SOUTH LYNCHES FIRE DEPARTMENT
Document No.:
MED - 500.01
Approved:
March 15, 2005
Approved By:
Title:
AUTOMATED EXTERNAL DEFIBRILLATOR
(AED) PROGRAM - FLORENCE COUNTY
Supersedes:
August 14, 2000
Dr. Daniel E. DeCamp M. D.
A. INTRODUCTION
Defibrillation is only one aspect of the medical care required to resuscitate a patient with a
shockable EKG rhythm. Depending on the situation, other supportive measures may include:
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Cardiopulmonary Resuscitation (CPR)
Administration of Supplemental Oxygen
Drug Therapy
B. MEDICAL CONTROL
A physician shall serve as Medical Control for the AED program. The authorizing physician
assumes medical control and takes responsibility for the performance of the emergency care
providers. The authorizing physician shall issue standing orders/protocols, which are in effect
under the authority of the medical control director.
C. OPERATOR CONSIDERATIONS
The LifePak 500 AED is intended for use by personnel who are authorized by a
physician/medical director and have, at a minimum, the following skills and training:
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CPR training
AED training equivalent to that recommended by the American Heart Association
Preference given to First Responder trained persons
Training in the use of the LifePak 500 AED, or other as applicable
D. GUIDELINES FOR USE
The LifePak 500 AED is to be used only on patients in cardiopulmonary arrest. The patient must
be unconscious, pulseless, and not breathing spontaneously before the device is used to analyze
the patient's EKG rhythm. The device is not intended for on children less than eight years of
age.
I
E. QUIK-COMBO ELECTRODES
The AED uses disposable Quik-Combo defibrillation/EKG electrodes with or without the REDIPAK preconnect system. The use of Quik-Combo electrodes allows rapid transfer of care to
other devices that also use Quik-Combo electrodes, such as Physio Control's LifePak 10
monitor/defibrillator.
F. SHOCK WARNING
The rescuer must always state loudly a "clear the patient" message such as: "I'm clear. You're
clear. Everybody clear", or simply "Clear", before pressing the shock control.
G. COORDINATION BETWEEN ACLS PERSONNEL AND AED USERS
The following guidelines are suggested for the interface between ACLS personnel and personnel
using AEDs.
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ACLS-trained and authorized providers should have authority over the patient
transferred to them after initial contact has been established with the AED users.
On arrival, ACLS-trained providers should ask for a quick report from the AED user,
and then direct them to proceed with their protocol. This is particularly applicable
when ACLS-trained providers are unfamiliar with the operation of the AED.
ACLS-trained providers should consider the shocks delivered by the AED user as part
of their ACLS protocols. For example, if the patient remains in ventricular
fibrillation after three (3) shocks by the AED, then the ACLS provider should enter
the ACLS ventricular fibrillation treatment sequence at the point at which the first
three shocks have been delivered.
The AED should be removed and a conventional monitor/defibrillator attached only
when clinically convenient, provided that the AED is operable and performing as is
should.
H. POSTRESUSCITATION CARE
Once an AED user team completes its protocol, several things could happen. No matter what the
outcome, patient care remains paramount. If the patient regains a pulse, the AED/resuscitation
team will continue to provide supportive care with one or a combination of the following:
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Proper airway control and ventilatory management
Supplemental oxygen, if available
Appropriate airway clearance if vomiting occurs
Continued monitoring of vital signs
Physical stabilization and transport
Continued support while awaiting the arrival of ACLS provider team
II
I. TRANSFER OF PATIENT TO EMS/ACLS WITH OTHER DEVICE
The Quik-Combo electrodes allow rapid transfer of care to the devices that also use Quik-Combo
electrodes. To transfer the patient from the LifePak 500 AED to another device:
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Turn off the power to the LifePak 500 AED.
Disconnect the Quik-Combo electrodes from the LifePak 500 AED. Leave the
electrodes on the patient.
Connect the Quik-Combo electrodes to the Quik-Combo therapy on the next device.
J. CASE REVIEW and QUALITY ASSURANCE
Every event in which an AED is used must be reviewed by the medical director or designated
representative. This means that every incident in which CPR is performed must have a medical
review to establish whether the patient was treated in accordance with professional standards and
local standing orders/protocols.
The case-by-case reviews will be performed in two ways; by written/printed report and by the
memory of the AED which stores information about the usage event. Case reviews utilizing both
of these types provide more complete information.
Quality Assurance refers to both the microperformance, that is, the performance of personnel
involved in the treatment of individual patients; and the macroperformance, that is, the overall
effectiveness of a system using AEDs. Review of the treatment of an individual patient in
cardiac arrest can lead to identification of a problem in a system's training program.
K. TRAINING PROGRAM
The only pyschomotor skills required by an AED user involve recognition of a cardiac arrest,
proper attachment of the device, and adherence to the memorized treatment sequence. Learning
to use and operate an AED is easier than learning to perform CPR.
Initial training for AED operators will consist of the following:
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Completion of D.O.T. First Responder or equivalent course, including certification in
Cardiopulmonary Resuscitation (CPR) through the American Heart Association.
Completion of a training program on the Physio Control LifePak 500 using a
combination of manufacturer's recommended training programs and/or materials, as
well as the American Heart Association's AED training information.
Training will designed to ensure the most efficient care of the patient using the ECC/Chain of
Survival concepts. Trainees shall know how to interact between CPR and AED usage.
III
I.
USAGE OF A AED DEVICE
1. Indications
Patients who are pulseless, apneic, and 12 years of age or older and/or weigh more
than 90 pounds
2. Contraindications
The presence of breathing, pulse, or responsiveness.
3. Precautions
a. Ensure that the patient is pulseless before initiating AED usage.
b. Avoid direct contact with the patient while the defibrillator is analyzing or
defibrillating the patient.
c. Avoid contact with metal or other conductive materials.
d. Announce "Clear" and visualize that everyone is clear prior to defibrillating the
patient.
4. AED usage protocol
a. Establish unresponsive.
b. Check ABCs (Airway, Breathing, Circulation)
c. Begin CPR if indicated, until AED is ready for operation.
d. Ensure that the chest is dry, remove medication patches and jewelry, and shave
excessive hair if necessary.
e. Stop CPR and verify pulselessness.
f. Operate AED
1. Press "ON" to turn the AED on, green light will come on.
2. The "CONNECT ELECTRODES" message and voice prompt will occur until
the patient is connected.
3. Prepare for electrode placement.
 Place the patient on a hard surface away from water or conductive
material.
 Remove clothing from the patient's upper torso.
 Verify Step d above. If shaving is required, be careful not cut skin.
4. Apply the electrodes to the patient's chest.
 Place the electrode with the heart design lateral to the patient's left nipple
with the center of the electrode in the mid-axillary line, if possible.
 Place the other electrode on the patient's upper right torso, lateral to the
sternum and below the clavicle.
 Starting from one end, press the electrodes firmly onto the patient's skin.
5. Connect the electrode cable connector to the AED.
6. Follow the screen messages and voice prompts provided by the AED.
5. Shock Procedure (If Shock Advised)
a. Announce "Clear", visualize the area, and press "SHOCK".
b. Analyze.
c. If shock advised, announce "Clear" and press "SHOCK".
d. Analyze.
e. If shock advised, announce "Clear" and press "SHOCK".
f. Check. Pulse. If no pulse is present, perform CPR for one (1) minute.
g. Check pulse.
IV
h. If no pulse present, analyze.
i. If shock is advised , repeat steps 5.a -5h above.
j. AED users should continue to repeat the above until any of the following occurs:
 AED advises "NO SHOCK".
 Pulse is restored.
 Patient care is properly handed off to EMS personnel.
6. If "NO SHOCK" is advised at any time:
a. Perform CPR for one minute if patient remains pulseless.
b. Analyze
 If shock is advised continue CPR, follow protocol, and advise EMS of status.
J. SPECIAL SITUATION
1. When placing electrodes on the patient, be aware of the following special situations;
 Obese patients or patients with large breasts - Apply the electrodes to flat area on
the chest, if possible. If skin folds or breast tissue prevent good adhesion, spread
skin folds apart to create a flat surface.
 Thin patients - Follow the contour of the ribs and spaces when pressing electrodes
onto the torso. This limits air space or gaps under the electrodes and promotes
good skin contact.
 Patients with Implanted Pacemakers - If possible, place Quik-Combo electrodes
away from the internal pacemaker generator. Treat this patient like any other
patient requiring care. Pacemaker pulses may prevent advisement of an
appropriate shock, regardless of the patient's underlying rhythm.
 Patients with Implanted Defibrillators - Apply the electrodes in the anteriorlateral position. Treat this patient like any other patient requiring care.
History: August 14, 2000 - Update with new Medical Control Administrator approval.
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