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Home My WebLink AboutMINUTES - 01182005 - C68 Contra TO: BOARD OF SUPERVISORSCosta r _ ':• FROM: INTERNAL OPERATIONS COMMITTEE i DATE: DECEMBER 20, 2004 • County SUBJECT: PROPOSAL TO EQUIP SHERIFF'S PATROL VEHICLES WITH AUTOMATED EXTERNAL DEFIBRILLATORS SPECIFIC REQUEST(S)OR RECOMMENDATIONS)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS 1. ACCEPT status report on the possible deployment of automated external defibrillators (AEDs) in Sheriff patrol vehicles. 2. SUPPORT and ENCOURAGE community donations to help fund the placement of AEDs in public places. 3. DIRECT the County Counsel to provide an opinion to the Internal Operations Committee as to whether there are any laws that govern the use of defibrillators by law enforcement or the division of responsibilities between law enforcement and emergency response personnel when responding to police and medical emergencies. CONTINUED ON ATTACHMENT: YES SIGNATURE: R OMMENDATION OF COUNTY ADMINISTRATOR =T(GCOMMEND)TINOF BOARD COMMITTEE PPROVE OTHER SIGNATURE(S): GAYLE B-.111LKEMA, CHAIR MARK DeSAULNIER ACTION OF BOARD O APPROVE AS RECOMMENDED OT ER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT vee` COPY OF AN ACTION TAKEN AND ENTERED UNANIMOUS(ABSENTc ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN AYES: NOES: ATTESTED: JANUARY 18,2005 ABSENT: ABSTAIN: JOHN SWEETEN,9LERK OF THE BOARD of SUPERVISORS AND COUN ADMINISTRATOR CONTACT: JULIE ENEA(925)335-1077 BY ,DEPUTY CC: INTERNAL OPERATIONS COMMITTEE STAFF DR.JOSEPH BARGER,HSD-EMS MEDICAL DIRECTOR SHERIFF-CORONER COUNTY COUNSEL Deployment of Defibrillators in Sheriff Patrol Vehicles December 20, 2004 Internal Operations Committee Page 2 BACKGROUND On December 9, 2003, the Board of Supervisors referred to the Internal Operations Committee the study of equipping Sheriff's patrol vehicles with automated external defibrillators (AEDs). On October 18, 2004, the Internal Operations Committee received the attached staff report on the use of automated external defibrillators in public buildings and in law enforcement vehicles and received testimony from the Sheriff's Department, which expressed concerns over the practicality of deploying defibrillators in Sheriff's vehicles. The Sheriffs concerns included the manner in which medical calls are currently dispatched, the training requirement for Sheriff's deputies, the medical choice between using a defibrillator or administering CPR, the cost of equipment and training, and the equitable deployment of devices within the communities. The Committee considered the possibility of implementing a pilot program and asked for a presentation from the Health Services Department on the County's Public Access Defibrillation Program. On December 20, 2004, Dr. Joe Barger, EMS Medical Director, met with the IOC to discuss the Public Access Defibrillation Program managed by the Health Services Department. Dr. Barger explained that of the 300 to 400 emergency calls related to heart attacks to which they respond, the survival rate averages from 10% to 15%. Every minute that passes while a person is in cardiac arrest results in a 10% degradation of his/her chance of survival. The Health Services Department has attempted to respond to the need for fast response through a program of equipping public buildings such as churches and schools with AEDs. The Department has 42 AEDs which will be refurbished and made available soon for distribution to local agencies. While the Sheriff has concerns over the proposal to equip patrol vehicles with AEDs, he is supportive of the Health Services Department's program to place the devices in public places. In response to the Sheriffs concerns over the deployment of AEDs in patrol vehicles, the IOC requests that the County Counsel study the laws related to the issue and report any findings to the IOC. County of Contra Costa OFFICE OF THE COUNTY ADMINISTRATOR MEMORANDUM DATE: October 13, 2004 TO: INTERNAL OPERATIONS COMMITTEE: Gayle B. Uilkema, Chair Mark DeSaulnier, Member FROM: JULIE ENor Deputy CAO .1 SUBJECT: EQUIPPING ERIFF PATROL VEHICLES WITH PORTABLE IBRILLATORS On December 9, 2003, the Board of Supervisors referred to the Internal Operations Committee the study of equipping Sheriffs emergency response vehicles with defibrillators. As the referral was made late in the year, it was referred to the 2004 IOC for study. To assist the Committee in examining the possible deployment of defibrillators in sheriff patrol vehicles, staff researched the issue on the Internet and contacted the Town of Moraga, which has AEDs in its police cars. Following is some information gathered from that research. Conce t Police and other law enforcement officers can play a vital role in fighting a major killer— sudden cardiac arrest. The public safety arsenal is expanding to include automated external defibrillators (AEDs) to give anyone struck down by sudden cardiac arrest another chance at life. AEDs deliver a lifesaving pulse of electricity to restore a person's normal heartbeat. Every minute counts. Typically, only five to ten percent of people struck down by sudden cardiac arrest survive. However, if AED shock is administered within three minutes of collapsing, the survival rate can increase to 74%. Reducing response time by even one or two minutes from collapse to shock can mean the difference between death and survival. Police officers, particularly patrol officers, are often the first responders to an emergency scene because their vehicles are already en route. In remote parts of unincorporated Contra Costa County, this is particularly true. Equipping sheriff patrol vehicles with AEDs could save lives that might otherwise be lost due to sudden cardiac arrest. ' Defibrillators in Sheriff Vehicles October 13, 2004 Internal Operations Committee Page 2 In addition to saving lives, the AEDs can give early warning of heart disease and heart attacks, as it collects vital information during an emergency that can be used by treating physicians. Ease of Use AEDs are designed to be safely and easily used by anyone with minimal training. The AED analyzes the heart's rhythm and advises whether a shock is needed. Therefore, delivering a defibrillation shock requires very little decision making on the part of the rescuer. Officer Safety Concerns Staff interviewed Darrell Lee, Reserve Officer of the Moraga Police Department and EMS Coordinator/Paramedic with Moraga/Orinda Fire District, regarding the town's use of AEDs. The Moraga Police Department has had AEDs in all of its patrol cars for about six years. When asked what he had learned from the implementation process and what he would recommend to other agencies, he emphasized simplicity and officer safety. It is important to make the protocol simple and easy to use for an officer. He also stressed that officer safety should always be the first consideration. Officers must always be certain that the scene is safe before employing the AED. In high crime areas, that might mean having two officers on the scene—one to administer defibrillation and one to maintain security of the scene. An officer using a defibrillator without backup could be in a vulnerable position. Coordination with EMS Depending on how AEDs are deployed, the process for dispatching officers with AEDs would require close coordination between Sheriffs Dispatch and local EMS/Fire. Consolidated communications dispatch with simultaneous deployment of the closest law enforcement and EMS units is the ideal, but not necessary. If the County were to deploy AEDs in sheriff patrol vehicles, protocols for emergency response would need to be clarified and coordinated. Physician Oversight The County has a Public Access Defibrillation Program which assigns defibrillators to public agencies within the County that agree to establish or participate in the Program. Physician oversight for that program is provided by Dr. Joseph Barger of the Health Services Department. The physician's main duties in this regard are to: ■ Provide medical leadership and expertise ■ Serve as an advocate and spokesperson for the program ■ Coordinate the program with the local EMS 1 Defibrillators in Sheriff Vehicles October 13, 200 Internal Operations Committee Pa ge9,2> ■ Ensure rescuers are properly trained and their skills maintained ■ Assume responsibility for how the program is planned and conducted Legal Liability Concerns The County Counsel has not yet been asked to opine on the legal liability risks associated with equipping sheriff vehicles with defibrillators. Staff gathered the following information through research, but recommends that County Counsel be consulted before any deployment of defibrillators in sheriff vehicles is initiated. Good Samaritan laws in all 50 states grant civil immunity to people who use an AED in an emergency, but not all laws cover people acting in the line of duty. In 2002, AB 2041 (copy attached) was passed and adopted (Civil Code Chapter 718) providing immunity from civil liability to a person or entity that acquires an AED for emergency use and renders emergency care, if that person or entity complies with all regulations governing the placement of an AED and ensures all of the following: ■ That the AED 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. ■ That the AED is checked for readiness after each use and at least once every 30 days if the AED has not been used in the preceding 30 days. Records of these checks shall be maintained. ■ That any person who renders emergency care or treatment on a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible, and reports any use of the AED to the licensed physician and to the local EMS agency. ■ For every AED unit acquired up to five units, no less than one employee per AED unit shall complete a training course in cardiopulmonary resuscitation and AED use that complies with the regulations adopted by the Emergency Medical Service Authority and the standards of the American Heart Association or the American Red Cross. After the first five AED units are acquired, for each additional five AED units acquired, one employee shall be trained beginning with the first AED unit acquired. Acquirers of AED units shall have trained employees who should be available to respond to an emergency that may involve the use of an AED unit during normal operating hours. ■ That there is a written plan that describes the procedures to be followed in the event of an emergency that may involve the use of an AED, to ensure compliance with the requirements of this section. The written plan shall include, but not be limited to, immediate notification of 911 and trained office personnel at the start of AED procedures. I Defibrillators in Sheriff Vehicles October 13, 2004 Internal Operations Committee Pagel!14- Other applicable regulations require involvement of a licensed physician in developing a program to ensure compliance with regulations and requirements for training, I notification, and maintenance. This is sometimes referred to as "physician oversight. Costs Program costs might include: • AEDs ($2,500 - $3,000 per unit) • Peripheral equipment (about $75 per device) • Maintenance (about $100 per device) • Insurance? • Training costs • Program management costs • Event documentation costs • Quality assurance costs Most of these costs are notcurrentlybudgeted and new funding would need to be identified to implement such a program. Strategic Deglovment Ideally, if the County were to deploy defibrillators in sheriff vehicles, we would equip every patrol unit with an AED and train every officer to use it. Due to the expense of such a proposal and the time it would take to implement such a large deployment, the County might want to consider a phased approach, first placing AEDs in vehicles that patrol the densely populated areas and remote areas that are harder for EMS teams to reach. 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(2) Authorize the Health Services Emergency Medical Services Agency to assign these defibrillators to public agencies within the county agreeing to establish or participate in a Public Access Defibrillation Program. FISCAL.IMPACT; No County General Fundimpact. Medtronic Physio-Control has agreed to provide these defibrillators to the County for$1,400 each for a total cost of$58,800. This cost will be covered by CSA EM-1 (Measure H). BACKGROUND: For the past two years,Medtronic Physio-Control has placed 42 CR Plus automatic defibrillators on first responder units in fire service agencies in Contra Costa County as part of a vendor-sponsored product evaluation. (Note that these units were approved by the Federal Drug Administration and were publicly available prior to being placed on first responder units.) The purpose of the product evaluation was to enable the vendor to collect detailed data on product performance in the'field.'Naw that the product evaluation has been completed,the first responder units that participated in the evaluation will resume use of the Medtronic Physio-Control LifePak 500 defibrillators used by first responders countywide. Public Access Defibrillation(PAD) is now recognized as an effective community program to save lives of sudden cardiac arrest victims. A study published in the August 11,2004 New England Journal of Medicine reaffirmed the American Heart Association's position supporting community-based lay rescuer programs that include both cardiopulmonary resuscitation(CPR)and automated,external defibrillation(AED). The CR Plus is an ideal unit for use by lay rescuers. The units proposed for purchase are in like-new condition and have been used under close supervision by the EMS Agency and by the vendor. Medtronic Physio-Control is making these units available to the County for purchase at$1,400/unit, a$799/unit savings from the$2,199 new purchase -price. The EMS Agency is developing a program that will provide defibrillators and initial training to public agencies within the county agreeing to participate in a ongoing Public Access Defibrillation program. Priority in selection of participants in the Public Access Defibrillation program will go to locations serving large numbers of the public,to agencies agreeing to ongoing training and maintenance of equipment, and to establishing programs in all regions of the county. CONTINUED ON ATTACHMENT: YES SIGNATURE: -------------------------------- -------- RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COM61TTEE APPROVE OTHER SIGNATURE(S): -- ------------------------------ ----- ACTION OF BOARD ON APPROVE AS RECOMMENDED OTHER VOTE OF SUPERVISORS r CALIFORNIA AED LAW The following is a summary containing relevant portions of the law(s). This material is not intended as legal advice and may contain inaccurate or incomplete information. I Background On July 23, 1999, the Governor of the State of California signed Senate Bill 911 ("Legislation" below) which "grants Good Samaritan protections to uncompensated AED users". This supplements Section 1714.21 of the Civil Code, and adds Section r 1797.196 to the Health and Safety Code. In addition, regulations for training and use of AEDs ("Regulation" below) are set forth in the California Code of Regulations, Title 22 (Social Security), Division 9 (Prehospital Emergency Medical Services), Chapter 1.8 "Training Standards for Use of the Automated External Defibrillator by Non-Licensed or Non-Certified Personnel". AED Definition The Legislation defines an AED as"an automated or automatic external defibrillator." The Regulations define an AED as"an external defibrillator capable of cardiac rhythm analysis which will charge and,with or without further operator action, deliver a shock after electronically detecting and assessing ventricular fibrillation or rapid ventricular tachycardia.These devices are known as fully or semi-automatic defibrillators." Use Compliance Requirements The Legislation states that"In order to ensure public safety, any person who acquires an AED shall do all of the following: 1. Comply with all regulations governing the training, use, and placement of an AED. 2. Notify an agent of the local EMS agency of the existence, location, and type of AED acquired. 3. Ensure all of the following: 4. That expected AED users complete a training course in cardiopulmonary resuscitation and AED use that complies with regulations adopted by the Emergency Medical Services(EMS) Authority and the standards of the American Heart Association or the American Red Cross. 5. That 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. 6. That the AED is checked for readiness after each use and at least once every 30 days if the AED has not been used in the preceding 30 days. Records of these periodic checks shall be maintained. 7. That any person who renders emergency care or treatment on a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible, and reports any use of the AED to the licensed physician and to the local EMS agency. 8. That there is involvement of a licensed physician in developing a program to ensure compliance with regulations and requirements for training, notification, and maintenance." The Regulation states that"Prescribing physician""means a physician and surgeon, licensed in California,who issues a written order for the use of the automated external defibrillator to authorized individual(s), and who develops, implements,and maintains"medical control. The Regulation states that"'Before prescribing and authorizing the use of an AED,the prescribing physician shall establish appropriate policies and procedures which shall include: 1. A description of the utilization of the AED, including written protocols which may include, but are not limited to,authorization of personnel, standing orders and case by case reviews. 2. provisions to comply with any local EMS agency's policies and procedures; 3. a mechanism for the training and testing of the authorized individual in the use of the AED; 4. a mechanism that will ensure the continued competency of the authorized individual to include periodic training, and skill proficiency demonstrations at least quarterly, monitored by either the prescribing physician,or his/her designee(which may be another authorized individual); 5. a method of medical control to include reviews of each incident of application and the recording of such, either by means of magnetic tape or other suitable storage; 6. the conditions for the recission or termination of the authorization for the utilization of the AED." The Regulation states that"'the prescribing physician shall issue the authorized individual a written validation or other documented proof of the authorized individual's ability to use an AED." Training Requirements The Legislation states that an individual or entity that acquires an AED must complete"'a basic CPR and AED use course that complies with regulations adopted by the Emergency Medical Services(EMS) Authority and the standards of the American Heart Association or the American Red Cross for CPR and AED use" The Regulation states that""an individual shall be eligible for the training prescribed...if the person has been trained in CPR, and has demonstrated proficiency in CPR practices to the satisfaction of the prescribing-physician." The Regulation states that"the training shall consist of not less than four(4) hours, presented in two(2) sessions, preferably over a period of at least two days, and shall include the following topics and skills: s 1. proper use, maintenance and periodic inspection of the AED; 2. the importance of: 3. CPR, 4. defibrillation, 5. advanced life support, 6. internal emergency response system; 7. overview of the local EMS system, including 9-1-1 access, and interaction with EMS personnel; 8. information relating to defibrillator safety precautions to enable the individual to administer shock without jeopardizing the safety of the patient or the authorized individual or other nearby persons; 9. recognition that an electrical shock has been delivered to the patient and that the defibrillator is no longer charged; 10. rapid, accurate assessment of the patient's post-shock status to determine if further activation of the AED is necessary; and, 11. authorized individual's responsibility of continuation of care, such as the repeated shocks if necessary,and/or accompaniment to the hospital, if indicated, or until the arrival of more medically qualified personnel. The Regulation also states that"in order for an individual to be authorized to use the AED,the individual shall pass a written and skills examination,to be determined by the prescribing physician,which tests the ability to assess and manage the specified conditions"described in the section about Training. Liabili The Legislation states that a trained user who"in good faith and not for compensation, renders emergency care or treatment by the use of an AED at the scene of an emergency shall not be liable for any civil damages resulting from any acts or omissions in rendering the emergency care." Additionally, "a person or entity who provides CPR and AED training to a person who renders emergency care...shall not be liable for any civil damages resulting from any acts or omissions of the person rendering the emergency care." "A physician who is involved with the placement of an AED and any person or entity responsible for the site where an AED is located shall not be liable for any civil damages resulting from any acts or omissions of a person who renders emergency care..." "The protections specified in this section shall not apply in the case of personal injury or,wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED." . r t BILL NUMBER: AB 2041 CHAPTERED BILL TEXT CHAPTER 718 FILED WITH SECRETARY OF STATE SEPTEMBER 20, 2002 APPROVED BY GOVERNOR SEPTEMBER 20, 2002 PASSED THE ASSEMBLY AUGUST 28, 2002 PASSED THE SENATE AUGUST 27, 2002 AMENDED IN SENATE AUGUST 22, 2002 AMENDED IN SENATE AUGUST 14, 2002 AMENDED IN ASSEMBLY APRIL 16, 2002 INTRODUCED BY Assembly Member Vargas FEBRUARY 15, 2002 An act to amend Section 1714.21 of the Civil Code, to amend Section 1797.190 of, and to amend, repeal, and add Section 1797.196 of, the Health and Safety Code, relating to liability. LEGISLATIVE COUNSEL'S DIGEST AB 2041, Vargas. Liability: emergency care. Existing law provides immunity from civil liability to any person who completes a basic cardiopulmonary resuscitation (CPR) or automatic external defibrillator (AED) course that complies with regulations adopted by the Emergency Medical Services (EMS) Authority and the standards of the American Heart Association or the American Red Cross, and who, in good faith, renders emergency care by the use of an AED at the scene of an emergency, without the expectation of receiving compensation for providing the emergency care. This bill would revise those provisions by deleting the requirement that a person complete a basic CPR or AED course. The bill would further provide immunity from civil liability to a person or entity that acquires an AED for emergency use and renders emergency care, if that person or entity is in compliance with specified requirements. Existing law authorizes the EMS Authority to establish minimum standards for AED use and training by unlicensed or uncertified individuals. Existing law requires specified persons to meet those standards. This bill would expand the authorization to establish standards and would delete the requirement that specified persons meet those standards. This bill would also require that the supplier of an AED notify the local EMS authority of the existence, location, and type of AED acquired, and provide to the acquirer specified information governing the use and maintenance of the AED. The bill would additionally require certain persons or entities that have acquired an AED to ensure employee training in CPR and AED use, as specified, and to follow particular emergency safety procedures. The bill would specify that the above requirements shall remain effective until January 1, 2008. r THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1714.21 of the Civil Code is amended to read: 1714.21. (a) For purposes of this section, the following definitions shall apply: ' (1) "AED" or "defibrillator" means an automated or automatic external defibrillator. (2) "CPR" means cardiopulmonary resuscitation. (b) Any person who, in good faith and not for compensation, renders emergency care or treatment 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. (c) A person or entity who provides CPR and AED training to a person who renders emergency care pursuant to subdivision (b) is not liable for any civil damages resulting from any acts or omissions of the person rendering the emergency care. (d) A person or entity that acquires an AED for emergency use pursuant to this section is not liable for any civil damages resulting from any acts or omissions in the rendering of the emergency care by use of an AED, if that person or entity has complied with subdivision (b) of Section 1797.196 of the Health and Safety Code. (e) A physician who is involved with the placement of an AED and any person or entity responsible for the site where an AED is located is not liable for any civil damages resulting from any acts or omissions of a person who renders emergency care pursuant to subdivision (b) , if that physician, person, or entity has complied with all of the requirements of Section 1797.196 of the Health and Safety Code that apply to that physician, person, or entity. (f) The protections specified in this section do not apply in the case of personal injury or wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED. (g) Nothing in this section shall relieve a manufacturer, designer, developer, distributor, installer, or supplier of an AED or defibrillator of any liability under any applicable statute or rule of law. SEC. 2. Section 1797.190 of the Health and Safety Code is amended to read: 1797.190. The authority may establish minimum standards for the training and use of automatic external defibrillators. SEC. 3. Section 1797.196 of the Health and Safety Code is amended to read: 1797.196. (a) For purposes of this section, "AED" or "defibrillator" means an automated or automatic external defibrillator. (b) In order to ensure public safety, any person or entity that acquires an AED is not be liable for any civil damages resulting from any acts or omissions in the rendering of the emergency care under subdivision (b) of Section 1714.21 of the Civil Code, if that person or entity does all of the following: (1) Complies with all regulations governing the placement of an AED. (2) Ensures all of the following: (A) That the AED is maintained and regularly tested according to the operation and maintenance guidelines set forth by the , r 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. (B) That the AED is checked for readiness after each use and at least once every 30 days if the AED has not been used in the preceding 30 days. Records of these checks shall be maintained. (C) That any person who renders emergency care or treatment on a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible, and reports any use of the AED to the licensed physician and to the local EMS agency. (D) For every AED unit acquired up to five units, no less than one employee per AED unit shall complete a training course in cardiopulmonary resuscitation and AED use that complies with the regulations adopted by the Emergency Medical Service Authority and the standards of the American Heart Association or the American Red Cross. After the first five AED units are acquired, for each additional five AED units acquired, one employee shall be trained beginning with the first AED unit acquired. Acquirers of AED units shall have trained employees who should be available to respond to an emergency that may involve the use of an AED unit during normal operating hours. (E) That there is a written plan that describes the procedures to be followed in the event of an emergency that may involve the use of an AED, to ensure compliance with the requirements of this section. The- written plan shall include, but not be limited to, immediate notification of 911 and trained office personnel at the start of AED procedures. (3) Building owners ensure that tenants annually receive a brochure, approved as to content and style by the American Heart Association or American Red Cross, which describes the proper use of an AED, and also ensure that similar information is posted next to any installed AED. (4) No less than once a year, building owners will notify their tenants as to the location of AED units in the building. (c) Any person or entity that supplies an AED shall do all of the following: (1) Notify an agent of the local EMS agency of the existence, location, and type of AED acquired. (2) Provide to the acquirer of the AED all information governing the use, installation, operation, training, and maintenance of the AED. (d) A violation of this provision is not subject to penalties pursuant to Section 1798.206. (e) The protections specified in this section do not apply in the case of personal injury or wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED. (f) Nothing in this section or Section 1714.21 shall be construed to require a building owner or a building manager to acquire and have installed an AED in any building. (g) This section shall remain in effect only until January 1, 2008, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2008, deletes or extends that date. SEC. 4. Section 1797.196 is added to the Health and Safety Code, ti (Coauthors: Senators Alarcon, Morrow, Peace, Perata, Rainey, Schiff, Sher, and Solis) (Coauthors: Assembly Members Baugh, Cardoza, Davis, Havice, Maddox, Romero, Torlakson, Washington, Wildman, and Zettel) I FEBRUARY 25, 1999 An act to add Section 1714.21 to the Civil Code, and to add Section 1797.196 to the Health and Safety Code, relating to emergency care. LEGISLATIVE COUNSEL'S DIGEST SB 911, Figueroa. Emergency care: automatic external defibrillator: acquisition and liability. Existing law provides immunity from civil liability to any person who, in good faith and without compensation or the expectation of compensation, renders emergency care at the scene of an emergency. Existing law expressly provides immunity from civil liability to any person who completes a designated cardiopulmonary resuscitation (CPR) course and who, in good faith, renders emergency cardiopulmonary resuscitation at the scene of an emergency, without the expectation of receiving compensation for providing the emergency care. This bill would provide immunity from civil liability to (1) any person who, in good faith and not for compensation renders emergency care or treatment by the use of an automated external defibrillator at the scene of an emergency, has completed a basic CPR and automated external defibrillator (AED) use course that complies with regulations adopted by the Emergency Medical Services (EMS) Authority and the standards of the American Heart Association or the American Red Cross for CPR and AED use, (2) a person or entity who provides CPR and AED training to a person who renders emergency care pursuant to (1) , and (3) a physician who is involved with the placement of an AED and any person or entity responsible for the site where an AED is located if that physician, medical authority, person, or entity has complied with certain requirements. The bill would provide that its protections shall not apply in the case of personal injury or wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED. Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, authorizes the Emergency Services Authority to establish minimum standards for the training and use of automatic external defibrillators by individuals not otherwise licensed or certified for the use of the device. This bill would require any person who acquires an automatic external defibrillator to comply with specified requirements in the bill. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. It is the intent of the Legislature that an automated external defibrillator may be used for the purpose of saving the life of another person in cardiac arrest when used in accordance with Section 1714.21 of the Civil Code. SEC. 2. Section 1714.21 is added to the Civil Code, to read: 1714.21. (a) For purposes of this section, the following definitions shall apply: (1) "AED" or "defibrillator" means an automated or automatic external defibrillator. (2) "CPR" means cardiopulmonary resuscitation. (b) A person who has completed a basic CPR and AED use course that complies with regulations adopted by the Emergency Medical Services (EMS) Authority and the standards of the American Heart Association or the American Red Cross for CPR and AED use, and who, in good faith and not for compensation, renders emergency care or treatment by the use of an AED at the scene of an emergency shall not be liable for any civil damages resulting from any acts or omissions in rendering the emergency care. (c) A person or entity who provides CPR and AED training to a person who renders emergency care pursuant to subdivision (b) shall not be liable for any civil damages resulting from any acts or omissions of the person rendering the emergency care. (d) A physician who is involved with the placement of an AED and any person or entity responsible for the site where an AED is located shall not be liable for any civil damages resulting from any acts or omissions of a person who renders emergency care pursuant to subdivision (b) if that physician, person, or entity has complied with all requirements of Section 1797.196 of the Health and Safety Code that apply to that physician, person, or entity. (e) The protections specified in this section shall not apply in the case of personal injury or wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED. (f) Nothing in this section shall relieve a manufacturer, designer, developer, distributor/ installer, or supplier of an AED or defibrillator of any liability under any applicable statute or rule of law. SEC. 3. Section 1797.196 is added to the Health and Safety Code, to read: 1797.196. (a) For purposes of this section, "AED" or "defibrillator" means an automated or automatic external defibrillator. (b) In order to ensure public safety, any person who acquires an AED shall do all of the following: (1) Comply with all regulations governing the training, use, and placement of an AED. (2) Notify an agent of the local EMS agency of the existence, location, and type of AED acquired. (3) Ensure all of the following: (A) That expected AED users complete a training course in cardiopulmonary resuscitation and AED use that complies with regulations adopted by the Emergency Medical Services (EMS) Authority and the standards of the American Heart Association or the American Red Cross. (B) That 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. (C) That the AED is checked for readiness after each use and at least once every 30 days if the AED has not been used in the preceding 30 days. Records of these periodic checks shall be maintained. (D) That any person who renders emergency care or treatment on a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible, and reports any use of the AED to the licensed physician and to the local EMS agency. (E) That there is involvement of a licensed physician in developing a program to ensure compliance with regulations and requirements for training, notification, and maintenance. (c) A violation of this provision shall not be subject to penalties pursuant to Section 1798.206. J00 a t ht4 v 1" S r,� t i A J he third shock,her heart started right up.By then,the paramedics I knew she was doing all right when she started arguing with them." C?f cer john.Hannah,Rye Police,New York YOUR GUIDE TO PUTTING A HEART SAFE AED PROGRAM IN PLACE Police and other law enforcement officers have a vital role to play in fighting a major killer—sudden cardiac arrest(SCA).The public safety arsenal is expanding to include automated external defibrillators(AEDs) to give anyone struck down by SCA another chance at life! Sudden cardiac arrest can happen anywhere,anytime--to people of all ages in all walks of life,including law enforcement officers.An electrical malfunction that makes the heart quiver in a deadly rhythm called ventricular fibrillation (VF) usually causes sudden cardiac arrest.A lifesaving pulse of electricity is the single most effective way to restore the heart's normal rhythm. Every minute counts.Typically,only S to 10 percent of people struck down by SCA survive.But if people in VF get the lifesaving AED shock within 3 minutes of�collapsing,the survival rate can increase to 74 percent.' .Reducing response time by even 1 or 2 minutes from collapse to shock can mean the difference between death and survival.2 In Miami-Dade County,equipping police officers with AEDs nearly doubled the survival rate from sudden cardiac arrest for people in VF.3 As you can see,it could be a matter of life and death to have AEDs within easy reach of law enforcement officers who are trained to use them.Who's often first on the scene in an emergency? • Police officers,sheriff's deputies and highway patrol,whose units are .. on the road while fire trucks and ambulances may be parked at the station or transporting patients • Correctional officers responding to incidents involving prisoners and fellow officers long before EMS makes its way within a secured facility o Specialty police,such as search and rescue,treasury agents and SWAT teams,operating in remote,undercover and dangerous situations Communities recognize the benefit of equipping patrol units,police precincts, jails and prisons with lifesaving AEDs.Because early defibrillation is becoming the standard of care in many communities,the public will increasingly expect officers to arrive on the scene not only with their radios and firearms,but with AEDs as well. No two law enforcement agencies or facilities will implement an AED program in exactly the same way.This guide outlines steps to help you tailor a program that works for your situation. *Although not everyone can be saved from sudden cardiac arrest,studies show that early defibrillation can dramatically improve survival rates. Law Enforcement AED Implementation Guide To help ensure success,put someone in charge of coordinating your efforts. Be sure to cover these bases: GET READY LJ Assign a project coordinator U Champion the idea and gain consensus U Review laws and regulations or consult your agency's legal counsel or risk manager L) Coordinate with local emergency medical services(EMS) GET SET 'Q Arrange for medical direction U Plan how to dispatch AED-equipped officers Z- 1 Choose your equipment and vendor L) Design policies and procedures D Assess how many AEDs you'll need and where they'll do the most good -J Develop and fund a budget for equipment,training and PR (public relations) -:1 Train officers and plan for refresher training GO L) Acquire and deploy AEDs and other supplies -:1 Promote your program to raise awareness and support D Build quality assurance into your operation At Medtronic,we're here to help every step of the way.A team of AED specialists is available for consultation as needed.Call your sales consultant at 1-800-442-1142 or visit www.aedhelp.com. ............... ",the defibrillator successfully was a damn good feeling,but it's an }the feeling to stop by Adele's house and see she's doing just fine." Officerjohn Hannah.,Rye Police,New York CHAMPION THE IDEA AND GAIN CONSENSUS To implement a successful early defibrillation program,you'll need support from the top of your organization and from the rank and file.It helps to have a strong champion for your program.Of course you'll want backing from top management such as the police chief,sheriff or superintendent and from union leadership,if possible.But don't overlook other key players,such as your community's emergency medical services(EMS)team,communications center leadership,and your agency's legal counsel and risk manager.Early in the 2 Law Enforcement AED Implementation Guide process,form a cross-functional team representing the many areas that will be touched by the program,from planning to operations.Arrange a meeting so people can air their concerns and you can build support among decision makers. Winning political approval can also make the program more successful.The mayor,city council and county commissioners not only hold the purse strings, but may champion the program,especially if they have a personal reason to do so,such as losing a family member to SCA or heart attack in a situation where medical response was delayed.If your program needs approval at the polls,you'll want to target voters.Presentation materials are available to help spread the word about how AEDs can help guardians of public safety make a difference between life and death. automatic external defibrillators by police officers could result in saving of countless lives...,4 International Association of Chiefs of Police REVIEW LAWS AND REGULATIONS AEDs are designed to be safely and easily used by anyone with minimal training. The AED analyzes the heart's rhythm and advises whether a shock is needed. Therefore,delivering a defibrillation shock requires very little decision-making on the part of the rescuer.Still,law enforcement agencies are concerned about their liability for acquiring and using AEDs.In the United States,the Cardiac Arrest Survival Act of 2000 encourages placement of AEDs in federal buildings— including prisons—and offers federal liability protection for users,purchasers and trainers of AEDs. Good Samaritan laws in all 50 states grant civil immunity to people who use an AED in an emergency,but not all laws cover people acting in the line of duty. W Because court decisions,laws and regulations regarding AED use vary H •.'''` "'}{ '`." depending on your locale,your legal and risk management staff will be your best 2.0 I A 0 M 22 resources for advising you in setting up and running your program.They may put to rest any concerns and point out that as AED use is becoming the standard of care,communities may risk liability for failing to provide defibrillation as part of emergency response. Typically,AED laws and regulations require: • Training to operate an AED • Coordination with the emergency medical service in your community • Medical direction • Record-keeping for each use of an AED El Regular maintenance of the equipment For more information regarding state laws pertaining to AED use,contact your sales consultant or visit www.aedhelp.com For a summary of AED state laws in the U.S.,see: http://www.aedhelp.com/legal/downloads/aed legislation summary.pdf Law Enforcement AED Implementation Guide 3 COORDINATE WITH LOCAL EMERGENCY MEDICAL SERVICES(EMS) Early defibrillation by a first responder such as a police or corrections officer is just one link in the"Chain of Survival"defined by the American Heart Association,which requires: 1) Early recognition and reporting of emergencies like cardiac arrest 2) CPR initiated quickly by bystanders Survival rote5 will suffer d ooed 3) Early defibrillation by the first responders,such as law enforcement, without crinat response to cardiac fire,or ambulance crew emergency call-5 and 4) Advanced cardiac life support by medical professionals to stabilize timely bond-off to EMS. the victim o _0 6 ................ As you can see,a law enforcement officer trained and equipped with an AED -level response system,which includes CPR by plays a vital role in the multi bystanders,defibrillation and basic life support by first responders,and advanced life support b medical professionals.In many locations,notifying the 'AW y local emergency medical services(EMS)system that you have AEDs is a requirement when you implement an AED program.In,addition to being a partner in dispatch for cardiac emergencies,EMS can provide guidance on equipment choice and placement,training-and medical direction.To ensure seamless delivery of care,it's essential to have clear protocols for smooth hand- off to EMS from the responding law enforcement officer.To download a sample form for notifying EMS if your AEDs are located in a building or other fixed location,go to www.aedhelp.com. ARRANGE FOR MEDICAL DIRECTION Although AEDs are designed for use by anyone with minimal training,ing,the U.S. Food and Drug Administration classifies them as medical devices that can't be purchased without a prescription from a physician.This physician often also serves as the"medical director"of an AED program.He or she is not expected to be on the scene of AED use,but provides ongoing medical oversight. The medical director provides the"standing orders"rescuers should follow when using an AED in a medical emergency.The physician may sign off on training plans and policies and procedures,update them to take into account new treatment recommendations,evaluate data recorded on an AED during a medical emergency,and help assess each use of an AED to suggest any improvements.Many states require medical authorization and documentation in order for legislation to cover an AED program. Law Enforcement AED Implementation Guide If you have a good working relationship with your local EMS,they can be very helpful in this area. In fact,the EMS medical director may be willing to act as yours also.This is ideal.If you are not well coordinated with EMS or prefer to branch out on your own,medical direction may be provided by: • An interested physician in the community or local hospital • A physician employed by your agency • The basic medical oversight programs available from Medtronic PLAN HOW TO DISPATCH AED-EQUIPPED OFFICERS How you dispatch officers with AEDs will require close coordination with your local emergency medical services(EMS)system.Survival rates will suffer3. without coordinated response to cardiac emergency cans and timely hand-off to medical professionals who can provide advanced life support.Consolidated communications dispatch with simultaneous deployment of the closest law enforcement and EMS units is the ideal,but not necessary.How your jurisdiction handles it depends on your existing communications center.It's ' essential that all response agencies coordinate their protocols,and continue to fine-tune procedures once officers with AEDs are being deployed. Good screening protocols will help communications centers ensure efficient and rapid deployment of AED-equipped officers.Several screening methods,known as Emergency Medical Dispatch(EMD),have been effective in medical call screening.EMD may assist your agency in managing the types of calls that AED-equipped officers respond to,and increase coordination with your existing EMS system.EMD requires additional training for dispatchers.At a minimum, your dispatch protocols should be specific and clearly identify medical problems your that will trigger an AED response from your agency. Seek the odivce Of local EMS and progl'007 If your agency uses mapping technology,you can add the locations of AEDs in 9 -ector regarding medical dit the community to the system and assist in call screening and response. Should 07e type of AEDs to buy. someone without knowledge of the AED program call for help,the dispatcher can let the caller know the location of the nearest AED. Other technologies, such as Automated Vehicle Location(AVL)devices,can also enhance the efficient use of AED-equipped police vehicles by allowing the closest unit to respond. CHOOSE YOUR EQUIPMENT AND VENDOR Because of their experience and knowledge,your local EMS and program medical director can be very valuable in advising you regarding the type of AEDs to buy.Additionally,make sure you ask about the reputation of the vendor for reliability,durability and ongoing support.Selecting a single brand of AED will greatly simplify training and maintenance. Important considerations include: • Reputation of the AED manufacturer for product quality and customer service • Compatibility with the equipment of local EMS • Easy operation,with clear voice prompts Law Enforcement AED Implementation Guide 5 t ti ❑ Biphasic technology with capability to adjust shocks and energy levels to match the victim's needs ❑ Defibrillation electrodes that are pre-connected to save precious seconds ❑ Maintenance-free batteries ❑ Dlr c ' e t field service team for on-site repairs L) Validated computer-based refresher training ❑ Data collection and management software :w LIFEPAK AEDs from Medtronic are ideal for infrequent users,since voice and visual prompts guide users through operation.Automatic self-testing and an r always-visible readiness display help assure the device is ready to go.Medtronic a {,'` •z:ti4 �r d offers several services needed to implement an AED program including:medical A K« � prescription,medical direction and oversight,training,post-event data ............... download and data review.For more information visit: .;: http://physiocontrol.cons/products/heartsafe.cfm. h DESIGN POLICIES AND PROCEDURES--AND KEEP IMPROVING THEM Medtronic Physio-Control The groundwork you laid earlier will pay off as you develop policies and LIFEPAK CR Plus and LIFEPAK 500 AEDs procedures that mesh smoothly with existing public safety duties and your local EMS system.If a state or national accreditation or certification program accredited your agency,be sure to check whether equipping your officers with AEDs affects any standards.As with other policies and procedures,those relating to AEDs will require periodic updating as laws and regulations change, as best medical practices evolve,and as you learn from your own experience using AEDs. Be sure to include: Who manages the AED program Who provides medical direction As •« -1 Standing orders stating when the AED should be used,when it shouldn't with a// • be 5ure to be used,and training required to use it upd« ^ as « d ❑ Types of calls that trigger AED dispatch,and how it will be coordinated regulations •. as r a7edic« with the community's emergency medical services team evolve,and as youleat-17 ❑ Types and locations of AEDs and related equipment(such as gloves and fi'On7 yourr facemask for CPR) • AEDs. ❑ Training and refresher training policy ❑ A process and schedule for checking and maintaining equipment ❑ Any records that must be kept each time an AED is used to satisfy departmental and any state reporting requirements ca How to handle data the AED recorded during use(patient's heart rhythm, AED assessment and any shock delivered) 6 Law Enforcement AED Implementation Guide • What to do after an event,such as downloading and transferring data from the AED,notifying the medical director,reviewing the event to determine how procedures might be improved,stress debriefing, replenishing supplies,and returning the AED to service • A process to periodically review and update the policies and procedures Be sure to have your medical director as well as your legal and risk management staff review your policies and procedures.Your AED program records should also include: operating instructions,contact information for your vendor,supply ordering information,training roster,and pertinent state laws and local regulations. A sample policy and procedure is available at www.aedhelp.com. ASSESS HOW MAW AEDs YOUU NEED AND WHERE THEY'LL.DO THE MOST GOOD To achieve a good response time,you'll want enough AEDs in the right places,a clear communications pipeline,and enough officers trained to respond quickly. The American Heart Association recommends defibrillation in less than 4 to 5 minutes—ideally in less than 3 minutes.5 Every additional minute of delay lowers the rate of successful resuscitation by 7 to 10 percent.6 Ideally,you will equip every patrol unit with an AED and train every officer to use it.In corrections facilities,precincts,and other buildings,your internal communication systems will greatly impact the time to respond.In the event of a sudden cardiac arrest,how will staff alert both external EMS and internal AED responders without delay?You can save precious seconds with automatic notification systems,such as wiring a monitored wall cabinet containing an AED so that opening the door triggers an alert to the communications center. You'll particularly want coverage of places: Ca That are harder for EMS teams to reach(such as deep inside a facility,high in a tall building,and remote or locked locations) • Where people may be subject to strenuous activity,including exercise • With many older people,who are at higher risk for SCA There is no one simple formula that applies to all sites.Walking the facility, carrying a stopwatch and floor plans,is often the best way to determine the number of AEDs needed and specific locations.Ideally,you want a'drop to shock' time no longer than 3 to 5 minutes.Walking at a brisk pace,you can cover about 300 feet per minute. You might take a phased approach,first placing AEDs in vehicles that patrol the most densely populated areas and in high-occupancy buildings or hard-to-reach locations,and equipping other spaces in later phases. Law Enforcement AED Implementation Guide 7 DEVELOP AND FUND A BUDGET FOR EQUIPMENT,TRAINING AND PR Although adequate budget and staffing are constant concerns for public safety agencies,you can build a strong case for early defibrillation.With proper information,you can convince elected officials and budget committee members of the wisdom of spending money on lifesaving early defibrillation.Using population demographics,call volumes for cardiac arrests, and cost of equipment,you can calculate a projected."cost per life saved" figure.7 Keep in mind that as AEDs become the standard of care,a jurisdiction may face liability for not having an early defibrillation program in place. Possible sources of funding include: U Government grants for emergency preparedness at the city,county,state and federal levels -J Local corporations,insurance carriers and industries that would benefit J Business improvement districts or other taxing districts Health plans,local hospitals and hospital guilds J Civic organizations,such as Rotary,Elks,Eagles and Lions clubs D Neighborhood Block Watch and other organizations that support police efforts J Private foundations After-selecting a vendor,estimate your program costs.In addition to the AEDs, budget for: 0 Cost of initial training,refresher courses and related supplies such as AED training devices,extra training electrodes and manikins ............. N Extra defibrillation electrodes and supplies such as pocket mask,scissors, gloves,razor(to shave chest hair if necessary), and towel(to dry chest area),which can be stored with the AED 0 Vehicle mounts,storage units or carrying cases for AEDs N Replacement of batteries and electrodes(which have expiration dates even if never used) N Device maintenance or service agreement,which is usually arranged with the AED vendor E Data management system,which may include a computer,modem, printer and software N AED replacement cost,such as a five-year amortized fund to pay for future units You may need to initiate your program in phases in order to distribute costs over time,especially in larger systems.Consider leasing or volume purchasing programs to keep costs down. Law Enforcement AED Implementation Guide TRAIN OFFICERS AND PLAN FOR REFRESHER TRAINING Strengthening the Chain of Survival requires more than training officers to use an AED.They should know how to quickly recognize signs of sudden cardiac arrest,notify others as needed,start CPR right away,locate and use the defibrillator,and care for a victim until the EMS team arrives.Training for officers in patrol units should include dispatch protocols.In facilities such as precincts,jails,prisons,and courthouses equipped with AEDs,training should also include how to notify both external EMS teams and internal AED responders without delay. It's important to address concerns officers may have.Training will demonstrate that AEDs are easy to use,and in fact difficult to misuse,especially if devices have visual prompts and voice commands to guide rescuers.Officers who are concerned about liability may be reassured to learn the devices are intended for use on people who are clinically dead and are designed to analyze a patient's heart rhythm and deliver a shock only if needed. Unless officers received training in AED use at the police academy,they should take standard training classes that meet the guidelines of a nationally recognized program,such as the American Heart Association,the American Red Cross and the National Safety Council.Typically,classes are about four hours long and give office*rs both the skills and confidence to intervene in a cardiac emergency.To make learning more effective,use scenarios that law enforcement officers are likely to face on the job.Be sure your training complies with state • and local regulations.Often,immunity from civil liability applies only to people who have been trained to use an AED. Options include having courses taught on-site by an independent training company,or at a convenient location in the community through local EMS,a local hospital or community college.Some agencies adopt a"train the trainer" approach,where credentialed staff members instruct the training course.Your sales representative can also help locate appropriate training. Once officers have completed the AED course,it is important to perform in- service training with an AED training device that looks like and acts like the "live"AED.This lets you simulate a wide range of possible scenarios and eliminates the need to take a"live"AED out of service. Keep good records of the officers trained,and when they need refresher courses. Plan for renewal training as you would for other periodic inservice training. Retraining should occur at least every two years—sooner if your policy, procedures or equipment changes.Computer-based refresher training(CBT)is a qx, 'useful tool to keep skills sharp.This type of training,can be readily available 24/7 to officers who may want more practice.As an incentive to keep skills fresh,you can post the name of the officer with the current highest score. Choose a CBT program that is validated as an effective learning tool.8 A demo download of AED Challenge;"a refresher training program,is available on www.aedhelp.com. --------------------------------------- Law Enforcement AED Implementation Guide 9 ------------- ACQUIRE AND DEPLOY THE AEDs AND OTHER SUPPLIES Upon delivery,inspect and install your AEDs according to the operating instructions from the manufacturer.To ensure AEDs are ready when you need them,the officers'daily equipment check should include the AED.The AED project coordinator should follow the maintenance guidelines provided in the operating instructions.This includes keeping records of the expiration dates of consumables such as the battery and electrodes and replacing as needed. PROMOTE YOUR PROGRAM TO RAISE AWARENESS AND SUPPORT Publicizing your early defibrillation program helps promote the entire range of public safety services that your agency provides.It highlights your agency's commitment to saving lives.A communications campaign will help people become familiar with your expanded public safety role,and inform them what to do if they witness a cardiac emergency. Ways to publicize your program include: News media coverage when AEDs are put into service Media coverage when an officer saves a life with an AED J Announcements at Neighborhood Block Watch,Business Improvement District,and other community meetings Posters and brochures Decals on doors of patrol units and facilities J Articles in employee and union newsletters Notice on your intranet and public Web site Julie's Story Julie experienced A durin dinner U E-mail or voicemail notification to employees,or print notices mailed at a restaurant with paychecks )ulie's husband •;CPR Police officer answering the 911 call Such publicity strengthens the Chain of Survival.Citizens will be reminded of used his . Dto , Paramedics provided advance care the need to immediately call for help in a cardiac emergency,and may be encouraged to take CPR and AED training themselves.In facilities such as precincts and corrections facilities,your campaign should highlight the location of AEDs and inform staff'of how to alert trained responders in the event of a cardiac emergency. BUILD QUALITY ASSURANCE INTO YOUR OPERATION Once you're up and running,follow the policies and procedures developed to Dotoinonag6inent enableskeep the equipment,supplies and trained responders at the ready to handle a yoti to doCLIMetIt hOcardiac emergency. are handled, track the ntirriber of people ,, On schedule,officers should go through the checklist for devices and supplies, • . . r just as with other equipment they use on a routine basis.The project rn�glit be r to coordinator should order new supplies as needed,determine that new officers la7prave 5urvival rates. are trained,and that all staff receive refresher training as needed.This enables officers to refresh skills,renew certifications,and learn about changes in equipment,policies and procedures. Law Enforcement AED Implementation Guide Record keeping is a vital part of all law enforcement activities,and AED use is no exception.Data collection and management enables you to document how rescuers handle cases,track the number of people helped,justify money spent on early defibrillation,and provide data for analysis—to determine trends and identify how to modify procedures to help improve survival rates.Revise your policies and procedures as you learn from any experience using the AEDs,or with updates in best medical practices or equipment. THERE'S NO TIME TO LOSE! As you can see,the public safety officer trained and equipped with an AED plays a vital role in the multi-level response to cardiac emergencies.Although there are many steps involved in creating and maintaining a successful AED program, the rewards are great.The results can significantly benefit the health and welfare of your community,as well as your fellow officers.Get started now on saving more lives. ---------------- Law Enforcement AED Implementation Guide USE THIS CHECKLIST TO HELP LAUNCH YOUR PROGRAM Assign a project coordinator Ll Champion the idea and gain consensus ❑ Review laws and regulations or consult your legal counsel or risk manager ❑ Coordinate with local EMS Arrange for medical direction Q Plan how to dispatch AED-equipped officers LJ Choose your equipment and vendor 0 Design policies and procedures %. Q Assess how rr an AEDs you'll deed and., here they'll do the most good 0 beveODland fund a bud: t fore ui rnent, rann and PR g q P Tragi o flcers and ►ian for .e. o. hl+�r �ra1ning ACCclre and deo AEs and'other Iles p y Rrt rriot+� o tr ro ran"I to rase a aren . and: u ►port Y p 12 Law Enforcement AED Implementation Guide Medtronic is the world's largest provider of external defibrillators.We've already helped thousands of customers implement AED programs.For more information call 1.800.442.1142 or visit www.aedhelp.com.Medtronic will gladly assist you at every step. National Training Organizations American Heart Association,www.americanheart.org American Red Cross,www.redcross.org National Safety Council,www.nsc.org Other Resources AED help,www.aedhelp.com Biphasic waveform information,www.biphasic.com National Center for Early Defibrillation,www.early-defib.org Guidelines for Public Access Defibrillation Programs in Federal Facilities. Department of Health and Human Services General Services Administration. Federal Register,66FR 28495,Notice,May 23,2001 Cardiac Arrest and Automated External Defibrillators(AEDs). Technical Information Bulletin.December 17,2001. U.S.Dept.of Labor Occupational Safety and Health Administration(OSHA), www.osha.gov/dts/tib/index.html References: 1 Valenzuela,T.D.,et al.2000.Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.New England Journal of Medicine,343(17):1206-09. 2 Mosesso,Vincent N.Jr.MD,et al.2002.Proceedings of the National Center for Early Defibrillation Police AED Issues Forum,Prehospital Emergency Care,6(3):273-82. 3 Myerburg,R.J.et al.2002.Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest.Circulation,106:1058-64. 4 AED Resolution,International Association of Chiefs of Police, http://www.theiacp.org/Resolutions/index.cf n?fuseaction=dis-public-view&resolution id=110&C FID=99041&CFTOKEN=94444980 5 American Heart Association in collaboration with ILCOR.2000.Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care.International consensus on science.Circulation;102(suppl):I-1-I-89. 6 Cummins,R.O.,1989.From concept to standard of care?Review of the clinical experience with automated external defibrillators.Annals of Emergency Medicine;18:1269-75. 7 Larsen,M.P.,Eisenberg,M.S.,Cummins,R.O.,Hallstrom,A.P.1993.Predicting survival from out of hospital cardiac arrest:a graphic model.Annals of Emergency Medicine,22:1652-58. 8 Jerin,J.M.,et al.1998.Automated external defibrillators:skill maintenance using computer assisted learning.Academic Emergency Medicine,5(7):709-717. Law Enforcement AED Implementation Guide 13 MEDTRONIC PHYSIO-CONTROL Nearly 50 years ago,Medtronic pioneered the defibrillation technology that offers hope for the hundreds of thousands of people who experience sudden cardiac arrest each year.Because of the LIFEPAK reputation for quality and reliability,more physicians,hospitals and emergency medical services teams rely on LIFEPAK defibrillators than any other brand.As more people become aware of the importance of early defibrillation,more law enforcement agencies, businesses,schools,airports and stadiums(wherever people live,work and play) are setting up AED programs in the effort to save more lives. For more information call 1-800-442-1142 or visit www.aedhelp.com. Y' Medtronic Physio-Control am fromc 11811 Willows Road NE P.O.Box 97006 Redmond,WA 98073-9706 USA Tel:425.867.4000 Fax:425.867.4121 www.physiocontrol.com www.medtronic.com PHYSIO-CONTROL and LIFEPAK are registered trademarks of Medtronic Physio-Control Corp.Medtronic is a registered trademark of Medtronic,Inc.©2003 Medtronic Physio-Control Corp. MIN 3203137-000/CAT.26500-001570 "You're Under Arrest" Page I of 2 In California,the San Fernando Police Department a tiny city nestled on the northern fringes of the San Fernando Valley just outside Los Angeles, recently implemented an AED program, thanks to the tireless efforts of Sergeant Alan Cowen, refired deputy chief of the Los Angeles City Fire Departments t's Bureau of EMS. Cowen, a aramedic and reserve police office r with San Fernando for more than 15 years, had always p known that quick defibrillation is the key to successful resuscitation. Selling the concept of police officers providing that service was another matter. "About sixy ears ago, I approached Chief Dominick Rivetti with the idea of putting defibrillators on police vehicles, based strictly on response time, which is anywhere from I to 3 minutes in this 2.4- square-mile city," says Cowen. "I'm thinking, since we have our own dispatch center, we could intercept the 9-1-1 calls, be on scene in a minute and defibrillate, and it would be the ideal solution. The chief listened and said he didn't think we were ready for it,but thanks a lot. Six years went by before I brought it up again." In 1998, says Cowen, he went back to the chief with the information that airlines were now carrying defibrillators, and some police departments were using them as well. In addition, the city of San Fernando had long since abandoned its two fire stations and contracted with the Los Angeles City Fire Department for fire and EMS services. "The public wasn't aware that the closest ambulance station to San Fernando is not a paramedic service,," Cowen adds. "It's an EMT-staffed ambulance out of one of the L.A. fire stations. I told the chief I knew we could do better and could raise the level of care to the community." Chief Rivetti agreed to look at a proposal, which Cowen presented within a week, complete with cost, budget,training,DHS and EMS agency approvals--the works. "I realized that we might only use an AED once or twice a month, so we weren't looking at heavy-duty use," says Cowen, "but if we could save one life, it would be worthwhile." The chief liked the idea, presented it to a somewhat apprehensive city council, and the rest is history. On March 30 this year, San Fernando PD became the owners of three Laerdal Heartstart defibrillators,two of which were placed in patrol cars and one at the police station, which is located in the city hall. With support from a Los Angeles-based medical director, Cowen undertook the job of training the department!s 35 regular and 45 reserve officers,first reviewing CPR and first aid.,then teaching defibrillation. "A few of the officers grumbled about having to learn one more thing,but the union said nothing, and they didn't ask for more money," says Cowen. Cowen attributes much of the response to his position as one of them,as well as his experience as a paramedic. "They know if there's a medical crisis or, worse, if one of them gets hurt, shot or stabbed,or someone has a heart attack,they feel comfortable having me around. So everyone climbed on board, and the training went very well. Our first call came just 6 days after the program began,when one of our officers responded to a nursing home. Unfortunately,when he hooked the patient up, it said'Do Not Shock' because the patient was already dead. The AEDs haven't been used since, but it's,not a matter Of'if—irs http://www.advancedrt.comlarticles/rwdcles/arrest.html 6/24/04 "You're Under Arrest" Page 2 of 2 a matter of'when.' We'll have a save, and it will be a big deal." http://www.advancedrt.com/articles/rtarticles/arrest.html 6/24/04 Cost Effectiveness of Police AED Page 1 of 1 SKYAID Cost Effectiveness of Suburban Police Early Defibrillation Programs - 7 New Mtssron Years' Experience added 4/28101 Overview_ Details Academic Emergency Medicine Volume 7, Number 5 430, Medical Watch Robert A Swor, Raymond E Jackson,Kevin H Chu, Rebecca G Pascual Scott Compton Heart attack and Chris McEachin Wiliam Beaumont Hospital, Royal Oak, MI Stroke ' World health ABSTRACT EmEmenc-y Cost effective Media_ Objective: To calculate the cost effectiveness of a 7 year Police AED program in 4 suburban -_Site Maw communities. Method: 10 year retrospective study (7/89-7/99) of patients of 4 suburban communities during SKYCAR two study periods: _Details 1) Police first response and ALS care(No AED) and Overview 2)AED equipped police first response (P-AED)with subsequent ALS care. VTOL Utstein data elements including survival to discharge were collected. Airline Costs for AED program were obtained from police agencies. Il/liiita__ry Transportation Cost/life saved and cost/year life saved were calculated using three methods: Images 1)obtained survival data; Site Man 2) Estimated improved survival using improved response interval and 3) Improved time to shock data. Search Literature based estimates of life expectancy after cardiac arrest survival were used to estimate costlyear life saved. Student's t-test and chi square were used for analysis. Translate 8 languages Results:213 pts met study criteria; (81 No-AED,and 132 P-AED).The two groups were not different by pt age,ALS response interval, % VF, %witnessed (wit), or arrest location. Interval to first defibrillator equipped EMS arrival was significantly less in the P-AED group(2.0 vs 5.4 minutes, p<0.001) as was the interval from 911 call to first VF shock(6.6 vs 8.4 minutes, p=0.02).Survival to discharge was improved with P AED(12.5%vs 9.8%, p=0.56) but was not statistically significant. Cost/life saved varied from$22,939 to$37,467,and costlyearllife saved ranged from $5,237 to$8,554. Conclusion: Police AED is a cost effective intervention in these suburban communities which have relatively rapid EMS response intervals. http:/// r .skyaid.Or Skyaid°/*2OOrg/Medi cal/Cost effectiveness Police e AED.htm 6/24/04 AED -Cardiac Resuscitation Page 1 of 1 a Deportments Adr1 ini%trahon Parka Sk Moo haa+ ,• ... ..:.. core DEPARVMFENT Public Works Help Wanted to Purchase Life Saving Equipment The Burlingame Police Department is purchasing an innovative new device that will save lives. The Zoll AEDPlus is ._ a cardiac resuscitation device which is - used for low-energy defibrillation to °R restore normal heart rhythm to people suffering who are g a heart attack.It is ,4 ., also surprisingly easy to use. v Cardiac - Arrest strikes people of all ' ages and fitness levels, usually without warning.Many of these lives could be saved if bystanders act promptly to T.., phone 911 and begin CPR,and if trained . '' responders provide defibrillation within minutes. It is well known that a leading cause of death in California is Cardiac Arrest. Each year approximately 50,000 people die from Sudden Cardiac Arrest in California alone. Due to the quick response times of law enforcement officers to emergency calls, communities through the United States have been employing AED's in their law enforcement vehicles. This simple program has saved many lives and has taken cardiac arrest saves from 2%to 50% in communities where the AED's are being used. The Burlingame Police Department will be purchasing one of these AED (Automated External Defibrillator)devices for use at the Burlingame Police Station for any employee or citizen who suffers a cardiac attack at that facility. It is our sincere desire to put a unit in each one of our police vehicles so that this technology could be used for anyone who needs it. Because of budget cutbacks,funding is not available for such an important purchase right now. The units cost$1,500.00 apiece. If anyone would like to get involved by making a tax-deductible donation towards the purchase of AED's for the Burlingame Police vehicles,please contact Officer Ronda Caine or Sgt.Peter Tokarski at 650-7774100. You can also send email inquires to aedP—poiice.ci.burlingame.ca.us Please help us make a difference. http://www.burlingame.org/police/aed.htm 6/24/04 Police Department: The A.E.D. Program Page 1 of 1 ars ' Glendora Police Department The AED Program Technology has advanced to the point where devices called Automatic External Defibrillators (AED) are available. They are lightweight, portable and require minimal training to be used. The devices weigh four to six pounds . 9 j and cost about $4,000 each. Each day more than 1,000 Americans { suffer a condition known as "sudden cardiac arrest." More than 95% of them die. The American Heart Association estimates that 20,000 or more of these deaths could be prevented each year if early defibrillation were made readily available. In 1997, Glendora became the first community in Los Angeles County to train and equip its police officers with AED's. During the first two and a half years of operation, Glendora Police Officers using AED's saved five lives. The Glendora Police Department now has nine (9)AED units. Various groups and individuals donated all of these units to the Glendora Police Department. The cost of supplies is approximately$400 per year for each unit, and is also covered by donations. �moi-i -4- -1k -6- -.- -� If you are interested in supporting our AED Program, please use our Glendora Police Department Donation Form. of Me Fw*lls- 116 E. Foothill Blvd., Glendora,GA 91741-3380 Phone: (828)914-8200, Fax: (826) 914-8221 Comm nts_e_nd_$ugaestions QW—Home Pacie_Qisdaimer http://www.ci.glendora.ca.us/police/aed.html 6/24104 Health News: Ll fecl i ni c.com Page 1 of 3 Key Word Search Defibrillators and Police: A life-Savin Combinatic My Health Record 8/12/2002 By Amanda Gardner HealthScoutNews ReporterMONDAY, Aug. 12 (HealthScoutNews) -- Giving FREE automated external defibrillators to police officers on patrol increases the Blood Pressure survival chances of people having sudden cardiac arrest. Health Station Locator That's the conclusion of a study appearing in the new issue of Circulation. For Physicians In most communities, fire department-based rescue squads equipped with Resources automated external defibrillators (AEDs) respond to 911 calls. Meed icativns F:1d a Duct; "The problem with that system is that they're basically starting from time zE =wok,-hook at some physical location remote from the patient, and it takes time to get i the patient," says Dr. Robert ]. Myerburg. He is the lead author of the study yea Ith ase w s director of the division of cardiology and professor of medicine and physiolo, Rem nde-s the University of Miami School of Medicine. My Saved Articles Links "Those first few minutes are absolutely critical," Myerburg says. About Us A patient's chance of survival is best within the first minute Myerburg Y 9 Y ��ntac� �s the second m' sa s. mute, the chances of survival drop to 50 percent. By the fourtl Press. Re!easas minute, the odds are only 25 percent. d�� .'r Acing ts "Police are already on the road so if you simultaneously notify police and finHeath Station ,video rescue people, the combination shaves about three minutes off the response time," Myerburg says. Dei 'o Before giving AEDs to the lice for 9 9 police the study, the response time was a littlE erg-r,s of Use under eight minutes. Afterward, it was under five minutes. The survival ratE P.i, ac, Polio patients in ventricular fibrillation, which is when the heart's electrical activit, becomes disordered, almost doubled, from 9 percent to 17.2 percent. /D 21002 Lifechni.c.cym "We have made a lot of progress in technology, and the AEDs are just one example," says Dr. Gerald Hollander, director of clinical cardiology at Maimonides Medical Center in Brooklyn, N.Y. "what we're struggling with is gap between what we know to be helpful and implementing the knowledge i practical way. This is a good example of a relatively simple approach which make a difference." Having defibrillators out in the community like this is a big step, but not the step. "This is part of what I view as a broad approach to community rescue problems, but it's not the end of the story," Myerburg says. "This is progres but more progress needs to be made to get the percentage higher." Some 250,000 Americans die from sudden cardiac arrest every year. http://www.lifeclinic.com/healthnews/article view.asp?story=50853 0 6/24/04 Health News: Li fecl i ni c.com Page 2 of 3 , Defibrillators are machines that give electric shocks to the heart to restore normal rhythm. Portable defibrillators (AEDs) are now appearing in airports, casinos, stadiums, office buildings and other places where large numbers of people gather. In the new study, researchers equipped 1,900 police officers in Florida's Mia Dade County with 1,900 AEDs that they carried with them. All the police off underwent four hours of training and had a chance to operate the machine during a practice session. The devices are "smart defibrillators," meaning th can recognize the heart rhythm and alert the operator that the rhythm is on that should be shocked, Myerburg explains. The 911 system was then re jiggered so that both police and fire/rescue tez were dispatched to medical emergencies at the same time. The AEDs were assigned to individual police officers who took the units hom with them when off-duty. "The units were there for the neighborhood," Myerburg says, adding one po officer who was transferred to another job kept the AED with him and used save the life of a coach at a Little League practice. While on duty, the police got to the scene before the fire/emergency teams about 60 percent of time, cutting response times to 4.88 minutes, compare( 7.64 minutes. Help arrived in less than five minutes for 41 percent of calls, compared to 14 percent for the standard response method. Although the survival rate for the group of patients in ventricular fibrillation jumped to 17.2 percent, the overall survival benefit was only 1.6 percent, because more than half (61 percent) of the victims had conditions that coull be helped by a defibrillator. The Miami-Dade police force has bought 400 more AEDs since the study wa concluded, and the study authors are hoping other forces will follow suit. "Nobody had looked at a large community that was uniformly equipped with defibrillators in police cars to see if it made a difference," Myerburg says. "V actually got the data. Other people can emulate this knowing that it makes difference." Interestingly, one of the places where technology is struggling to keep up is some hospitals. Currently, if a patient in a hospital has a fatal arrhythmia (E disruption of the normal electrical conduction system of the heart), the nurs who finds the patient has to call a special defibrillation team to come. Precic minutes are lost while the team travels from another area of the hospital. "It seems almost absurd in a situation where we're putting automatic defibrillators in airports and casinos that professionals in the hospital settinc not more aggressive with these kinds of devices," Hollander says. Maimonides is starting a program to use more automatic defibrillators in the hospital, Hollander says. The hospital is also planning to adopt totally automatic defibrillators for higr http://www.lifeclinic.com/healthnews/article view.asp?story=508530 6/24/04 Health News: Lifeclinic.com Page 3 of 3 or risk patients in intensive care and other monitored units. The devices would attached to the patients and,, if it detected a fatal arrhythmia, would deliver shock within 30 seconds. What To Do The American Heart Association has information on defibrillation and ventre fibrillation.SOURCES: Robert J. Myerburg,, M.D., director,, division of cardiolc and professor of medicine and physiology, University of Miami School of Medicine, Miami; Gerald Hollander, M.D.,, director,, clinical cardiology,, Maimonides Medical Center,, Brooklyn,, N.Y.; Aug. 13, 2002, Circulation Copyright C)2002 ScoutNews,, LLC.All rights reserved. 'JEL Sud This P{W-to Riend! Bainter Friendly Page! J ,S,a,-,,, 'My Niicfe List' AF Technical problems with the web site?E-mail techhelpOlifeclinic.com Comments about the web site? E-mail suggestions Health related questions?Ask the Expert h"://www.lifeclinic.com/healthnews/article view.asp?story=50853 0 6/24/04 Portable defibrillators Page I of I October 15,1999 Portable Heart Defibrillato Placed in All Police Cam Claremont, CA —The deployment of automatic external defibrillators(AED)in all Claremont police patrol cars means heart attack victims in Claremont will have a better chance of surviving. Studies show that for each minute the heart doesn't beat the chances for survival go down by 10 percent. Claremont's patrol officers are usually the first to arrive at the scene of a medical emergency, often several minutes before paramedics. Therefore, equipping officers with AEDs and the training to use them significantly enhances the police department's ability to save lives. Claremont is the first department in the eastern San Gabriel Valley/western Inland Empire to place the units in cars, and the third in Los Angeles County. The battery-powered devices are portable, easy to use, and safe. Instructions are provided directly by the AED, and the units can't deliver a shock to a victim unless their heart is in fibrillation. After delivering the shock,the AED continues to instruct the operator on proper care of the victim (i.e., check pulse and breathing). Six AEDs have been purchased by the police department using State and Federal grant money. Contributions are being sought from local service organizations to purchase additional defibrillators for the police and other City facilities. The City's goal is to eventually have an AED in every public building. http://www.ci.claremont.ca.us/Press°/�2Oreleases/1999�/�2OArchive/Portable�/�2Odefibrillators... 6/24/04