Top of Page. The report also recommended the following changes to improve OHCA outcomes: Creating a national registry to track cardiac arrest events and outcomes Requiring AED placement and use training in schools Improving EMS cardiac arrest recognition and treatment coordination Conducting PAD program quality improvement initiatives Increasing related research Data Collection and Methods We examined the extent that state law included 13 types of PAD interventions.
A summary of public access defibrillation laws, United States, Prev Chronic Dis ;9:E Centers for Disease Control and Prevention.
A Policy Evidence Assessment Report. Accessed March 22, Heart disease and stroke statistics— update: a report from the American Heart Association. Circulation ; 12 :e67—e Institute of Medicine. Accessed January 16, American Heart Association response to the Institute of Medicine report on strategies to improve cardiac arrest survival.
Circulation ; 11 — Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the Resuscitation Outcomes Consortium population of 21 million. J Am Coll Cardiol ;55 16 — Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med ; 7 — Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation.
Circulation ; 9 — Ventricular tachyarrhythmias after cardiac arrest in public versus at home. N Engl J Med ; 4 — Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest. Resuscitation ;— Appraising the evidence for public health policy components using the quality and impact of component evidence assessment.
Glob Heart Mar ;10 1 :3— Analysis of out-of-hospital cardiac arrest location and public access defibrillator placement in Metropolitan Phoenix, Arizona. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med ; 17 — Use of automated external defibrillators by a U. Nationwide public-access defibrillation in Japan. N Engl J Med ;— Automated external defibrillator program does not impair cardiopulmonary resuscitation initiation in the public access defibrillation trial.
Acad Emerg Med ;13 6 — Take Heart America: a comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest. Crit Care Med ;39 1 — Berger S. Cardiopulmonary resuscitation and public access defibrillation in the current era—can we do better yet? J Am Heart Assoc ;3 2 :e Availability of automated external defibrillators in public high schools. Despite these life-saving recommendations, few states have laws that require PAD programs in high-risk or high-density locations Table.
An analysis of AED use rates in municipal buildings in Copenhagen found that PADs implemented through local or political initiatives were not used because of a low incidence of cardiac arrest at the site and a lack of accessibility to the AEDs by the general public OHCA is not a reportable event in any US jurisdiction; few communities are able to plan an effective response because they lack the data to identify high-risk populations and locations or to evaluate if existing PAD programs are properly deployed Between and , In addition, deaths were associated with an AED malfunction in the same time period A survey of PAD programs established in business, educational, and community buildings located throughout Johnson County, Iowa, found that after 2 years no site complied with all the AHA recommendations for community lay rescuer PAD programs This study revealed multiple deficiencies in and barriers to adherence to the AHA guidelines, such as lack of access to and notification of the AED location, failure to replenish batteries, expired pads, scheduling of maintenance checks either infrequently or not at all, and limited to no funds for AED upkeep.
At the time this study was conducted, Iowa law did not require AED maintenance. Further research evaluating facilitators and barriers to adherence to PAD program elements comparing jurisdictions with comprehensive PAD legislation to less regulated jurisdictions should help to identify the most effective policies for sustaining PAD programs. Good Samaritan laws provide this immunity by restricting the circumstances under which a lay rescuer can be sued for civil damages, thereby facilitating the use of AEDs by lay bystanders witnessing a cardiac arrest.
Similarly, laws that protect PAD program facilitators from liability make it easier for businesses, schools, organizations, and others to implement PAD programs.
We identified 3 states that do not provide immunity to untrained lay rescuers; such policies could impede efforts to use AEDs even though evidence shows that untrained lay persons can apply an AED safely and effectively. Concerns about the liability risks of implementing a PAD program were raised in a survey of Florida fitness club owners and managers, leading the study authors to conclude that a carefully designed, implemented, and operated PAD program may be the best risk management strategy However, assessments of the legal risks associated with AEDs have found litigation arising primarily from not having a readily available AED and trained staff on the premises when a cardiac arrest occurs 11, Jurisdictions that confer broader liability protection on PAD program facilitators are more likely to have the flexibility to implement PAD programs in sites with a high risk of OHCA rather than placing them in low-risk areas in reaction to concerns about litigation.
The descriptive nature of this analysis limits our ability to discern whether comprehensive PAD policies are effective in saving lives. We were unable to associate cardiac arrest survival rates with the strength of a state policy or to assess the extent to which PAD programs are properly implemented in the states. Therefore, we are unable to assess to what extent PAD policies underlie geographic differences in cardiac arrest survival rates. Our analysis was limited to state laws; therefore, we do not know the extent to which municipal ordinances requiring more PAD elements than required by state law improve PAD effectiveness.
Finally, our review did not capture the actual rate of enforcement of PAD policies or the use of economic incentives to purchase AEDs. Although all states and the District of Columbia have enacted laws to make PAD programs more widespread, policies in many jurisdictions leave these programs at risk of failure because critical elements necessary to ensure AED functionality are not always required. Further research is also needed to identify the most effective PAD policies for increasing AED use by lay persons and improving survival rates.
We thank Amber K. There are no funding sources for this manuscript. Telephone: E-mail: smg0 cdc. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.
Skip directly to search Skip directly to A to Z list Skip directly to site content. Protecting People. Search The CDC. Placement of and Access to Automated External Defibrillators. However, all considerations are based upon. Factors that should be considered include:. Response Time: The optimal response time is 3 minutes or less.
This interval begins from the moment a person is identified as needing emergency care to when the AED is at the side of the victim. Survival rates decrease by 7 to 10 percent for every minute that defibrillation is delayed. Therefore, it is recommended that Federal agencies train as many employees as possible on the use of AEDs.
Demographics of the Facility's Workforce: Leadership should examine the composition of the resident workforce. Since the likelihood of an event occurring increases with age, special consideration should be given to the age profile of the workforce. Wilderness Areas and National Parks that host large numbers of visitors are more likely to experience an event, and an appraisal of the demographics of visitors should be included in an assessment.
Specialty Areas: Facilities where strenuous work is conducted are more likely to experience an event. Additionally, specialty areas within facilities, such as exercise and work out rooms, should be considered to have a higher risk of an event than areas where there is minimal physical activity. Large facilities and buildings with unusual designs, elevators, campuses with several separate buildings, and physical impediments all present unique challenges to LRRs. Characteristics of Proper Automated External Defibrillator.
There are several elements that contribute to the proper placement of AEDs. The major elements are:. An easily accessible position e. A secure location that prevents or minimizes the potential for tampering, theft or misuse, and precludes access by unauthorized users.
Facilities should take additional steps to assure that an AED has not been stolen or improperly removed. A location that is well marked, publicized and known among trained staff.
A nearby telephone that can be used to call backup, security, EMS, or to be sure that additional help is dispatched. Protocols should clearly address procedures for activating local EMS personnel. These protocols should include notification of EMS personnel of the quantity, brands and locations of AEDs within the facility.
This information will enhance dispatch and the EMS responder protocol, enabling proper planning and scene management once EMS personnel arrive at the victim's side.
Equipment stored in a manner in which the removal of the AED automatically notifies security, EMS or a central control center is ideal.
Where automatic notification of the opening of an AED storage cabinet or removal of an AED from a cabinet is not implemented, emphasis should be placed on notification procedures and equipment placement in close proximity to a telephone. It is recommended that additional items that may be necessary to a successful rescue be placed in a bag and stored and accessible with the.
Keep in mind that CPR is an essential element of an effective rescue and that, as a victim collapses, other physical injury may occur concurrently:.
Appropriate sizes of CPR face masks with detachable mouthpieces, plastic or silicone face shields preferably clear , with one-way valves, or other type of barrier device that can be used in mouth to mouth resuscitation. Disposable razor to dry shave a victim in chest areas, if needed, as well as a supply of 4x4 gauze pads to clear and dry an area, to assure proper electrode-to-skin contact. Two biohazard or medical waste plastic bags for waste or for transport of the AED should it become contaminated.
In large or complex facilities, access routes should be given careful consideration. Such facilities may demand the use of a designated responder or team approach, in which at least one responder has keys or passes to allow for the use of a more direct route or elevator override key to expedite access and transport by appropriate medical or EMS personnel. All AEDs are equipped with a credit card size device i.
Depending on the design of a particular PAD, the. AED will either accompany the victim to the hospital or will be retained on site for the medical advisor as part of the PAD's program review. After an event, the PAD medical director should be promptly notified, and a review and assessment of performance should be performed. This process is best led by the PAD's physician overseer. A copy of the full report should be provided to and reviewed by the. Incident reports and follow-up should be performed as soon as possible, and restocking of supplies and returning the AED to service should be accomplished promptly.
All aspects of the performance of the system, people, device, and protocols should be addressed in a non- judgmental manner with an eye toward verifying or improving effectiveness and to identify problem areas that must be resolved.
Responsibility for each step should be clearly articulated in protocols. The results of routinely scheduled and post-event reviews should be shared and discussed with facility management and other interested parties, as deemed appropriate in a particular facility.
Individuals with responsibility for facility oversight are also responsible for the PAD program and should remain informed about their program's performance. The physician should be responsible for assuring that privileged or confidential patient information is shielded.
An essential post-event consideration is the psychological effect on LRRs and others. It is not at all uncommon for LRRs, witnesses and co-workers to have psychological or stress reactions to an event.
These people may have both emotional and physical reactions that need to be addressed, but for which there is a reluctance to come forward to ask for help. Facility leadership has a positive obligation to reach out and offer help to these individuals, affirming that such responses are normal and to a large extent to be expected. Post-event support is especially important in cases where a rescue is unsuccessful.
Post- event support should be available and offered promptly after an event, and the invitation to seek assistance should remain open. This type of psychological care is best provided by trained professionals with expertise in the area of critical incident stress management. Provision of these psychological services should be addressed in the PAD program design and protocols. During Health Unit Duty Hours: 7 a. Monday through. Friday; weekends and Federal holidays, the Health Unit is closed.
In any potentially life-threatening cardiac emergency:. Any additional AED units will remain on site as a back-up. Non-Health Unit Hours: 12 a. FR Doc. E Filed ; am. Subscribers can access the reported version of this case. Search over million documents from over countries including primary and secondary collections of legislation, case law, regulations, practical law, news, forms and contracts, books, journals, and more.
Advanced A. Founded over 20 years ago, vLex provides a first-class and comprehensive service for lawyers, law firms, government departments, and law schools around the world. Subscribers are able to see a list of all the cited cases and legislation of a document.
Subscribers are able to see a list of all the documents that have cited the case. Subscribers are able to see the revised versions of legislation with amendments. Subscribers are able to see any amendments made to the case.
Subscribers are able to see a visualisation of a case and its relationships to other cases. An alternative to lists of cases, the Precedent Map makes it easier to establish which ones may be of most relevance to your research and prioritise further reading.
You also get a useful overview of how the case was received. Subscribers are able to see the list of results connected to your document through the topics and citations Vincent found. VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy.
Your World of Legal Intelligence. Dated: August 7, The fourth link in the chain of survival is early advanced care. Although it is possible to have the full range of planning and design activities performed by a consultant or contractor, it should be kept in mind that the actual responders at a facility typically will be those who work there and that both individual Page employees and union interests, in accordance with collective bargaining agreements, should be considered in any process.
For guidance on establishing, coordinating and implementing a comprehensive Occupancy Emergency Program, see 41 CFR Only commercially available AEDs that have been cleared for marketing by the U.
Protocols should be reassessed periodically in accordance with a regular schedule of reviews as determined in consultation with the PAD's supervising physician. A current protocol that takes into consideration both new treatment recommendations and any changes in the FDA labeling of the AED should be integrated into the PAD training and education and re-training programs.
The Page risk of liability for failing to comport with applicable regulations, and for acts or omissions that result in harm, are important and ever- present concerns that should be addressed in the PAD program.
However, all considerations are based upon 1 an optimal response time of 3 minutes or less and 2 an assessment of the level of risk in a facility's environment. Factors that should be considered include: Response Time: The optimal response time is 3 minutes or less.
0コメント