Frequently Asked Questions about AEDs
What is the 3 Minute test?
Effective AED programs are designed to deliver shock within 3-5 minutes of collapse. Following are 3 tips to ensure you are able to provide help in time.
- When deciding where to place AEDs, use a 3 minute response time as a guideline to help you determine how many AEDs are needed and where to place them. The rule of thumb is 1 1/2 minutes to get to the AED, and 1 minute to return to the victim.
- Determine if there are places on site where the incidents of cardiac arrest may be higher such as fitness areas, areas used for sports, or areas that are hard to reach quickly. Other area to consider include those with quick access to stairways and exit doors, near trained responders, and with quick access to playground and athletic fields.
- Make sure your school has a mobile AED for school events away from campus.
Why do we need AEDs in the Community? Can't we just call 9-1-1?
AEDs are a very important part of the total response to sudden cardiac arrest in the community. Sudden cardiac arrest (SCA) is the leading cause of death in the U.S. and it claims approximately 365,000 lives in North America each year. Most commonly this sudden cardiac arrest, or stoppage of the heart, occurs because of an electrical event. Automatic External Defibrillators in the community allow us to get that shock into a patient quickly. So people, such as bystander or lay individuals, can give live-saving treatment and get that heart started again even before the emergency medical personnel can arrive. Survival is directly linked to the time interval between the SCA and the first AED shock delivered to the victim. Statistics validate that when a shock is delivered within one minute, survival rates can increase seventeen fold from 5% (by relying on EMS only to respond) to levels as high as 86% in some cases.2
Time is the most important element in saving an SCA victim. Even the best EMS systems have difficulty arriving "in time." They average nine minutes3 which is often "too late." Because AEDs can be used by nearly anyone, widespread deployment in public places, including; schools, businesses, airports and sporting events, gives SCA victims the best chance of survival. '
What is the 4 Step Chain of Survival?
The American Heart Association (AHA) recommends a specific four-step "Chain-of-Survival" for SCA. The hallmarks of this sequence which are well documented as dramatically increasing survival rates are:
- Early 911 Access - we need to get emergency responders on their way.
- Early Cardio-Pulmonary Resuscitation (CPR) - we want as many people as possible trained on CPR so they can keep the victim's blood flowing
- Early Defibrillation with an Automated External Defibrillator (AED) - once the blood is flowing, we want to defibrillate the patient or to shock that heart back into a rhythm that will sustain life. This supports the notion that these AEDs are readily available in our communities.
- Early Advanced Life Support (ALS) - as soon as the emergency medical personnel can arrive, they can start an IV, give medications, protect the airway, and get that victim to a hospital where more definitive care can be given.1
What are the Components of an Effective AED Program?
- Number of AEDs and Placement. Effective AED programs are designed to deliver a shock to the victim within 3 minutes of collapse. When deciding where to place AEDs, use a 3 minute response time as a guideline to help you determine how many AEDs you need and where to place them (one and a half minutes to get to an AED and 1 1/2 to return to the victim). Schools should determine if there are places on-site where the incidence of sudden cardiac arrest may be higher, such as fitness areas and areas used for sports, or areas that are hard to reach quickly. Also consider areas where many people gather such as gymnasiums, classrooms, cafeterias, and main offices. AEDs should be as visible and easily accessible as possible.
- Training. Make sure people know what their role is in a cardiac arrest situation. Have training for CPR and use of the Defibrillation equipment. Though the AED equipment is intuitive, when there is training on how to use the equipment, people feel more confident and they don't delay in initiating the intervention.
- Regular Preventative Maintenance of AED Equipment. Make sure all of the pieces are there and everything is working accordingly.
- Documentation. What are you doing, when are you doing it. Is everybody clear on the policies and procedures, and is everyone being kept up-to-date on how to respond in a critical situation.
Who can operate an AED?
Almost anyone can use an AED. Today's AED analyzes the victim's condition and, if necessary, delivers an electric shock to the heart to restore a patient's heart rhythm. It is not possible to deliver a shock to a patient if they don't need it. AEDs ONLY provide a defibrillating shock to the victim if the victim's heart rhythm meets SCA characteristics. So AEDs help those in that unique situation - and only provide therapy (or "shock") if the patient requires it. Trained clinicians use manual defibrillators.
Are AEDs easy-to-use?
AEDs are designed for use by virtually anyone with minimal training. Look for AEDs that provide text screens that run in tandem with voice prompts - especially important in chaotic, noisy environments. As well, an AED that provides audible CPR coaching will assist with setting the appropriate pace for proper chest compression. All of these features, of the AED, contribute to effectively manage and guide the rescuer through a stressful situation. Listen and do.
How to determine AED placement?
Effective AED programs are designed to deliver a shock to a victim within 3 to 5 minutes of collapse. When deciding where to place AEDs, use a 3-minute response time as a guideline to help you determine how many AEDs you need and where to place them -(One and a half minutes to get to an AED and 1 1/2 to return to the victim). Schools should determine if there are places on-site where the incidence of sudden cardiac arrest may be higher, such as fitness areas and areas used for sports, or areas that are hard to reach quickly. Also consider areas where many people gather, such as gymnasiums, classrooms, cafeterias and main offices. There are no right or wrong answers to these questions. Once you know the answers to these questions, it will be easier for you to decide where to place AEDs.4
How Can I Ensure my AED will be Ready in an Emergency?
- Schools should designate someone who is responsible for maintaining the AEDs. Refer to your AED user's manual for directions on daily and weekly scheduled maintenance.
- Provide a calendar with reminders for the individual responsible for maintaining the AEDs. Make it visible to all.
- Make sure your AED can perform daily self checks on battery, hardware, software, and pads (pads presence and function).
- Most AED batteries must be replaced at 4 years. It is important that the AED have a battery gauge so that the user (and individual in charge of maintaining the device) can see how much power remains in the AED battery.
What liability do schools incur by deploying AEDs?
All 50 states have Good Samaritan laws with language about AEDs. These laws typically involve three main elements: medical direction (a licensed physician to oversee your program), training, and record keeping/tracking (of device serial numbers and locations, battery expiration dates, etc.).
Additionally, the Cardiac Arrest Survival Act signed by President Clinton in 2000 provides AED users and acquirers with liability protection. In fact, with AEDs becoming common safety devices, schools could be at risk for not having these devices on site.
State and local requirements for AED programs play an important role in setting program constraints. Most states specify what type of responder training is expected, how to work with state and local EMS, and how to maintain or renew the AED program. Be aware of these key requirements as you start implementation:
- Most state laws require a state-licensed physician to act as a medical supervisor of the program.
- Most state laws require you to notify local EMS of AED programs or to register AED programs with local EMS.
- Most state laws require that responders complete a nationally recognized training CPR/AED course for lay responders. American Heart Association, American Red Cross and ECSI provide certified courses that can be completed in less than four hours.
Myth: You can accidentally over "shock" a victim, or shock them when they don't need it
Fact: AEDs will not administer "therapy" unless it assesses the victim requires it
Myth: You can hurt someone by administering defibrillation therapy
Fact: The victim is in cardiac arrest and is essentially dead; your only action is to administer the AED and CPR
Where specifically would we place our AEDs?
AEDs should be as visible and easily accessible as possible. Some areas you might consider are:
- At or near the front office
- Centrally located where most staff, students and guests gather
- Within quick access to stairways and exit doors
- Near your trained responders
- Within a gym or workout area
- In the cafeteria
- Near quick access to playgrounds and athletic fields
- Mobile AEDs are recommended for school events away from campus
What training is required?
In most cases, simple CPR and AED training is all that is required. For example, the American Heart Association offers the Heartsaver AED course, which can be completed in less than four hours. Training requirements vary from state to state.
What if we can only afford one AED but have a large school or many schools in our district?
Upon request, Cardiac Science will work with you to best deploy your AEDs based on your specific needs and budget. Of course, even one AED is much better than having none at all. We strongly encourage you to have one or more AEDs on hand.
How do we maintain our AEDs?
It is important to identify an individual within your school to be responsible for maintaining the AEDs. This person will confirm the devices are ready to use when a rescue is required, and will replace supplies as needed. Since every unit may be different, refer to your AED user's manual for specific directions on daily and weekly scheduled maintenance.
Following is a listing of suggested maintenance for your AED units.
- Replace Pads every 2 Years - Every AED in the market uses defibrillation pads with a water-based gel. The gel eventually dries up and pads must be replaced every two years regardless if they were used in a rescue. It is also important to have an AED that does daily self tests to ensure pads are plugged in and operable.
- Replace Batteries every 4 Years - Most AED batteries must be replaced at 4 years. It is important that the AED have a battery gauge so that the user (and individual in charge of maintaining the device) can see how much power remains in the AED battery. Cardiac Science Powerheart AEDs are the only AEDs that have a 4-year full operational guarantee on the battery.
- Create Maintenance Calendar - Provide a calendar with reminders for the individual responsible for maintaining the AEDs.
- Design AED Program - Ask your AED representative about Program Management services that give schools online access to an AED tracking system with email reminders that help ensure detailed records are kept and AEDs are maintained properly. This online software is not tied to a school's database or internal online systems. This way, records are not lost in the event of data system corruption or loss. In addition, program management services provide medical direction and CPR/AED training to ensure a comprehensive and successful AED program and to meet legal compliance.
- Documentation After Rescue - If the AED is used in a rescue, always contact your local AED representative and medical director to ensure AED data is downloaded and documented. Defibrillation pads should always be replaced after a rescue.
- Performance of Self-Checks - Make sure your AED can perform daily self checks on battery, hardware, software, and pads.
What is the Pediatric Emergency Assessment, Recognition, and Stabilization (PEARS) program?
PEARS was developed by the American Heart Association for people who do not deal frequently with critically ill children. They needed a program that would help providers know how to respond to critical first few minutes and feel confident in doing it, even if they don't do it every day. This program is well geared for school nurses and can help them to assess, categorize, decide, and act early to stabilize a child in severe cardiopulmonary distress.
3 Mosesso VN Jr, Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med. 1998;32:200-207.
4 American Heart Association AED Implementation Guide, 2004