Automatic External Defibrillator

The following Automatic External Defibrillation (AED) protocols are included here for use by Medical Control approved AED agencies, and for informational purposes for other users of this manual.

These standing orders enable a Monroe County Medical Control Authority certified Automatic Defibrillation Technician (ADT) to operate within their jurisdiction without on-line Medical Control. When presented with a patient meeting the following criteria, the defibrillator will be applied by the ADT without delay.

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1. Patient has no respiratory effort for at least 5 seconds.

2. Patient has no carotid pulse for at least 5 seconds by palpation.

Due to differences in defibrillator technology (i.e., monophasic/biphasic), the ADT shall follow manufacturer's guidelines for weight and age parameters.

All patients meeting the above criteria WILL have the automatic defibrillator applied unless any of the following conditions exist:

1. Advanced life support is on the scene.

2. Using the automatic defibrillator would endanger others:

a. While moving the patient during transport.

b. While performing chest compressions, ventilations, or other patient contact.

c. If patient is lying in water.

3. Decapitation, decomposition, rigor mortis or other signs of obvious death.*

 

* Refer to the MCMCA "Dead on Scene" Policy

Pre-Dispatch

1. Batteries will be maintained according to manufacturer specifications.

2. Two (2) unexpired sets of automatic defibrillation pads will be stored in the defibrillator carrying case.

3. An appropriate ECG recording and storage medium will be in-service for each use of the AED (micro-cassette or microchip, data card etc.)

4.    The AED agency shall be responsible for ensuring that the AED is prepared to accurately record each event. Post-event data transfer will comply with manufacturer and software instructions.

5. The following supplies will be carried with the AED: small towel, scissors, and pocket mask.

6. The defibrillator will be tested with a compatible simulator/tester according to manufacturer specifications at least twice monthly.

Dispatch/Enroute

1. The Automatic Defibrillation Technician will take the defibrillator to the patient's side on all runs.

2. Other equipment taken to the patient's side should not delay the defibrillator.

1. Overview scene for hazards. If unable to defibrillate patient because of safety concerns (e.g. standing water, dangerous atmosphere, etc.) quickly move patient to safety.

2. Check breathing for at least five (5) seconds.

3. Check carotid pulse for at least five (5) seconds.

4. If patient meets treatment criteria, expose patient's chest on three (3) sides, use scissors if necessary. All clothing must be removed between electrode sites. Remove Nitroglycerin patches.

5. If patient is wet or sweaty, dry with towel.

6. Apply apex electrode pad first . Pad should be applied to patient's left chest at a spot where a line from the front of the patient's arm pit intersects the lower border of the rib cage.

7. Apply right chest electrode pad to patient's right chest wall, two (2) finger widths below the right clavicle (collar bone). Edge of electrode should just clear the right border of the sternum. The electrode must not cover the sternum or interfere with CPR.

8. Assure connection between electrodes and defibrillator.

9. If the patient has an implanted pacemaker or defibrillator the electrode should be placed at least four (4) inches away from the implant site. If right electrode pad is placed on the patient's back, it should be between the scapulas. The apex electrode should be placed more on the patient's front chest.

10. Clear everyone away from the patient. No one may be touching the patient while the AED is assessing.

11. Assure that the defibrillator is turned on.

12. Follow all commands from the defibrillator. The Automatic Defibrillation Technician may only touch the patient when the defibrillator prompt is appropriate.

13. If at any point the Automatic Defibrillation Technician feels that an unsafe condition exists, the technician should immediately disarm the defibrillator. When the unsafe condition is cleared, the defibrillator should be turned on.

14. The sequence of CPR and defibrillation should be repeated until either ALS arrives or the defibrillator will no longer shock the patient.

15. If using a defibrillator with audio record capability, the Automatic Defibrillation Technician should call out the following information during times that the defibrillator is quiet:

a. The Automatic Defibrillation Technician's name.

b. The Automatic Defibrillation Technician's agency.

c. Date and time.

d. Location of incident.

e. Any patient data available (e.g., sex, age, bystander CPR, down time, medical history).

f. Arrival of ALS.

g. Verbally identify location of defibrillation pads.

16. Upon arrival of ALS, the care of the patient will be directed by ALS providers.

17. Data recorded by the defibrillator and a run sheet will be sent to Medical Control within 24 hours of the event.

18. Under NO circumstances can the defibrillator be placed into the "ASSESSING MODE" in a moving vehicle. The vehicle must be stopped before the "ON" button is pressed to put the defibrillator back into the "ASSESSING MODE".

Post Event

1. Replace electrodes. Maintain battery per manufacturers' instructions.

2. Complete appropriate reports. Review run with other personnel.

3. Coordinate the transfer of patient event data with Medical Control.

 

CONTINUOUS QUALITY IMPROVEMENT AND EVALUATION

 1. The medical director will serve as liaison between the Medical Control Authority and AED service providers, and will maintain all individual case records. The medical director will evaluate each incident for the effectiveness, efficiency, and appropriate use of the AED.

2. The director will report the results of AED usage and quality assurance data to the Medical Control Authority on an annual basis.

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