ADMINISTRATIVE REGULATION - 5141
The following procedures should be implemented for the use of automated external defibrillators (AEDs).
An AED is used to treat victims who experience Sudden Cardiac Arrest (SCA) (see definition in next paragraph). It is only to be applied to victims who are unconscious, and without pulse, signs of circulation and normal breathing. The AED will analyze the heart rhythm and advise the operator if a shockable rhythm is detected. If a shockable rhythm is detected, the AED will charge to the appropriate energy level and advise the operator to deliver a shock.
Sudden Cardiac Arrest (SCA) is a condition that occurs when the electrical impulses of the human heart malfunction causing a disturbance in the heart's electrical rhythm called ventricular fibrillation (VF). This erratic and ineffective electrical heart rhythm causes complete cessation of the heart's normal function of pumping blood resulting in sudden death. The most effective treatment of this condition is the administration of an electrical current to the heart by a defibrillator, delivered within a short time of the onset of VF.
AED System Coordinators
The Irvine Unified District Coordinator of Health Services is the District AED Coordinator. Each site will designate their AED Site Coordinator.
Responsibilities of the District AED Coordinator
1. Monitor sites maintenance records and staff training reports to ensure compliance.
2. Liaison with each site coordinator and distributor to coordinate equipment purchase/replacement/repair.
3. Coorindate IUSD School Nurses in providing AED review offerings at each school site including non-student facilities annually.
4. Revision of the District AED procedure as required.
5. Ensure that instructions on how to use the AED are posted next to every AED. Instructions must be printed no smaller than 14-point type.
Responsibilities of the Site AED Coordinators
1. Coordination of equipment and accessory maintenance.
2. Determine placement of the AEDs in a secured location. The location of the AEDs on the school site must be approved by the District Coordinator.
3. Assign trained personnel for the Daily Readiness Status of the AED.
4. Annually notify school employees as to the location of all AED units on campus.
5. Maintain a file of specifications/technical information sheet for each approved AED model assigned to the school.
6. Coordinate the post-incident review to evaluate the effectiveness of Site AED Emergency Response.
Authorized AED Users
1. The new standars have eliminated training requirements for personnel who may need to use an AED (SB 658).
2. "Any person who, in good faith and not for compensation, renders emergency care or treatement by the use of an AED at the scene of an emergency is not liable for any civil damages resulting from any acts or omissions in rendering the emergency care." (California Civil Code 1714.21)
Location of AEDs
It is the goal of the district to have one AED at each elementary, two AEDs at the middle school sites, one AED at the district office, one AED at M&O, two AEDs at the Alternative Education site, and three AEDs at each comprehensive high school site. During school hours, the AEDs will be available at designated locations. These locations shall be specific to each K-8 school site, but should allow the device to be easily seen by staff adjacent to the Health Office. The locations should allow staff members to retrieve the device during normal school/office hours. At each middle school site, it is the goal of the district to locate one AED adjacent to the school's Health Office, and one AED at or near the Physical Education locker room area. At each comprehensive high school site, it is the goal of the district to locate one AED adjacent to the school Health Office, one in the gymnasium, and one with each athletic trainer as a traveling AED.
Authorized Automatic External Defibrillators
The District approved AED will be identified by the District AED Coordinator. This product was determined through the request for proposal (RFP) process. There will be only one manufacture's model allowed as part of the Irvine Unified School District AED Program.
Procedure for Routine Maintenance of AEDs
1. The AED will perform a self-diagnostic test every 24 hours that includes a check of battery strength and an evaluation of the internal components.
2. As described in the California Health and Safety Code § 1797.196: "The defibrillator is maintained and regularly tested according to the operation and maintenance guidelines set forth by the manufacturer, the American Heart Association, and the American Red Cross, and according to any applicable rules and regulations set forth by the governmental authority under the Federal Food and Drug Administration and any other applicable state and federal authority."
3. The AED Site Coordinator and assignees will perform a monthly AED check for rescue readiness and record the results. The copy of the record will be sent to the District AED Coordinator at the end of each month.
4. If electrodes or battery is near expiration, notify District AED Coordinator.
5. Each AED will have a set of electrodes connected to the device. One resuscitation kit will be connected to the AED device. This kit will contain two pair of non-latex gloves, one razor, scissors, and one facemask barrier device.
Procedure Following the Use of the AED
1. Initiate the retrieval of data from the AED's memory.
2. Restock all necessary AED supplies.
3. Clean AED according to manufacturer's recommendations.
Medical Response Documentation
It is important to document each use of the emergency response system. An accident/incident report must be completed. If the victim was a student, documentation must be completed in the health record.
Post Event Review
Following an emergency response where an AED was used, a review shall be conducted to learn from the experience. The AED Site Coordinator or designee shall conduct and document the post-event review. The District and Site Coordinator and all key participants in the event shall participate in the review. Included in the review shall be the identification of actions that went well and the collection of opportunities for improvement. Emotional support and/or counseling may be suggested for those involved in the incident.
Use of the AED
1. Assess the scene for safety and activate the AED Emergency Response Site Plan.
2. Determine the responsiveness of the victim. If unresponsive, activate Emergency Medical System (EMS) by calling 911.
a. Give location of the victim and, if possible, designate a person to wait for EMS to direct them to the victim.
b. Assess the victim: airway, breathing, and circulation.
c. Initiate CPR while the AED is brought to the victim and placed on the victim's left side near the head.
3. A responder should not use the AED if he/she suspects the victim is younger than eight years old, or weighs less than 55 pounds. If available and the AED is equipped with pediatric defibrillator electrode pads, a trained responder can use the AED with children who show no signs of circulation as young as one year of age.
a. Turn the power ON.
b. Uncover and prepare the chest for AED use.
c. Attach the defibrillation electrode pads to the victim and to the AED device.
d. Follow verbal prompts given by the AED. Stop CPR when directed by the AED prompt while the AED analyzes the heart rhythm.
e. If SHOCK is advised, follow the machine prompts for action. Be sure all rescuers are "clear" and no one is touching the victim before shock is delivered (say out loud, "I am clear, you are clear, everybody is clear"). Push "shock" button when instructed. After shock is delivered, check for signs of circulation. If no signs of circulation, continue CPR. The AED will continue to monitor the patient's heart rhythm during CPR. Continue to follow the machine's prompts.
f. If NO SHOCK is advised: If no signs of circulation, continue CPR. If pulse is present, check breathing. If victim is not breathing or breathing abnormally, start rescue breathing. AED will continue to analyze the heart rhythm.
g. Continue cycles of analysis, shocks (if advised) and CPR until EMS arrives. Continue CPR until EMS rescuer tells you to stop. Victim must be transported to the hospital by EMS. Leave AED attached to the victim; EMS will disconnect the AED.
4. Assist EMS as directed until they take complete charge of the victim. Provide EMS with information about the victim: name, age, any known medical problems, and the time of the incident. Also provide information as to current condition and number of shocks administered.
5. Notify the Site Administrator who will make the necessary reports to District Administration.
6. Notify the District AED Coordinator about the incident.
7. Notify Parent/Guardian if victim is a student.
8. Notify relative or other responsible party for victims other than students.
9. Following each incident, send completed forms (accident/incident reports) to Risk Manager, District Insurance Office.
10. Document in student health record.
Event Summary Form
Immediately after an event, the responder is required to complete an event summary form. The actual form is included with this administrative policy. At a minimum, the event summary will have the responder complete the following questions:
Was the event witnessed?
Was bystander CPR initiated?
What is the location of event?
Was internal response plan activated? If yes, time of activation?
What was the arrival time at patient's side with AED?
What is the name of the AED rescuer?
What is the name of the 911 caller?
What is the name of the CPR rescuer?
What are the names of bystanders?
What was the condition of the victim at the time of transport?
Was counseling/emotional support provided?
32040-32044 First Aid equipment
49300-49307 School safety patrols
49407 Liability for treatment
49408 Emergency information
49409 Athletic events; physicians and surgeons; emergency medical care; immunity
49470 Medical and hospital services for athletic program
49471 Medical and hospital services not provided or available
49472 Medical and hospital services for pupils
49474 Ambulance services
51202 Instruction in personal and public health and safety
Health and Safety Code
1797.196 Automatic external defibrillators, immunity from civil liability
American Heart Association: http://www.americanheart.org
American Red Cross: http://redcross.org
California Department of Health Services: http://dhs.ca.gov
Revised: May 4, 2010