions”. Visual prompts will also assist the quality (depth) of compressions. CPR chest compressions should be delivered at a rate of 100 per minute. The rate of

compressions is guided by a metronome. The metronome beginning to beep indicates the

AED has detected compressions. Compressions are then guided by a series of prompts.

4.6.12. Continue to follow the voice and visual prompts and apply CPR until help (ambulance paramedic) arrives.

NOTE

Starting with an error condition – a red x

If the status indicator shows a red X, turn the unit on. If the unit prompts for electrode

connections, check the connection. If the unit prompts to change batteries then proceed

with the rescue. The unit will continue delivering shocks until unable to do so.

If the AED does not turn on at all, emits a beeping tone and the status indicator shows a

red X, then the batteries are too flat to deliver a shock. If spare batteries are available,

replace the batteries and continue.

CAUTION

Do not touch the electrodes, the victim or any conductive surface touching the victim

during ECG analysis. The AED can pick up a signal from the operator, affecting ECG

analysis.

The AED delivers the shock

WARNING

Always stand clear and move bystanders clear of the patient when delivering shocks.

Defibrillation energy can be conducted through the patient into the body of the operator

or bystanders, resulting in electric shock, if touching the victim.

Lift any oxygen giving equipment such as bag valve masks away from the patient upon the

‘Shock Advised’ prompt.

Basic Life Support

D: Danger

Check for any hazards, risks or other safety concerns.

R: Responsive?

Is the patient unresponsive AND unconscious AND not breathing normally AND

not moving?

S: Send for Help

Send someone to get help or if you are alone, call for help

A: Airway

Open the patient’s airway and look for ‘signs of life’.

B: Breathing

Check – look, listen and feel. If not breathing normally – Start CPR.

C: Compressions

Give a cycle of 30 compressions followed by 2 breaths.

D: Defibrillator

Attach the AED as soon as it is available.

a) Continue CPR as best as possible while you:

attach electrode pads

turn on the AED.

b) Continue CPR until you hear the AED prompt:

“Don’t Touch Patient. Analysing.”

c) Follow the AED’s prompts.

Refer to the flow chart in the back of your AED pack.

Table 3. CPR Prompts

Message Cause Your action

Start CPR No compressions detected Begin CPR

If you’ve begun CPR, push harder.

Metronome begins beeping AED has detected compressions. Match metronome.

Push harder Compressions too shallow. Push harder. Be guided by the bar graph on the LCD.

Good compressions Operator has responded to Push Harder prompt with good compressions.

Continue CPR.

NOTE

When compressions are very shallow, the AED may not detect them. It will continue to

prompt: “Start CPR” or “Push harder”.

After 2 minutes, the AED will prompt “Stop CPR. Don’t touch patient”, “Analysing”.

It analyses the patient’s ECG again, and issues a new set of instructions. If you continue CPR

during ECG analysis, the AED prompts: “Analysis halted. Keep patient still”.

Depth of compressions

Compressions should be at least one third of the depth of the chest, with each compression.

This equates to at least 5 cm in adults.

When using CPR-D adult padz, the AED can detect the depth of compressions, but not the

size of the victim. It prompts for the depth of chest compressions based on the assumption

that 5 cm equates to one third of the depth of the chest. For adults, the AED will only

prompt if you don’t push hard enough. There is no conflict between your CPR training and

the AED’s operation.

WARNING

With smaller patient’s such as children down to the age of 8 years, only compress the chest

one third. This is best achieved by using only one hand.

5. Training

5.1. AEDs are designed so they are able to be used without the need for training. The CSO recognises that it is best practice to ensure strategies are available to familiarise staff with the use of the ZOLL fully automated AED.

NOTE

As with all AED’s, the ZOLL fully automatic AED Plus will only deliver a shock if required.

All staff receive CPR training annually. Included in that training is instruction with demonstration on the use of an AED. The San College of Education (provider of CPR, Anaphylaxis and Asthma and First Aid training for the Diocesan of Broken Bay schools (DBB)) is aware that all DBB schools have a ZOLL fully automatic AED Plus.

The Catholic Schools Office (DBB) has issued a comprehensive training DVD from ZOLL with each defibrillator. Staff and students are encouraged to view the training DVD.

The AED is supported with a flow chart that describes basic life support and how the ZOLL fully automated AED Plus operates when the cover is removed.

The AED is fully automatic, so it guides the operator with audible and visual (on screen and pictogram) instructions for each stage of the rescue situation.

The CSO has developed Operational Guidelines and Procedures for the use of the AED.

The CSO has purchased a ‘ZOLL trainer AED’ to be used for training as requested. This trainer AED demonstrates using a number of sequences how the ZOLL fully automatic AED Plus operates. Contact the WHS Officer.

An e-learning training program for the use of the ZOLL fully automatic AED Plus has been developed by ZOLL Australia and is available for use by CSO DBB schools and workplaces. Access is via Curianet / CSOHS online. Contact the WHS Officer for username and password.

6. After an Event

6.1. If the ZOLL fully automatic AED Plus has been used, the person who has used the AED or first aider must contact the WHS Officer, to ensure that the AED is cleaned and refurbished so that it can be quickly returned to service. 6.2. The first aider must complete an Incident Report form - for any event where the AED is used. See also Section 11. ‘Counselling’ in this document, should this be required.

7. Warnings and Precautions

There are some precautions to take when operating an AED. These include:

Do not use the adult pads from the AED if the patient is a child younger than 8 years of age or lighter than 25 kilograms (specific pads are required). Use the Child / Paediatric pads which are supplied and located at the back of your ZOLL pack.

Do not use the AED in the presence of flammable gases.

If needed, clean and dry the patient’s chest, using the wet and dry wipes in the rescue kit before attaching the CPR Padz.

Patients with a hairy chest will require shaving using the razor in the rescue kit, to ensure good contact with the CPR Padz.

If an implanted pacemaker is identified, (usually placed just under the skin of the chest, below the collarbone) place the pad at least 10 centimetres away. Ensure everyone stands clear when an electric shock is delivered. Do not touch the victim except when performing CPR (this prevents interference and injury to bystanders when a shock is given). Be sure to listen to the instructions from the AED.

When using the AED, do not use mobile phones within one meter of the AED to avoid radio frequency interference.

Do not remove the pads until the ambulance arrives and paramedics take over, even if the victim regains consciousness or no shock is advised.

8. Purchase

The CSO has issued ZOLL fully automatic AED Plus units to all schools, to ensure appropriate coverage across the DBB.

If schools feel they require further AED’s to cover their school area, please contact your school Consultant . A central register is being kept to ensure the AED is identified for inspection and maintenance.

9. Installation and Storage of AED Units

9.1. The defibrillator must be installed or stored in an immediately accessible (during normal

office hours) signposted area. In order to minimise the risk of tampering or theft, it is

recommended that the defibrillator be stored in the specific box, supplied with the

defibrillator, which activates an alarm when opened.

9.2. The recommended cabinet needs to be located where, (if opened) it can be heard so

this must be taken into consideration when deciding on a location for installation. It should

also be located where it is protected from harsh environments. Contact the Facilities

Manager if you require advice on installation. Once installed, please advise the Procurement

Manager of the location of the AED at your workplace.

9.3. In addition the Procurement Manager must be notified if the unit is moved to a

different location within the workplace.

9.4. All staff and students should familiarise themselves with the location of the AED(s).

10. Set up and maintenance of the AED Unit

10.1 Setting up the AED

Your AED has been fully checked prior to delivery.

NOTE

There will be no maintenance required for 5 years, with exception of replacement of the

child Pedi-padz II, after 2 years in service. The CSO has a strategy in place to replace these

when due.

Upon receipt of the AED carry out the following:

a) Inspect all external surfaces. The unit should be clean, be free of structural faults and

have no missing parts.

b) Confirm the green tick appears in the status indicator, and the unit is not emitting a

beeping tone.

The AED can now be put into service.

NOTE

If there is a problem with your ZOLL Fully Automatic AED Plus, contact the WHS Officer

immediately.

If you have used your ZOLL Fully Automatic AED Plus in an emergency, contact the WHS

Officer immediately.

10.2 Monthly check

10.2.1. Your schools ZOLL Fully Automatic AED Plus has been programmed to perform weekly self – checks. However schools should check the AED monthly.

Use the Checklist in Table 4.

Table 4. Monthly check – Checklist

Month:

Check Pass Fail

Ensure the AED Wall Cabinet is clean and in good working order (alarm operates when door opened) and the AED wall sign is displayed above the cabinet.

Ensure the AED unit is clean and free of excessive wear.

Ensure the AED unit is free of cracks and has no loose parts.

Ensure the AED displays the green tick in the little window on bottom left side front of the AED.

Verify electrodes are within the expiry date (see outside of pack).

The CPR-D Padz expiry should read 24.4.2020 and the

Pedi Padz II expiry date should read 7.2.2017. These dates are visual from the tag at the front of the AED and from the Pedi Padz II box in the pouch at the back of the AED black case.

10.2.2. The ZOLL fully automatic AED Plus conducts self-tests weekly to ensure it is ‘rescue-

ready’ at all times. Following a successful completion of all self- tests, the AED status

indicator on the front of the unit displays a green tick (√) to show that all tests passed and

that the unit is ready to use.

10.2.3. If the status indicator displays a red (X) the AED is not ready for use and may be

defective.

10.2.4. It is recommended a visual check, ideally once per month is conducted to ensure the

green tick on the front of the unit is showing. A visual check of any AED units should also

occur during any workplace health and safety inspections.

10.2.5. Check that the CPR Padz have not expired (see expiry date on outside of pack) and

the rescue pack is present within the Unit. The AED should be kept clean. Clean the unit

using a soft, damp cloth (if required).

Refer to the checklist that has been created to assist with checks.

10.2.6. The WHS Officer must be contacted if:

o The ‘green tick’ on the AED has turned to a ‘red cross’ or there is an audible beep; o The AED is damaged;

o The AED is missing; o Padz are out of date. o The AED does not work in any way.

10.2.7. The AED is supplied with the following items located in a rescue kit pouch with the CPR-D padz:

o A shaver to shave excessive hair if necessary; o Scissors to cut a bra or other clothing if necessary; o Wet and dry wipes to clean the patient’s chest if necessary; o A barrier mask for providing rescue breaths; o Gloves for protecting the rescuer.

11. Servicing of the AED

11.1. The Employee Wellbeing and Safety Unit maintains a central register of all ZOLL fully automatic AED Plus units distributed to schools.

11.2. The Procurement Officer will arrange servicing and replacement batteries and pads before their expiration dates. The first service will occur 2 years from the date supplied to schools. This service will include replacement of the Pedi Padz II. A strategy is in place to ensure this occurs.

11.3. The ZOLL AED Plus is supplied with a 7 year manufacturer’s warranty.

11.4. The CPR D-Padz have a 5 year shelf life.

11.5. The Pedi Padz II have a shelf life of 2 years.

11.6. The ten Lithium batteries Type 123A, have a 5 year shelf life – 300 shocks / 13 hour's monitoring, redundancy battery system / backup battery.

11.7. The AED cabinet battery for the alarm to operate is 1 x industrial 9 volt alkaline battery.

11.8. No persons should attempt to service the AED. If there is a problem with the AED, please notify the WHS Officer immediately.

12. Storage

12.1. Store the AED away from:

Strong radio transmission sources

Excess levels of electrical activity.

12.2. It is recommended that the AED be housed inside the provided AED Wall Cabinet and

in a safe, secure but easily accessible location.

12.3. Positioning the wall cabinet and AED on an external wall within school grounds may

not be secure from potential theft.

12.4. Keep it dry and clean.

13. Counselling

13.1. The DBB provides free, confidential and professional assistance to employees and to other persons whose care is the responsibility of the employee, through the AccessEAP Employee Access Program the CSO provider for our Employee Assistance Program (EAP). 13.2. Students have access to counselling through: School Counselling Services

Frequently Asked Questions (FAQ’s) about the ZOLL Fully Automatic AED Plus®.

What is an AED?

An AED (Automated External Defibrillator) is a device that analyses and looks for shockable

heart rhythms, advises the rescuer of the need for defibrillation and delivers a shock if

needed.

What is Sudden Cardiac Arrest (SCA)?

Sudden cardiac arrest (SCA) simply means that the heart unexpectedly & abruptly stops

beating. This is usually caused by an abnormal heart rhythm called ventricular fibrillation

(VF). The only effective treatment for VF is Defibrillation. However almost equally as often

as Ventricular Fibrillation, the presenting rhythm is Asystole or PEA (pulseless electrical

activity) where a defibrillator would advise "NO SHOCK" and the only effective treatment is

good quality CPR.

Is SCA the same as a heart attack?

No. A heart attack is a condition in which the blood supply to the heart muscle is suddenly

blocked, resulting in the death of part of the heart muscle. Heart attack patient’s usually

(but not always) experience chest pain and usually remain conscious. Heart attacks are

serious and sometimes will lead to SCA. However, SCA may occur independently from a

heart attack and without warning signs. SCA results in death if not treated immediately.

Who is at risk of SCA?

While the average age of SCA patient’s is 65, it can affect anyone, anywhere at any time and

is increasingly affecting younger people.

What is VF?

Ventricular Fibrillation (VF) is an abnormal heart rhythm often seen in SCA. This rhythm is

caused by an abnormal and very fast electrical activity in the heart. VF is chaotic and

unorganised; the heart just quivers like jelly on a plate and cannot effectively pump blood.

VF will be short lived and deteriorate to asystole (a flat line) if not treated promptly.

How is VF treated?

The only effective treatment for ventricular fibrillation (VF) is an electrical shock called

defibrillation. Defibrillation is an electrical current applied to the chest. The electrical

current passes through the heart with the goal of stopping the VF and giving an opportunity

for the heart's normal electrical system to take control. This current helps the heart

reorganize the electrical activity so it can pump blood again. An automated external

defibrillator (AED) can defibrillate the heart.

If defibrillation is so important, why should I do CPR?

Without CPR, blood will pool up in the heart and not circulate, thus not circulate oxygen rich

blood to the brain. CPR provides some circulation of oxygen rich blood to the patient’s brain

and around the heart. By performing CPR you will delay brain death and the death of heart

muscle. CPR also makes the heart more likely to respond to defibrillation. It is vital.

Will I hurt the victim by using an AED?

When used on people who are unresponsive and not breathing, the AED is extremely safe.

The AED makes shock delivery decisions based upon the patient’s heart rhythm, and will

only defibrillate a shockable rhythm.

Can I accidentally shock another rescuer or myself?

AEDs are extremely safe when used properly. The electric shock is programmed to go from

one electrode pad to another through the patient’s chest. Basic precautions, such a verbally

warning others to stand clear and visually checking the area before and during the shock,

will virtually ensure the safety of rescuers.

Should I use the AED if the victim has a pacemaker or is pregnant?

Yes, never withhold the use of an AED on a person with sudden cardiac arrest (SCA). Where

a pacemaker is seen place the padz just below it.

What is the shelf life of CPR D-Padz electrode?

The CPR-D- padz (adult) electrodes have a 5 year shelf life. The Pedi Padz II (paediatric) has a

shelf life of 2 years.

How does the CPR D-Padz electrode measure the depth of compressions?

There is an accelerometer in the CPR puck that measures distance moved and the ‘Real CPR

Help’® algorithm converts compression data instantaneously and provides a metronome to

help the rescuer with the proper rate and depth with prompts like "Push harder" or "Good

Compressions".

After performing a manual self-test on the AED Plus, if it says "unit failed," what is the

NEXT thing that should be done?

Press the on-off button to turn the unit on; the unit should then prompt you to what the

problem is.

Do I have to wait for the entire picture LEDs to sequence before I can defibrillate?

No, the pictures do not stop you from immediately attaching the CPR D-padz electrode.

Once the electrodes are attached it will begin analysis automatically and will guide you

appropriately.

Can I defibrillate on a Wet surface?

Yes, as long as the usual safety rules are observed. Be sure the patient’s chest is wiped dry

and keep the electrode pads away from a damp or conductive surface.

Can I defibrillate on or near a metal surface?

Yes, as long as the usual safety rules are observed. Keep the electrode pads away from

contact with the conductive surface. Be sure not to allow anyone to touch the victim when a

shock is delivered.

Do I have to have an AED in my workplace? Is it law that you have to have an AED at

work? Why should I have an AED in my workplace?

There is no legal requirement for workplaces to have an AED. Workplaces with an ageing

workforce (there is more risk of cardiac arrest associated with this), or where high volumes

of public (of all ages) access the workplace, research shows that an AED in the workplace

can improve survival by up to 60% if the casualty is treated immediately.

Can an AED be used when it is wet or raining?

Yes, but care should be taken to ensure there is no direct contact between the user and the

casualty when the shock is delivered. It is important in this type of scenario that you dry the

casualty’s chest so that the adhesive AED pads will stick and give a good contact when a

shock is delivered.

What if I use an AED and make things worse by shocking someone that does not need

shocking?

It is impossible to shock someone that does not require it, as the device only shocks if the

person is in ventricular fibrillation or Ventricular tachycardia. You should consider that an

AED is only used on someone that is not breathing, unresponsive and shows no signs of life.

In reality you cannot make this condition worse.

Are AEDs dangerous unless used by a medical professional?

No; anyone can safely use an AED, even the untrained lay person or an emergency first aider

who witnesses a cardiac arrest, or who are nearby and can respond more quickly than the

ambulance service. The minutes saved are crucial and this strategy has been responsible for

saving many lives.

Should an AED be kept in a locked cabinet?

Given the importance of reducing to a minimum the time taken to administer a shock, it is

believed that no delays or constraints should be placed on any person willing to use an AED

nor should there be any physical barrier to restrict the immediate use of an AED such as a

locked cabinet. However, the cabinet you have been issued is ‘alarmed’, giving notice that

the AED is being accessed.

Could I kill someone if I try to defibrillate?

No; if someone is in cardiac arrest, in clinical terms they are already classed as dead. By

using an AED you increase their chances of survival. If a person is not in cardiac arrest the

device will not administer a shock.

ZOLL Fully Automatic AED Plus External Defibrillator · Chain of Survival - The Chain of Survival...

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