1. Rev. Dec 121 Loudoun County AED Program AED AED Teamwork* Integrity* Professionalism* Service*

2. Objectives Rev. Dec 122 Teamwork* Integrity* Professionalism* Service* Identify the function and anatomy of the heart Properly operate the AED Integrate AED into CPR/scene management Identify any special circumstances that impact AED use Maintaining and identifying problems associated with the AED

3. Rev. Dec 12 3 Definition “Defibrillation is the delivery of an electric current through the chest wall and heart for the purpose of terminating ventricular fibrillation or pulseless ventricular tachycardia and restoring a perfusing rhythm.” Teamwork* Integrity* Professionalism* Service*

4. 4 A & P of the Heart A network of specialized tissue, capable of conducting electrical current, runs throughout the heart muscle. As electrical impulses travel through this network, coordinated contractions of the heart muscle occur. Rev. Dec 12 Teamwork* Integrity* Professionalism* Service*

5. Rev. Dec 12 5 Electrical Pathway Sinoatrial Node (SA) Sinoatrial Node (SA) Atrioventricular Node (AV) Atrioventricular Node (AV) Bundle of His Bundle of His Bundle Branches Bundle Branches Purkinje Fibers Purkinje Fibers Teamwork* Integrity* Professionalism* Service*

6. Rev. Dec 126 Heart Function Electrical Electrical impulses through the heart. Evaluated with ECG monitor. An electrical rhythm does not mean there is a pulse! Mechanical Mechanical Actual pumping of the heart. Evaluated by checking pulse. Teamwork* Integrity* Professionalism* Service*

7. Rev. Dec 127 Shockable Rhythms Pulseless Ventricular Tachycardia (VT) may be the initial rhythm for a patient in cardiac arrest. Ventricular Fibrillation (VFib) is the most frequent rhythm present when a patient is found in cardiac arrest. Ventricular Fibrillation is a useless quivering of the heart that results in no blood flow, therefore no pulse. Early Defibrillation is the only effective treatment for Ventricular Fibrillation. AEDs shock Pulseless Ventricular Tachycardia (VT) and Ventricular Fibrillation (V Fib). Teamwork* Integrity* Professionalism* Service*

8. Rev. Dec 128 Shockable Rhythms Ventricular Fibrillation Pulseless Ventricular Tachycardia Teamwork* Integrity* Professionalism* Service*

9. Rev. Dec 129 The absence of any electrical impulse is called Asystole Teamwork* Integrity* Professionalism* Service*

10. Rev. Dec 1210 AEDs and Ventricular Fibrillation/ Pulseless Ventricular Tachycardia Defibrillation “shocks” the heart in an effort to restore normal electrical activity of the heart. Defibrillation “shocks” the heart in an effort to restore normal electrical activity of the heart. Defibrillation is the only effective treatment for VF/Pulseless VT, once the patient’s pump has been primed Defibrillation is the only effective treatment for VF/Pulseless VT, once the patient’s pump has been primed The ability to successfully defibrillate a patient into a normal rhythm diminishes rapidly over time. Teamwork* Integrity* Professionalism* Service*

11. Rev. Dec 1211 AEDs used by Loudoun County Fire & Rescue Companies Lifepak 1000 Lifepak 12 Teamwork* Integrity* Professionalism* Service* Lifepak 15

12. Rev. Dec 12 12 AED Components/Accessories AED with Battery AED with Battery Pediatric and Adult Pads Pediatric and Adult Pads Razor Wash cloth Spare batteries & Paper (for LP 12 only) Teamwork* Integrity* Professionalism* Service*

13. Rev. Dec 1213 Authorized Use of AED Granted to locally authorized FR, EMT, Advanced EMT, I/P Granted to locally authorized FR, EMT, Advanced EMT, I/P Active member of OEMS EMS Licensed Agency authorized to operate in Loudoun County Active member of OEMS EMS Licensed Agency authorized to operate in Loudoun County Current BLS – AHA Healthcare Provider Current BLS – AHA Healthcare Provider Recertification every 12 months Recertification every 12 months Teamwork* Integrity* Professionalism* Service*

14. Rev. Oct 0914 Indications for Use Standing Order – Cardiac Arrest Standing Order – Cardiac Arrest Pulseless and Apneic of any age Pulseless and Apneic of any age Teamwork* Integrity* Professionalism* Service*

15. Presumptive Death (DOA) Criteria Criteria Decomposition Decomposition Lividity or dependent pooling of blood Lividity or dependent pooling of blood Obvious mortal injury that is inconsistent with life Obvious mortal injury that is inconsistent with life Rigor mortis Rigor mortis Presence of a Virginia Durable Do Not Resuscitate (DDNR) order Presence of a Virginia Durable Do Not Resuscitate (DDNR) order If in doubt, begin resuscitation and contact medical control for guidance If in doubt, begin resuscitation and contact medical control for guidance Rev. Dec 12Teamwork* Integrity* Professionalism* Service* 15

16. Rev. Decd 12 16 Scene Safety/BSI Make sure that the environment is safe. Make sure that the environment is safe. Is the patient laying in water? Is the patient laying in water? Do you need to move the patient before starting care? Do you need to move the patient before starting care? It is not safe to defibrillate in a moving ambulance! It is not safe to defibrillate in a moving ambulance! Teamwork* Integrity* Professionalism* Service*

17. Rev. Dec 1217 CPR Procedure Patient is found pulseless and apneic or unresponsive: Patient is found pulseless and apneic or unresponsive: Procedures: Procedures: Look for signs of breathing…if none perform a pulse check for 5-10 seconds, if no pulse start CPR w/ compressions Look for signs of breathing…if none perform a pulse check for 5-10 seconds, if no pulse start CPR w/ compressions Perform CPR while attaching AED patches Perform CPR while attaching AED patches Turn on AED and analyze rhythm immediately Turn on AED and analyze rhythm immediately Teamwork* Integrity* Professionalism* Service*

18. Two Possible Scenarios Shockable Rhythm Shockable Rhythm After shock, immediately resume CPR After shock, immediately resume CPR Switch providers for compressions along with analyzing Switch providers for compressions along with analyzing Must have 3 consecutive prior to transport Must have 3 consecutive prior to transport Non-shockable Rhythm Non-shockable Rhythm Must have 3 consecutive prior to transport Must have 3 consecutive prior to transport Rev. June 0818

19. Rev. Dec 1219 “I’m Clear” “You’re Clear” “Everybody is Clear” “Shocking Now” While visually checking to make sure that no one is touching patient! Teamwork* Integrity* Professionalism* Service*

20. Rev. Dec 1220 Attaching AED to Patient Teamwork* Integrity* Professionalism* Service*

21. Rev. Dec 12 21 Effective Adherence of Pads Sweaty chest Dry with a towel Do not use alcohol Hairy chest Shaving may be needed Ultimate goal is to have complete skin contact. Teamwork* Integrity* Professionalism* Service*

22. Rev. Dec 1222 Sternum-Apex Position Sternum: Right Pad is placed below the right clavicle and to the right of the Sternum above the nipple. Apex: Left Pad is placed on the lower left ribs in the midaxillary line. Teamwork* Integrity* Professionalism* Service*

23. Electrode Placement Correct electrode position optimizes the amount of current flowing through the ventricles Correct electrode position optimizes the amount of current flowing through the ventricles Correct electrode positionIncorrect electrode position Teamwork* Integrity* Professionalism* Service* Rev. Dec 12 23

24. Pediatric Patient Use the AED1000 with adult pads on children older than 8 years old or more than 55 lbs (25kg) Use the AED 1000 with Pediatric Reduced Energy Defibrillation Pads on children 1 to 8 years old or 55 lbs (25kg) or less. Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 24

25. Pediatric Patient With Pediatric Pads, energy from the AED 1000 is reduced by a factor of 4 Approximately 50-75-86 Joules is delivered if the AED1000 is set at 200- 300-360 Joules Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* Attenuated (reduced energy) Pediatric Pads 25

26. Pediatric Patient Pediatric pads supplied for the LP1000 are not compatible with the LP12 or 15. Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 26

27. Pediatric Patient Place the Pediatric pads in the anterior- lateral position (same locations has adult pads) Rev. Oct 09 Teamwork* Integrity* Professionalism* Service* 27

28. Anterior/Posterior Position May be used if: May be used if: Adult pads on a pediatric patient if no pediatric pads are avail Adult pads on a pediatric patient if no pediatric pads are avail Child is small and pads will be within 1” of each other Child is small and pads will be within 1” of each other Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 28

29. Medtronic LifePak 12 or 15 Rev. Oct 09Teamwork* Integrity* Professionalism* Service* 29

30. Rev. Dec 1230 CONNECT ELECTRODES message and voice prompt occur until the patient is connected to the therapy cables Clear patient than push analyze button Teamwork* Integrity* Professionalism* Service* After confirming a Cardiac Arrest turn AED on

31. Rev. Dec 1231 Do not touch or move the patient or therapy cables during analysis. The AED requires 6-9 seconds to fully analyze the patient’s rhythm Allow machine to complete the analysis Never override the machine Teamwork* Integrity* Professionalism* Service*

32. Rev. Dec 1232 Allow machine to charge Do not over ride system Say “I’m clear” “Your clear” “Everyone’s clear” “Shocking now” Prior to pushing the shock button Teamwork* Integrity* Professionalism* Service*

33. Rev. Oct 0933 Lifepak has identifies an non-shockable rhythm Check carotid artery AED will count down 2 minutes of CPR Do not override the countdown Push Analyze when prompted Teamwork* Integrity* Professionalism* Service*

34. Medtronic Lifepak 1000 34 Teamwork* Integrity* Professionalism* Service* Rev. Dec 12

35. Lifepak 1000 Operations Confirm Cardiac Arrest Turn on AED Attach Pads AED will immediately began to analyze If AED detects a shockable rhythm machine will ask “If you witnessed the arrest push cancel” If AED has detected a non-shockable rhythm no prompt will be given start CPR for 2 minutes Follow prompts of the machine Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 35

36. Check for Pulse You may be prompted to check for a pulse after a no shock advised decision. YES and NO soft keys appear on the screen If patient does not have a pulse, press the NO soft key and CPR time begins If patient has pulse, press the YES soft key The 1000 will prompt the user to provide rescue breaths, if needed The 1000 enters continuous monitoring state Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 36

37. Rev. Dec 1237 If you do get a pulse, Assess the quality of the pulse. Assess the quality of the pulse. Assess and/or support breathing. Assess and/or support breathing. Check the patient’s blood pressure. Check the patient’s blood pressure. Do not turn off the AED or remove pads. Contact medical control. Contact medical control. Teamwork* Integrity* Professionalism* Service*

38. Rev. Dec 1238 Call Medical Control & Prepare to Transport ….. Maximum of 3 shocks with 2 minutes of CPR between shocks are delivered*. Three (3) “No Shock Advised” scenarios Patient regains a Pulse! Teamwork* Integrity* Professionalism* Service*

39. Rev. Dec 12 39 While enroute... If patient loses a pulse enroute… STOP AMBULANCE STOP AMBULANCE Reanalyze Reanalyze Continue with procedures as usual Continue with procedures as usual Contact receiving hospital with updated information Contact receiving hospital with updated information Teamwork* Integrity* Professionalism* Service*

40. Rev. Dec 12 40 Documentation Electronic PPCR – Report assessment findings Complete AED usage section Code summary (LP12). Teamwork* Integrity* Professionalism* Service*

41. SpecialSituations Rev. June 0841 Teamwork* Integrity* Professionalism* Service*

42. Special Situations Medication patches Medication patches Artificial pacemakers Artificial pacemakers Automated internal cardiac defibrillators (AICDs) Automated internal cardiac defibrillators (AICDs) Traumatic arrests Traumatic arrests Rev. Oct 09Teamwork* Integrity* Professionalism* Service* 42

43. Rev. Dec 1243 Medication Patches Aluminum backing or the medium is reactive. Aluminum backing or the medium is reactive. Patch either heats up or ignites. Patch either heats up or ignites. Expose the patient and remove ALL patches before defibrillation. Expose the patient and remove ALL patches before defibrillation. Wipe any medication off the chest. Wipe any medication off the chest. Use gloves when you remove it. Teamwork* Integrity* Professionalism* Service*

44. Rev. Oct 0944 Automated Internal Cardiac Defibrillator (AICD) In patients with recurrent arrhythmias. In patients with recurrent arrhythmias. If found on the right Do not place the pad on the AICD. If found on the right Do not place the pad on the AICD. It’s presence does not preclude attaching and using an AED. It’s presence does not preclude attaching and using an AED. Teamwork* Integrity* Professionalism* Service*

45. Rev. Dec 1245 Artificial Pacemakers Pulse generator and wires to the heart. Pulse generator and wires to the heart. Usually found on the left side of the cheat. Usually found on the left side of the cheat. If found on the right Do not place the pad over the pacemaker. If found on the right Do not place the pad over the pacemaker. A direct shock to the pacemaker could cause it to reprogram. A direct shock to the pacemaker could cause it to reprogram. Teamwork* Integrity* Professionalism* Service*

46. Rev. Dec 1246 Trauma & Obvious Death AED should not be attached to a patient that is obviously dead. AED should not be attached to a patient that is obviously dead. Signs of incompatible with life, e.g., rigor mortis, etc. Signs of injuries incompatible with life AED may be attached to a trauma patient in cardiac arrest since the cardiac arrest may have caused the trauma. AED may be attached to a trauma patient in cardiac arrest since the cardiac arrest may have caused the trauma. Teamwork* Integrity* Professionalism* Service*

47. Batteries of the AED Rev. Dec 1247 Teamwork* Integrity* Professionalism* Service

48. LP 1000 Battery The 1000 is powered by a nonrechargeable lithium manganese dioxide battery pak Battery pak fuel gauge indicates battery’s charge level Fully charged battery: all green lights illuminated Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 48

49. LP 1000 Battery Low battery: single steady green light Empty battery: single flashing green light Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 49

50. LP 1000 Battery The approximate level of charge in the battery appears on the readiness display when the 1000 is off Battery low: battery symbol has one bar Battery empty: battery symbol has no bars When low it cannot be replaced on the scene Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 50

51. LP 12 and 15 Batteries Rev. Dec 1251 The LP 12 and 15 Batteries are powered by lithium ion battery pak and are rechargeable Battery pak fuel gauge indicates battery’s charge level Fully charged battery: all green lights illuminated Can be replaced when low and will not interrupt the operation of the AED Teamwork* Integrity* Professionalism* Service*

52. Troubleshooting and Maintenance of the AED Rev. Dec 1252 Teamwork* Integrity* Professionalism* Service*

53. “Connect Electrodes” Message Possible causes: Electrodes are not adhered to the patient’s skin Electrodes are disconnected What to do Firmly press electrode onto the skin Check to be sure connector is completely inserted into the AED Clean, shave and dry the skin Replace the electrode pads If prompt continues, perform CPR until ALS arrives Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 53

54. Motion detected, stop motion” Possible causes: Patient movement due to: breathing, CPR being performed during analysis, some internal pacemakers, vehicle motion, or electrical/radio frequency interference What to do: Check patient for normal breathing Stop CPR during analysis Stop vehicle during analysis Move communication or other suspected devices away from AED when possible Teamwork* Integrity* Professionalism* Service*Rev. Oct 09 54

55. “Replace Battery” Possible causes: Battery pak has exceeded specified “on time” and/or energy discharges What to do: LP 1000 Continue to use during resuscitation LP 12/15 Obtain a replacement battery Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 55

56. Maintenance Symbol If the 1000 requires service, the wrench symbol appears If the wrench is visible, remove the 1000 from service and contact authorized service personnel Rev. Oct 09 Teamwork* Integrity* Professionalism* Service* 56

57. Maintenance Daily Auto Test (LP 1000 only) The 1000 performs automatic tests daily at 3:00 AM OK symbol visible: AED is ready for use Daily Auto Test will test for low or replace battery conditions Battery gauge on the readiness display updates every day Rev. Oct 09 Teamwork* Integrity* Professionalism* Service* 57

58. Maintenance Self-test Each time the 1000 is manually turned on, it performs internal self-tests to check that the internal electrical components and circuits work properly Also indicates a low or replace battery condition LP 12/15 does not provide this option Rev. Oct 09 Teamwork* Integrity* Professionalism* Service* 58

59. Routine Maintenance On a periodic basis check the following: OK symbol is visible on LP1000 Battery gauge level on LP 12/15 Use-by date on electrode pads has not passed Other emergency supplies stored with the unit are present (e.g., face masks, gloves, razors, etc.) Damage to or foreign substances Teamwork* Integrity* Professionalism* Service*Dev. Oct 09 59

60. Recommended Corrective Actions Wrench symbol visible: contact authorized service personnel Battery symbol visible: replace if low battery indicated Use-by date passed: replace electrode packet Supplies missing: replenish as needed Damage noted: contact authorized service personnel Foreign substance visible: clean with damp sponge or cloth with recommended cleaning agents Teamwork* Integrity* Professionalism* Service * Rev. Oct 09 60

61. After-use Care After the AED has been used: Clean off foreign substances Replace electrodes Replenish supplies as needed Check battery symbol for battery status and replace battery if low Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 61

62. Rev. Dec 1262 Review Questions Teamwork* Integrity* Professionalism* Service*

63. Rev. Dec 1263 Disorganized twitching of the ventricle in which no blood goes to the body is called: Ventricular Fibrillation Teamwork* Integrity* Professionalism* Service*

64. Rev. Dec 1264 What age range does the Semi-Automated External Defibrillation (AED) protocol allow the cardiac arrest patient to be treated with an AED? Patients who appear to be one (1) year of age or older Teamwork* Integrity* Professionalism* Service *

65. Rev. Dec 1265 Prior to ceasing resuscitation methods all providers will contact the appropriate LHC-Med Control. What are the two instances when immediate contact should be made? Valid DNR is discovered after CPR has begun Injuries/circumstances preclude the safe continuation of CPR efforts Teamwork* Integrity* Professionalism* Service*

66. Rev. Dec 1266 When using the LP 1000, after one shock with the AED, your next step is to __________. Start CPR/2 minutes of CPR Teamwork* Integrity* Professionalism* Service*

67. Rev. Dec 1267 Before delivering a shock, you must say, “________” while looking around the patient. I’m clear, your clear, we are all clear… Shocking now. Teamwork* Integrity* Professionalism* Service*

68. Rev. Dec 1268 When Should the Anterior- Posterior Pad Placement Site be Utilized? If the electrodes touch in the sternum-apex position Teamwork* Integrity* Professionalism* Service*

69. Rev. Dec 1269 The absence of any electrical rhythm in the heart is called ___________. Asystole Teamwork* Integrity* Professionalism* Service*

70. Rev. Dec 1270 As a First Responder, EMT/AET/I/P in Loudoun County, you are granted STANDING ORDERS to deliver ______ total shocks. 3 Teamwork* Integrity* Professionalism* Service*

71. Rev. Dec 1271 Does Hypothermia, overdose and/or drowning effect how a resuscitation is performed? Yes If may prolong the efforts and should be made identified to Medical Control early in the resuscitation. Teamwork* Integrity* Professionalism* Service*

72. Rev. Dec 1272 In a witnessed cardiac arrest if you had a choice between initiating CPR or connecting the AED, which should you do first? Attach the AED and follow the prompts Teamwork* Integrity* Professionalism* Service*

73. Rev. Dec 12 73 Are the pediatric AED electrodes used in a Lifepak 1000 the same as those used by a medic operating a Lifepak 12? No They are not compatible, and when an ALS provides arrives they will need to replace the pads from the Lifepak 1000 with their Lifepak 12 pediatric pads Teamwork* Integrity* Professionalism* Service *

74. Rev. Dec 1274 The primary locations for the placement of the electrodes of the AED on an adult patient is ___ and _____. Apex and Sternum Teamwork* Integrity* Professionalism* Service*

75. Rev. Dec 1275 What is age range to consider using pediatric pads? Intended for use on children 1 to 8 years of age or up to 25kg (55lb). Teamwork* Integrity* Professionalism* Service*

76. Rev. Dec 1276 One of three things must occur which trigger contacting Medical Control and preparing to transport the patient connected to the AED. They are: 3 shocks are given 3 consecutive no-shock advised Return of spontaneous pulse Teamwork* Integrity* Professionalism* Service*

77. Rev. Dec 1277 You are transporting a patient in the ambulance when the patient collapses into cardiac arrest. What do you do? Stop the ambulance, start CPR, attach the AED, and initiate rhythm analysis Teamwork* Integrity* Professionalism* Service*

78. Rev. Dec 1278 A patient for whom resuscitative measures have been terminated should be transported to which facility? LHC- Cornwall or LHC –Lansdowne ER If ALS procedures have been performed the ALS- AIC shall accompany the body to the ER Teamwork* Integrity* Professionalism* Service*

79. Rev.. Dec 12 79 You arrive to assist a patient in cardiac arrest who has an Automatic Implanted Cardiac Defibrillator (AICD). What should you do?. Attach AED and proceed as normal attempting to avoid the AICD. Teamwork* Integrity* Professionalism* Service*

80. Rev. Dec 12 80 The sternum pad is placed just below the right _____ clavicle Teamwork* Integrity* Professionalism* Service*

81. Rev. Dec 12 81 A 25 year old man is found lying in water on the deck of a backyard pool. He is unresponsive, not breathing, and pulseless. CPR is being performed as you prepare to use an AED. What should be the next steps? Remove the patient from the water, wipe the chest dry and then attach the AED pads firmly to the chest *Remember the provider scene safety, and to assure they are not standing in water nor the patient lying in a puddle of water. Teamwork* Integrity* Professionalism* Service *

82. Rev. Dec 12 82 Questions or Comments? Teamwork* Integrity* Professionalism* Service *