Download Project ADAM school manual - Children`s Hospital of Wisconsin

Automated Defibrillators in Adam’s Memory
Public Access Defibrillation (PAD) Implementation Manual:
AEDs in Schools
“Project ADAM has brought meaning to the tragedy my family has
endured. Working with schools around the state and nation, hearing
about the lives saved, and seeing successful PAD programs up and
running has meant so much to me. It is Adam’s life that has inspired
me, and continues to inspire me each and every day. It is the individuals
at each and every school that inspire me. Together we can make a
difference.”
-Patty Lemel, mother of Adam Lemel, a 17-year-old Whitefish Bay, Wis.,
high school student who collapsed and died while playing basketball.
3.1
Edition
acknowledgements
Project ADAM® would like to acknowledge the following community members and
professionals for their contributions to the 3rd-edition manual:
Project ADAM advisory committee
Karen Bauer, RT, Children's Hospital of Wisconsin
Stuart Berger, MD, medical director, Project ADAM, Herma Heart Center, Children's Hospital of Wisconsin:
professor, Pediatrics (Cardiology), Medical College of Wisconsin
Rainer Gedeit, MD, Critical Care, Children's Hospital of Wisconsin; associate professor, Pediatrics (Critical
Care), Medical College of Wisconsin
Aimee Gironimi, BA, Project ADAM Administrator, Children's Hospital of Wisconsin
Erica Halbleib, senior PR specialist, Public Relations, Children’s Hospital of Wisconsin
Maryanne Kessel, RN, MBA, Director, Herma Heart Center, Children's Hospital of Wisconsin
Joe Lemel, Adam Lemel's father
Patty Lemel, Adam Lemel's mother
Rick Scott, Children's Hospital and Health System Foundation
Sara Silver-Traband, media specialist, Public Relations, Children's Hospital of Wisconsin
Karen Smith, RN, Pewaukee School District (Wisconsin)
Janette Strasburger, MD, pediatric cardiologist, Children's Hospital of Wisconsin-Fox Valley; professor,
Pediatrics (Cardiology), Medical College of Wisconsin
Community Partners
American Heart Association
American Red Cross
American Safety and Health Institute
Robert Campbell, MD, Children's Healthcare of Atlanta
Children's Healthcare of Atlanta, Atlanta, Georgia
Brandon Condon, Medic First Aid®
Brenda Dobbs, Allied Medical
Alison Ellison, RN, NCSN, Children's Healthcare of Atlanta
Florida Hospital, Orlando, Florida
Mary Jean Erschen, RN, BSN, Center for Emergency Health
and Safety in Schools, University of Wisconsin-La Crosse
Chris Graceffa, RN, Philips Medical Systems
Jim Greco, Medtronic
Joe Hanson, AvanTech/Medtronic
Michael B. Hintz, RN, Racine Area Schools (Wisconsin)
Twyla Lato, RN, BSN, Waukesha Public Schools,
Waukesha (Wisconsin)
Yung Lau, MD, University of Alabama-Birmingham
© 2009 Children’s Hospital of Wisconsin.
Masonic Medical Foundation
Barbara Mostella, RN, MSN, University of AlabamaBirmingham
Kathleen Murphy, RN, MSN, Milwaukee Public Schools,
Milwaukee
National Center for Early Defibrillation
Leslie Oganowski, PhD, Center for Emergency Health and
Safety in Schools, University of Wisconsin-La Crosse
John Payne, MD, University of Mississippi Medical Center
Agustin Ramos, MD, Florida Hospital
Bronwen E.D. Ramos, RN, Florida Hospital
Charlie Ritter, Welch Allyn
Renee Strasser, Zoll Medical Corporation
Chris Verbrick, Cardiac Science
Wisconsin Department of Public Instruction
Wisconsin Emergency Medical Systems (EMS) Association
Wisconsin Association of School Nurses
table of contents
section one:
building momentum
Planning manual: goals 2
Introduction 3
Sudden cardiac arrest/sudden cardiac death 6
The case for AEDs in schools 9
section two:
school implementation
So you need to install an AED at your school. Now what? 10
Site assessment/AED placement 12
Choosing a PAD coordinator and medical director 14
Community partnerships/committees 15
Fundraising and budgetary guidelines 17
Choosing an AED 20
CPR and AED training 23
Ongoing program maintenance 25
Mock drills 26
The AED is used: follow-up procedures 28
section three:
resources/templates
Resources 31
Templates 33
Appendix A
1
section one:
building momentum
Planning manual: goals
Since 1999, Project ADAM®, a program of Children's Hospital of Wisconsin, one of the
leading pediatric health care centers in the nation, has provided schools with the resources
necessary for planning and implementing a public access defibrillation (PAD) program.
The goals of the planning manual address the needs of school coordinators as they work
toward achieving a fully functioning PAD program. These goals may be shared with school
administration and community members who have a vested interest in the outcomes of
such a program.
This Project ADAM planning manual provides a comprehensive overview of the process
for PAD implementation. The enclosed CD contains various planning templates. A
community awareness/student orientation video also is available. Contact your Project
ADAM coordinator.
Project ADAM planning manual goals:
1
2
4
To create awareness regarding sudden cardiac arrest, its signs and symptoms,
and the need for automated external defibrillators (AEDs) in schools.
To introduce the concept of the implementation process for creating a PAD program
in a school building.
3
To provide a comprehensive model for implementation.
To serve as an ongoing resource for PAD program coordinators.
5
To serve the community as a key resource for medical expertise and
information regarding AEDs, state laws, research on sudden cardiac arrest/
sudden cardiac death, information about signs and symptoms of sudden
cardiac arrest, pre-sports screening and community impact.
Project ADAM can serve as a resource for other organizations, although the primary goal
of the project is to provide resources, education and best practices to schools across the
country.
2
Abbreviations and acronyms
ADAM:
AED:
CHD:
CPR:
EMS:
ICD:
PAD:
SCA:
SCD:
Automated Defibrillators in Adam’s Memory
Automated external defibrillator
Coronary heart disease
Cardiopulmonary resuscitation
Emergency medical services
Implantable cardioverter-defibrillator
Public access defibrillation
Sudden cardiac arrest
Sudden cardiac death
Introduction
Project ADAM began in 1999 after a series of sudden deaths among high school athletes in
southeastern Wisconsin. Many of these deaths appear due to ventricular fibrillation – heart
arrest brought on by abnormal, sustained electrical stimulation of the heart muscle. The
project began after Adam Lemel, a 17-year-old Whitefish Bay, Wis., high school student,
collapsed and died while playing basketball. Adam’s parents, Patty Lemel and Joe Lemel,
along with David Ellis, a childhood friend of Adam's, collaborated with Children's Hospital
of Wisconsin to create this program in Adam’s memory.
Since Project ADAM began, more than 25 children and adolescents have experienced sudden
cardiac arrest in southeastern Wisconsin. Of these, eight survived after immediate CPR, use
of an on-site AED, early access to emergency responders and early advanced medical care.
Currently, more than 800 Wisconsin schools or school districts have been served by Project
ADAM. In addition, Project ADAM is working to establish affiliate sites across the country
in order to help all schools become equipped to handle a sudden cardiac incident. This will
lead to cutting-edge research and best practices on a national level.
Project ADAM’s Mission
Project ADAM is a not-for-profit program of Children's Hospital of Wisconsin. Project
ADAM’s mission is to serve children and adolescents through education and deployment
of life-saving programs that help prevent sudden cardiac arrest. Schools and other areas
where large groups of children and adolescents gather are the targeted geography.
3
Project ADAM provides a pediatric cardiac advisory committee, with the support of
Children's Hospital and its resources, to implement a unique program for sharing the most
current data and information on sudden cardiac arrest incidents. This ultimately will lead
to medical research that will prevent sudden cardiac arrest.
Project ADAM provides leadership experience and expertise as a community, state and
national resource. The program is a catalyst for creating partnerships and exchanging
information, thereby helping to advocate for the health and well-being of children.
Project ADAM delivers superior value to its philanthropic supporters through exceptional
fiscal stewardship, which maximizes the impact of contributed funds in addressing the
health care concerns of children. Support for Project ADAM is through public and private
funding sources as well as Children's Hospital of Wisconsin.
Project ADAM’s Vision
Project ADAM is committed to making automated external defibrillators universally
available to all children and adolescents by being the national resource for implementing
pediatric public access defibrillation programs, as well as working toward eradicating
sudden cardiac death in children through research, education and prevention initiatives.
In December
2004, a 15-year-old
boy from Racine, Wis.
was shocked back to a
normal heart rhythm after
suffering a sudden cardiac
arrest in the gym at his school.
His responders acted quickly,
using the school response plan
and AED with efficiency and
ease. The boy, later
diagnosed with an underlying
heart condition, is alive and
well after being treated
with immediate
critical care.
4
The ADAM Act
On July 1, 2003, President George W. Bush signed the ADAM Act into law. With Sen. Russ
Feingold (D-WI) and Sen. Susan Collins (R-ME) serving as the impetus for the passing of this
act, the ADAM Act has been designed to establish a national clearinghouse modeled after
Project ADAM that serves as a resource center for schools across the country wishing to
implement a PAD program.
Project ADAM is committed to the idea that all schools should have ample resources for
the training and implementation of such a program; we continue to work closely with
legislators across the country to bring attention to this most crucial federal effort.
“Adam's death, as well as the others who have died
similarly, symbolizes the undeniable fact that without the
proper chain of survival in place, children are denied the best
chance of survival. By spreading our message my hope is that the stories
you will read are not from a parent who has lost a child, but rather those of survivors
and their families, and that no parent will again stand witness to the death of
their child without knowing they had the best chance of survival.”
-Joe Lemel, Adam's father
Project ADAM began as the result of a tragedy for one Wisconsin family. It now is reaching
beyond Wisconsin's borders, bringing resources and expertise to schools across the country
through affiliate sites in other states and from our home in Milwaukee.
Since 1999, hundreds of schools in the state of Wisconsin and beyond have implemented
PAD programs. The need is great: on any given day, approximately 20 percent of a
community's population is in a school building (Circulation: “Journal of the American Heart
Association,” 2004). At any time, an AED could be needed to help save a life.
Our mission is school-focused. From 1999 to 2005, 25 adolescents just in southeastern
Wisconsin suffered a sudden cardiac arrest. Many were engaged in an athletic activity on
or around school grounds. Of those, 18 students did not survive, including Adam Lemel.
Had an AED been located at these schools, our world may have seen at least some of these
students grow into adults. Though this is merely a snapshot of the tragedies occurring
around the country, it is a reminder of the importance of a school emergency response
plan to address the use of the chain of survival: early 9-1-1, early CPR, early defibrillation
and early emergency medical care.
5
The Chain of Survival
(Source: American Heart Association.)
In rural areas, the need (for AEDs in schools) becomes even greater. The response time of
emergency medical services can be as short as three minutes or as long as 30 minutes. For
each minute that passes as SCA strikes, the chance of survival falls by 10 percent. With an
AED on-site, school responders immediately can attempt to save a life.
“When a life-threatening emergency occurs, the quality of the response in the first few
minutes, before emergency medical service (EMS) personnel arrive, can make the difference
between life and death. During the emergency, teachers, staff and students should know
what to do and be prepared to act quickly.”
- Mary Fran Hazinski, RN, co-author of the American Heart Association scientific advisory
recommending an emergency medical plan for schools (Source: Hazinski et al, 2004).
Sudden cardiac arrest/sudden cardiac death
What is it?
Sudden cardiac arrest is different from a heart attack. When a person suffers a heart
attack, blockage or closures of one or more blood vessels prevents the heart muscle from
receiving oxygen-rich blood, causing the muscle to die. When a person suffers a sudden
cardiac arrest, the heart muscle suddenly quivers erratically (called ventricular fibrillation),
preventing blood from being pumped to the body. Causes include:
Structural or functional abnormalities of the heart or lungs:
1. Hypertrophic cardiomyopathy (HCM).
2. Arrhythmogenic right ventricular dysplasia (ARVD).
3. Coronary artery abnormalities.
4. Primary pulmonary hypertension.
5. Myocarditis/dilated cardiomyopathy.
6. Restrictive cardiomyopathy.
7. Marfan Syndrome with aortic dissection.
8. Aortic valve stenosis.
9. Other known at-risk congenital cardiac abnormalities.
6
Primary electrical abnormalities of the heart or lungs:
1. Long QT syndrome.
2. Brugada syndrome.
3. Wolff-Parkinson-White syndrome.
4. Primary or idiopathic ventricular tachycardia/fibrillation.
5. Adrenaline-induced or exercise-induced ventricular tachycardia.
6. Heart block (congenital or acquired).
Acquired conditions
1. Commotio cordis (sudden blow to the chest causing fibrillation).
2. Drug abuse (cocaine, stimulants, inhalants).
3. Atherosclerotic coronary artery disease.
Post operative congenital heart disease/heart failure
(Source: Berger, 2004.)
Signs and symptoms
Sudden cardiac arrest and death are major public health concerns. Sudden cardiac arrest is
unpredictable, leading to the need for awareness and prevention. Outside of known risk
factors such as smoking, poor diet and exercise habits and use of drugs, there are numerous
factors that may determine whether a student or adult should see a physician due to
potential heart abnormalities.
Sudden cardiac arrest has warning signs and symptoms that, at times, go unnoticed.
Particularly with children and adolescents, it is important to recognize the following:
• Fainting (syncope) during or after exercise.
• Dizziness/lightheadedness.
• Excessive fatigue associated with exercise.
• Excessive shortness of breath associated with exercise.
• Heart palpitations/abnormal heart rate or rhythm (arrhythmia).
• High blood pressure.
• Congenital heart abnormality.
• Obesity.
• Diabetes.
• Family history of sudden death prior to age 50 or known heart abnormalities.
Often, children and adolescents do not notify an adult about particular occurrences of
the symptoms. It is important to monitor students who have a known congenital heart
abnormality or are experiencing any of the signs and symptoms of sudden cardiac arrest.
7
Prevention
Primary prevention
Pre-sports screening is an essential component of prevention. Although national screening
standards do not yet exist, most states have some type of health evaluation in place for
students entering sports. In Wisconsin, the Wisconsin Athletic Association requires a screening
prior to student involvement in sports. The screening may help determine whether a
student athlete is physically capable of certain exercise, and may determine the need for
further evaluation should symptoms of a cardiac ailment be present. For more information
on pre-sports screening, contact your state Department of Public Instruction.
Some types of primary prevention measures in at-risk students with heart conditions
include:
• Medications: A physician can administer medications if a heart condition has been
diagnosed.
• Implantable cardioverter-defibrillator (ICD): An ICD can be implanted under the
chest of someone who has been diagnosed with a heart abnormality that may
produce sudden cardiac arrest.
• Interventional procedures or bypass surgery: These procedures are performed
when diagnosed and deemed necessary to repair heart muscle defects or damage.
• Modification of risk factors: Making changes to risk-taking behaviors including
smoking, exercise and nutritional habits.
• Other methods of screening currently are under scrutiny as to their efficacy and
cost-effectiveness.
Even with the best screening methods, however, some silent heart conditions still will go
undetected despite the best efforts of the family, medical community and school. For this
reason, secondary prevention strategies are important.
Secondary prevention
Secondary prevention is the root of this manual: implementing a PAD program at every
school across the United States can be the difference between lives saved and lives lost.
CPR/AED procedures can be used on a student or adult at the school. Training a team of
responders who are knowledgeable about the chain of survival, including AED use, is
strongly recommended.
8
The case for AEDs in schools
Laws
Nationally, the lay-rescuer is protected under the Good Samaritan Law. From state to state,
other laws are in place to protect the layperson as well as the trained rescuer. Even though
these laws are in place to protect those who attempt to save a life, many questions arise
when a school is in the process of PAD implementation. The most common misperception
is a rescuer can damage a victim by inadvertently delivering a shock to the heart. An AED is
a safe device, designed and tested in both children and adults. Each AED has been shown by
the manufacturer and supported by the FDA to appropriately detect ventricular fibrillation.
Therefore, CPR/AED training and use of this device only can enhance your team's efforts to
attempt to provide the best possible care in an emergency. For a listing of laws by state,
visit the Web site AED Risk Insights and read AEDs in schools: A legal perspective at
www.edlpc.com/news_AED-schools.html.
Statistics
• Brain death and permanent death start to occur just four to six minutes after
someone experiences cardiac arrest. Cardiac arrest is reversible in most victims if it is
treated within a few minutes with an electric shock to the heart to restore a normal
heartbeat. This process is called defibrillation. A victim's chances of survival are
reduced by seven to 10 percent with every minute that passes without defibrillation.
Few attempts at resuscitation succeed after 10 minutes. If someone becomes
unconscious, call 9-1-1 immediately. They may be suffering from sudden cardiac
arrest.
• About 340,000 people per year die of coronary heart disease without being
hospitalized or admitted to an emergency room. That's about half of all deaths
from CHD – more than 930 Americans each day. Most of these are sudden deaths
caused by cardiac arrest.
• Although far more rare in children and adolescents, sudden cardiac arrest can and
does occur. It is estimated between 500 and 1,000 students in the United States
suffer a sudden cardiac arrest annually.
(Source: American Heart Association, 2005.)
To read the American Heart Association’s Scientific Statement, see Appendix A.
9
section two:
school implementation
So you need to install an AED
at your school. Now what?
Recognizing the need for your school to have an AED/AEDs is an excellent step, and one of
many steps needed to build a comprehensive PAD program at your school. Now, it's time
to put a plan into action.
Tip:
A timeline helps to keep the project on task. Beginning before
spring or summer break can be helpful – it may provide you with
more time to prepare and plan. Plan according to budgetary
needs and implementation goals (see example).
Months 1-3
• Identify PAD coordinator/create PAD committees.
1
• Acquire rough estimates for AED purchase/secure funding for purchase of AED.
• Conduct site assessment (see next chapter) to determine AED placement.
• Identify medical director through EMS or local hospital. This physician will write
the prescription for the AED and serve as the medical adviser for the program.
Month 4
• Hold an AED Vendor Day at school and/or committee meetings to choose AED.
Month 5
• Finalize AED vendor/purchase unit(s).
• Create policies and procedures for your school (template provided by Project ADAM).
1
Funding may take some time if it is not in your school budget. Consider your PTO/PTA, local Masonic lodge
(information available from Project ADAM. In Wisconsin, Masons offer matching fund initiatives), Kiwanis Club,
Rotary Club, or businesses to help support fundraising efforts.
10
Month 6
• If applicable, apply for training grant from Project ADAM for CPR/AED training2.
Month 7
• Create response team/list of trainees. Plan CPR/AED training date(s). Secure
mannequins, books, CPR/AED certified trainer.
Months 8-10
• Conduct response team CPR/AED training (anywhere from eight to 40 people
depending on school size, number of AEDs and school protocol).
• Mount AED(s) at school. Use directional stickers to lead the way to the AED
(stickers provided by Project ADAM free of charge).
• Announce program to student body, faculty, community and EMS via newsletters,
assembly, newspaper. Your community is eager to hear of your efforts!
• Submit policies/procedures to medical director and EMS (this is the law in many
states).
Grants may not be available at all Project ADAM sites. Please check with your state’s site regarding availability of
grant dollars.
2
11
Site assessment/AED placement
AED placement is crucial to the efficacy of the chain of survival. Determining the location
of the AED, particularly if only one device is purchased, should be completed by the PAD
coordinator, school administration, EMS and medical director. Project ADAM may be
available to assist in conducting your site assessment.
The AHA recommends the AED should be available to shock the victim within three to five
minutes of a person falling to the ground. Therefore, it is extremely important the AED is
placed for quick and easy access in an emergency.
Site Assessment Checklist
(All should be marked “yes” to effectively place the AED.)
CRITERIA
YES
NO
1. Is the AED accessible during all hours the building is open?
2. Is the AED highly visible to passersby?
3. Is the AED retrievable within two minutes (brisk walking) of
highly populated school areas?*
4. Are all barriers (gates, alarmed hallways, etc.) cleared to gain
access to the AED?
5. Is the AED near a telephone that is clearly marked for use?
6. Is the wall on which the AED is mounted able to handle the
wall case/wiring (if applicable)?
*If your school is beginning with one AED, it is best to place it where the most “traffic” occurs (for example:
gymnasium, auditorium, etc.) From there, additional AEDs may be placed as needed in other areas of the building.
12
Consider the following scenarios:
1. A student collapses on the gym floor during basketball practice. The coach asks a
student to run to the nurse's office to retrieve the AED. The student rushes to the office
only to discover the door is locked and the nurse is nowhere to be found. Struggling to
find someone to help, the student runs back to the gym after five minutes without the
AED. 9-1-1 has been called, CPR had been started, but it has been six minutes since the
student collapsed and EMS has not arrived.
2. Three students, while horsing around, remove an AED from its case in the gym. They are
caught just as they begin to play around with plugging the pads into the unit. The
teacher places the unit back in its case and escorts the students to the office for
disciplinary action. The AED is not checked for damage after the incident.
Frequently asked questions about public access defibrillation (PAD)
programs pertain to the above scenarios. Where should the defibrillator
be placed? Can it be locked? What if a student vandalizes an AED or its
cabinet?
1. An AED is not useful unless access is easy. Keeping an AED in a locked office or cabinet
does nothing during a crisis situation. Schools serve as a community resource as well –
there may be many after-hours events or events during school breaks in which an AED is
called to the scene. If you have implemented a public access defibrillation program at
your school, the AED should be mounted on a wall for access within two minutes of any
given area. If the school is large enough, two or three AEDs may be needed to ensure
retrieval of the AED and delivery of a shock within three to five minutes. Signs clearly
pointing in the direction of the AED should be posted throughout the school.
2. Many AED wall cabinets are equipped with an alarm. Rather than running the risk of
the key being unavailable in an emergency, an alarmed device (such as the one that
sounds when the fire alarm is pulled) is the best indicator the case has been opened.
Inform students and faculty that the AED is for emergency use only – just like the fire
extinguisher and fire alarm – and that the alarm will sound if tampered with. Many
schools have a policy in place to address student tampering (for example, three-day
suspension, detention, etc.).
If your AED has been tampered with in any manner, it must be thoroughly checked for
damages and effectiveness. Any time the AED is used, the case is vandalized, or the unit is
tampered with, the AED program coordinator must conduct a thorough check (see your
AED unit manual for the proper procedure) to ensure the unit is still working properly.
A call to the AED distributor also is an excellent way to ensure its effectiveness after any
incident.
13
Choosing a PAD coordinator and
medical director
PAD coordinator
The coordinator of your school’s PAD program is responsible for the development of budgets,
committees, a timeline and ongoing program maintenance. The coordinator should be in
the school consistently (for example, if not full-time, at least on a weekly basis) in order to
ensure the program’s efficacy.
The PAD coordinator may be one of the following:
• School nurse
• Athletic director
• Physical education teacher
• Support staff member
• Parent volunteer
• Health aide
Medical director
Your PAD program will require the appointment of a volunteer medical director from your
community. The medical director should be involved in the planning process and should
be aware of the signs, symptoms and treatment for sudden cardiac arrest.
The medical director will write the prescription for your AED unit(s) and will review your
policies and procedures to ensure accuracy. The medical director should be notified
immediately if the AED is used in an emergency. He or she may be involved in training,
planning and mock drills – this is not a requirement, but is recommended.
The medical director may be a physician who is a school parent, board member or
connection made by contacting your local medical center or EMS.
Typically, the medical director of a PAD program is a physician* in one of the following areas:
• Emergency medicine
• Pediatric cardiology
• Cardiology
• Sports medicine
• Pediatrics
• Critical care
• Internal medicine
* The medical director must be a board-certified physician in order to qualify as medical director.
Note: If either role is vacated, it is extremely important to transition the position to a
new leader.
14
Community partnerships/committees
Community partnerships
Organizer participation sends a signal that the organization (or school) cares about what
the community is saying or doing (Source: Kaye, 2001).
The above statement reflects the importance of including your community in the efforts
to establish a PAD program at your school. The more community members you have on
board, the more awareness and advocacy will be established to support your program.
Implementing a PAD program is
not a one-person task. The model
for implementation includes the
assistance and support of several
key organizers:
• National/statewide support
through Project ADAM.
• Local businesses and organizations: awareness and financial
support.
• School administration and faculty:
awareness, support and training.
• Parents and guardians: awareness,
fundraising efforts and training.
• Local EMS: Training and response
plan.
• Students: Awareness and training.
Committees
Committees should include key
community and school stakeholders.
Committees can be formed for any
aspect of implementation (many
committee members may overlap
from one to the next). Some
of these areas may not need
a committee.
15
Use your planning tools to determine where help is needed:
1. Fundraising.
2. AED research/purchase.
3. AED location(s).
4. Response plan (policies and procedures).
5. Mock drills.
6. CPR/AED training. Trained school responders may include:
• Custodial staff (critical responders, these staff members are typically in the
building whenever the building is open).
• Athletic staff.
• Teachers.
• School nurse.
• Parents.
• Students.
• Administration.
7. Incident response (school counselor, principal, nurse, EMS, medical director).
Create a relationship with your local EMS
Your local EMS is a critical link to your PAD program. EMS representatives may be able
to assist you with planning, AED purchasing, determining AED locations and policies/
procedures. When your policies and procedures are complete, submit the plan to your
EMS representatives. In Wisconsin, WI Act 7 covers the lay rescuer provided the EMS has
been notified in writing of your school’s PAD plan and all AED maintenance is up to date.
16
Fundraising and budgetary guidelines
Fundraising can be one of the most crucial components of getting your program started.
Many questions arise from administrators regarding budget: Where will we get the money
to sustain the program? How can I budget this in when we already are stretched? Who can
be responsible for raising money?
“You want to make sure that if it’s your son or daughter – and
that’s my stake, my two daughters – if they’re in the athletic program, they’re
covered with at least one AED in each building.”
-Carol Mueller, Grafton, Wisconsin mother who spearheaded raising money and
awareness for her school district. In 2005, due to Carol’s efforts, the Grafton school
district implemented a comprehensive PAD program in each of its five schools.
Ideas for fundraising include:
• Pancake breakfast/spaghetti dinner hosted by local business or organization.
• Car washes.
• Candle, bracelet or wrapping paper sales.
• Classroom penny drives.
• School bake sale.
• Donation jars at school office or around community.
• Neighborhood yard/garage sale.
Interested donors may include:
• Local businesses.
• Private donors/families.
• Private foundations.
• Local civic organizations (Masons, Kiwanis, Rotary, Lions Club, American Legion
among many others).
• State/federal grantors.
17
Tip:
Consider asking a parent to spearhead fundraising
efforts. Parental involvement is essential during your
planning stages. Many parents have worked tirelessly
to raise awareness and funds for schools in need.
Writing a proposal for potential funders
When seeking funding for your AED(s), consider whether the funding source has specific
criteria, including deadlines for submission. It is important to justify your need for the
funds as clearly as possible using the following guidelines:
1. Executive summary: Not exceeding one page, this is the most important part
of your proposal, as it will “capture” your audience. Explain to the reader the
purpose of your proposal as succinctly as possible.
2. Statement of need: Describe the problem for which a PAD program in your school
is the solution. Explain the benefits of implementing a PAD program in the school
(increased CPR/AED training, community awareness, emergency preparedness
measures, etc.)
3. Program description: Describe exactly how the program will be implemented.
Include objectives, anticipated outcomes, methods proposed to complete
objectives, program evaluation plans.
4. Program budget: Use the attached worksheet to create a budget tailored
to your needs.
5. Organizational information: school name, location, accomplishments, expertise, etc.
6. Conclusion: In a paragraph or two, summarize what is to be accomplished and
why it is important for your school.
7. Attachments: Include letters of support from the community, the AHA scientific
statement (included in this manual), newspaper clippings from other schools that
have implemented a PAD program, etc.
Budgeting for your program is a key step. Share your budget with administration for
a complete picture of the cost involved. The following template may help you create
a budget tailored to your needs.
18
Project ADAM®
budget worksheet
This worksheet is a starting point for planning a budget and setting fund-raising goals. It includes major categories
that affect program cost; there may be other costs to consider for any individual program. Permission is granted
for reproduction of this form.
Start-up Costs
Number of defibrillators
Adjunctive Equipment:
x Cost of machine
Alarmed storage box
Carrying case
Spare battery
Spare electrodes
Spare data card
CPR mouth barrier devices
Scissors (blunt end)
Razor
Towel
Non-latex gloves
Pediatric pads
____________________
____________________
____________________
____________________
SUM
=$___________
$________
$________
$________
$________
$________
$________
$________
$________
$________
$________
$________
$________
$________
$________
$________
$________
Training providers:
_____ Number of staff/students to be trained x $_____ each
Training instructors:
_____ Number of staff/students to be trained x $_____ each
Medical directorship (if paid)
Other:
Insurance
$________
Event documentation
$________
Quality assurance tools
$________
____________________
$________
____________________
$________
SUM $________
=$___________
=$___________
=$___________
=$___________
=$___________
Total Start-up Cost =$___________
Annual maintenance costs
Ongoing training (practice sessions, training new providers, retaining providers)
On-going training (training new instructors, retaining instructors)
Machine maintenance
Medical directorship
Insurance
Replacement items (pads, battery)
Other: ____________________________________________________________
=$___________
=$___________
=$___________
=$___________
=$___________
=$___________
=$___________
Total annual program maintenance cost =$___________
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Choosing an automated external
defibrillator (AED)
Aren’t they all the same? Why are there price differences? Is one better than another?
If I purchase a unit based on lower cost, will it work? I can’t decide – who can help me?
Project ADAM endorses the purchase of FDA-approved units. Be sure to purchase from a
company that has been in the AED market for more than two years and that manufactures
other medical devices – this will provide you with security in knowing you are making a
purchase from a reputable company. Each unit has unique features, though they all serve
the same purpose: delivering a shock to restore the normal rhythm of the heart. You may
ask: “Why, then, are there differences?” The answer is simple: as with any purchase, the
consumer has choices due to the high demand of such units.
Your choices may be based on several criteria:
1. What AED unit does our local EMS purchase?
2. What does our medical director recommend?
3. How many units do we need to purchase?
4. Can the company with which we conduct business provide us with
a comprehensive package?
5. Will we have a local contact from the AED company?
6. Does our school prefer features some models don’t have?
7. Does our school wish to purchase a portable unit as well as a wall-mounted
unit(s)?
8. Does the unit have pediatric defibrillation capabilities? (This is asked if the AED
will be used on children younger than 8 years or less than 55 pounds).
9. Does the AED vendor provide ongoing maintenance checks, and provide renewal
supplies (following an event in which the AED is used) free of charge or for a
discounted price?
10. What is the company policy regarding turn around if an AED needs to be
serviced? Do they provide another AED on loan until your unit is serviced?
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11. What is the longevity of the battery or the pads, and how much do the
replacements cost? What is the product warranty?
12. Is the company up to date with the newest technology?
Steps for choosing an AED:
1. Form a committee, including a representative of your local EMS.
2. Gather information on AED companies (Project ADAM provides a list of vendors
in your state).
3. Arrange to meet with the vendor(s) of your choice.
4. Discuss criteria with committee. Vote on unit of choice.
5. Contact vendor with questions or negotiable criteria.
6. Ensure funding is in place from your budget.
7. Arrange second meeting with chosen vendor to negotiate purchase and delivery.
8. Speak with other schools districts. Sometimes a group purchase can lower
your cost.
Tip:
Consider hosting an AED vendor day at your school. Invite several
FDA-approved vendors to visit and demonstrate their unit. Schedule
30-45 minutes with each vendor (separately) in your school gym or
conference room. Each vendor will provide the information necessary
for understanding the unit, ease of use and special features. Some
vendors may come with a pricing package in hand. Before the end
of their session you should have a solid idea of the pricing package,
including wall-mounted cases, alarms, pads, batteries, warranty and
replacement supplies.
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Pediatric defibrillation
The FDA, American Medical Association and several CPR/AED training organizations have
endorsed the use of AEDs for pediatric defibrillation. Pediatric defibrillation is recommended
for children ages 1 to 8 who are suffering sudden cardiac arrest. Consider the following
points:
• Joules (electrical currents) are significantly reduced when an AED delivers a shock
to a child. This accommodates the need for less energy delivered to a young heart
in cardiac arrest.
• Pad placement: guidelines are
different for children than for
adults. You will learn through
training and your AED vendor
that pads are to be placed on
the anterior and posterior
(front and back) of the chest
on small children. As the child
grows larger (closer to 8 years
of age/more than 55 pounds),
normal adult placement
(upper right, lower left of
chest) is used.
• AEDs now are manufactured
with pediatric capabilities.
Pads are provided for adults
and children and are clearly
marked for use. Both sets of
pads may be plugged in to the
same machine.
• If you have an existing AED
that does not have pediatric
capabilities, contact your AED
manufacturer to have the unit
upgraded or replaced. Even if
the AED is placed at the high
school, many young students
may use the building during
the summer months or for
special events.
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CPR and AED training
Planning your CPR/AED training requires patience and organization. Your CPR/AED training
committee can create a plan of action that suits the needs of your school(s). Consider the
following guidelines:
Choosing a CPR/AED instructor
• Often, a school staff member (school nurse, athletic director, athletic trainer or physical
education teacher) is a trained instructor through the AHA or American Red Cross (ARC).
If this is the case, it is cost efficient since you may not need to hire an outside source.
Consider becoming an instructor through an accredited organization if possible. This can
save money in the long run as you renew certifications or train new responders.
• If you do not have a trained instructor on staff, there are several options for hiring an
outside source. Your local EMS or fire/police department or other community programs
may have a trained instructor available for a fee. Additionally, there are many trained
instructors through AHA, ARC, American Safety and Health Institute (ASHI) and the
National Safety Council (NSC) who are available regionally.
• Many area community colleges or technical colleges have trained staff and class schedules
available.
• Consider the length of the training session and length of certification. The training
should last from three-and-a-half to six hours (longer for pediatric CPR/AED, which
generally will be the case for most schools). Certification varies – some certifications are
renewed annually, while others are renewed every two years. New training approaches
are being developed to make training more time- and user-friendly, including partial
online training. Check with your trainer to discuss options as they develop.
Organizing your training
• Plan to hold more than one training session to ensure participation. Generally, a trainer
can conduct one four-hour training with six to eight participants. For example, if you are
training 32 people, you will choose four dates for which participants can sign up, or simply
assign participants to a particular date and time.
• Be sure to budget your training (see Section 3: Resources/Templates). The following items
are to be purchased if not provided by the instructor as part of the training fee:
- Training manuals.
- Certification cards.
- Mannequins.
- Required paperwork.
- AED trainer (practice device).
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• You will need a TV/VCR or DVD and a large room (cafeteria, gym, conference room) for
your training.
• Incentives help gain participation! If the participants are volunteering to be trained,
consider providing food and beverages during the training, as well as gift cards or a small
stipend for participants. Training may be mandated for school staff, although this is not
always the case. Discuss your options with school administration or funders beforehand.
Cost
The cost of training staff and community members will depend on several factors:
1. Who is providing training? (Outsourced training organization, trained school
representative, local EMS).
2. Materials needed (mannequins, mouth barriers, AED training device, training
manuals, certification cards).
3. Do we pay our staff/substitutes for their time?
4. Are we training students?
• On average, the per person cost can be as little as $15 or as much as $55. Some trainers
may offer their services for free as a donation to the school.
• Certification cards should be included in the cost of training.
• If you outsource your instructor, she/he should come with the equipment necessary to
conduct the training.
• Your training dollars may be used to train one or two staff members to become instructors
and to purchase equipment. In the long run, this will save the school training costs,
especially if the school plans to begin student CPR/AED training.
Tip:
Consider linking with other schools or districts in your area to
conduct CPR/AED training. If you have a small group to certify or
renew, this can be helpful in cutting costs. If you are training for the
first time, partnering with another school/district may save you
time and planning – other schools may have a system in
place they are willing to share!
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Ongoing program maintenance
Your PAD program is up and running. Congratulations! In order to maintain a vital PAD
program at your school, consider the following:
Checking the AED/wall cabinet
• Assign a school staff member to perform required maintenance checks. Your AED vendor
will explain the necessary checks. Typically, the staff member should walk past the AED
unit to glance at the indicator light – generally, there will be a small light to indicate the
unit is charged and functioning properly.
• According to the AED unit directions, scheduled maintenance includes: battery check,
pad expiration and general upkeep (such as ensuring the wall-mounted case is intact,
no tampering has been noted, the unit is fully stocked with the necessary supplies).
• It never hurts to write in your computer calendar, or on a school calendar at the beginning
of each year whether the pads or batteries expire that year. Don’t buy these supplies too
far in advance because they do have expiration dates.
CPR/AED training
• Depending on the training organization, (AHA, ARC, ASHI or NSC), you will recertify your
crisis team and students annually or every two years. Create a plan to schedule these
trainings in advance so you can remain on track and updated with your CPR/AED
certifications. Studies have shown that repeated training improves a person’s response
in the event of a true emergency.
• Set training days during the year for consistency (for example, in-service days).
• As your program changes and/or grows, so will the need for additional trained
responders. Periodic updates to trained staff are necessary if you:
1. Experience staff turnover.
2. Add additional AEDs at your school.
3. Change the CPR/AED training curriculum.
4. Make CPR/AED certification a requirement for new employees in your school.
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Communication
• Annual reports to your medical director and local EMS help to maintain efficient records.
Remember: any use of the AED should be reported to your notification list!
• Periodic updates in the school newsletter will keep your school and community informed
of your PAD program. If you conduct training, mock drill or other program updates,
keeping the staff and student body informed is an important part of the process.
Mock drills
Conducting mock drills as part of your PAD program training is essential. No matter how
comfortable the response team is with the knowledge gained from CPR/AED training,
many glitches can and do occur when an incident arises. Mock drills help to work out
potential challenges and help to alleviate fear.
Note: Sample mock drill scenarios and practice templates are on the CD included in this
manual.
Planning for mock drills
• An initial drill should be conducted soon after initial CPR/AED training.
• Drills should be conducted regularly (at least twice per school year).
• Get students involved! It is important for students to recognize their part in an emergency.
If they are not trained responders, let them know there will be a drill and ask them to
observe. Project ADAM and other organizations have introductory videos, CD-ROMs and
other learning tools to help prepare students to be involved in an emergency situation
(see Resources in Section 3).
• Ask your local EMS/fire department to be available for assisting with scenarios.
• Notify your medical director when you’ll be conducting a mock drill.
• Be sure all participants are aware of AED locations!
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Conducting a mock drill
1. Notify trained staff of the planned date and time, allowing approximately 30 minutes
from start to finish. Based on past drills, you may become confident to stage a surprise
drill.
2. Design drill according to cognitive level (for example, adapt for parents, staff, students).
3. Prepare drill area with mannequin and supplies.
4. Consider drills for one and/or multiple responders.
5. Ensure a school-based scenario, choosing different locations for each drill.
One outdoor drill should be conducted each year.
6. Ensure all materials/responders are in place: access to AED, telephone
(for mock 911 call*) and a watch or timer with a second hand.
7. Ask EMS and/or medical director to be present if possible.
8. Use debriefing evaluation form (included on CD) to mark progress/challenges/successes.
*Inform responder they should not actually place the call.
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The AED is used:
follow-up procedures
“We thought someone else was doing that!” Several procedures should be in place to
prepare for when an AED is used in an emergency. It is important to make your protocol
reflect the responsibilities of staff and community members.
Downloading data: event storage
Immediately following an event in which the AED is used to shock a sudden cardiac arrest
victim (student, parent, grandparent, staff member, etc.), a designated staff member is
responsible for getting the data card from the unit (see manufacturer instructions for
location and method) to the appropriate person for computer downloading.
• Data cards contain protected health information. Do not give the data card to anyone other than your EMS or receiving hospital, the manufacturer’s representative,
the medical director, or those medical personnel for whom the victim or victim’s
family provide written permission to receive the information contained on the
data card. However, these data cards contain important clues to the cardiac arrest
victim’s medical history. They should be analyzed and not just left in the machine
to be erased with the next event or test.
• Ask someone from your medical center, fire department or EMS to be the point
person for downloading. If this procedure is in place ahead of time, it will save you
valuable time and energy.
• The data cards in AED units are designed to provide a printout of the event. The
printout will show the shockable rhythm (ventricular fibrillation or ventricular
tachycardia), AED shock and subsequent heart rhythm.
• Ask your AED vendor for a “practice data card” so your designated point person
can experience the procedure for downloading information. It is recommended
you conduct a practice session as part of your planning process.
Reservicing AED unit/restocking supplies
Your AED manufacturer will have guidelines for reservicing your unit. New pads will need
to be purchased and the AED battery will need to be checked or replaced depending on
the unit. Typically, the AED can be remounted without a great deal of delay; your AED
vendor representative should be able to service the unit within five days.
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• Use of an alternate AED unit may be necessary until the AED used for the emergency
is serviced. Create a plan with your local EMS or a school that has more than one
AED to ensure coverage until your original unit is reserviced.
• You may need to restock supplies. If the pads, battery (most do not need to be
replaced until expiration even if the AED is used), razor, towel or other supplies
were used and are not reusable, these items can be purchased and supplied by
your AED vendor. Many vendors provide these items free of charge following an
event.
Staff/student debriefing
A debriefing session is important to ensure the story is consistent and staff and students
are well informed following an event in which the AED is used.
• If the event occurs during school hours or a school event, determine the staff/
students who need immediate debriefing. This may include those who witnessed
the event or those who know the victim.
• If the event occurs after school hours or during an event in which staff students
were not present (for example, a community meeting, scouting group event, etc.),
determine how the event is announced (school newsletter, general announcement,
person-by-person basis, etc.).
• Focus on the school, the PAD program and Project ADAM if appropriate, not on
the survivor or victim.
• Ask for help from Project ADAM.
• Determine the type of debriefing necessary to determine staff necessary:
AED is deployed but is not used: PAD coordinator, building principal.
AED is deployed and used to save a life: PAD coordinator, building principal,
school crisis team (support staff).
AED is deployed, used and a death occurs: PAD coordinator, building
principal, school crisis team (support staff), clergy, medical director, EMS,
parent representative.
Project ADAM is available for debriefing sessions (in person if the school is
within a state where Project ADAM is located, via conference call if out of
range). The Project ADAM debriefing team consists of the project administrator,
medical director and advisory committee members as determined by need.
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Confidentiality/Sensitivity
The victim of a sudden cardiac arrest and his/her family may or may not wish to share their
story. Confidentiality and sensitivity to the event is necessary to ensure the wishes of the
family are met.
• If the victim of a sudden cardiac arrest is a student, the family will need to give
permission for the student’s information to be shared.
• If the victim of a sudden cardiac arrest is a staff member, parent or other adult,
their permission is necessary before sharing their story.
• Often, the victim of a sudden cardiac arrest may be sensitive or perhaps
embarrassed by the situation. Being mindful of one’s sensitivity is essential.
• Some survivors may wish to share their story. This can help with the healing
process and as a way for the victim to share their gratitude to those involved
in the save. If this is the case, be sure to discuss with the victim their options
for speaking with the community about the event.
Note: Please check your school district and/or state privacy laws before releasing information
pertaining to an event in which the AED is used.
Event notification
It is important to share the news of an AED being used at your school. Those who have
been part of the implementation process are interested to know public details of any
event in which the AED is used.
June, 2005:
On Wednesday evening, the grandfather of one of our high school students
suffered a sudden cardiac arrest. Because of the quick action of one of our
high school students (knowing where the AED is located) and the ER nurse
and another nurse in attendance at the event, this man’s life was saved.
We are very pleased with our staff, students and community for their quick
response to this serious situation. However, without your initial interest and
support of our project to purchase AED units, there would not have been
the success experienced.
- Letter from PAD coordinator to Project ADAM and community donors,
Greendale High School, Greendale, Wis.
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section three:
resources/templates
Resources
As Web site addresses, AED vendors and training programs are subject to change, please
be sure to call Project ADAM at (414) 266-3889 if you have questions, cannot access a site
or would like updated information. The following list is comprised of major resource sites
and does not reflect all resources available for CPR/AED programming or sudden cardiac
arrest/death.
School-related AED program information
• Project ADAM Web site, dedicated to the memory of Adam Lemel:
www.projectadam.com
• Louis J. Acompora Memorial Foundation: www.la12.org
• Gregory W. Moyer Defibrillator Fund: www.gregaed.org
• Sudden Cardiac Arrest Foundation: www.sca-aware.org
Student AED exposure
• Project ADAM video.
• American Heart Association – Be the Beat: www.bethebeat.heart.org
• Project S.A.V.E.: www.choa.org/ProjectSave
• Youth Heart Watch:
www.chop.edu/service/cardiac-center/our-services/youth-heart-watch.html
• Project ADAM Florida: www.projectadamflorida.com
• Project ADAM Illinois: www.mhcfoundation.org/projectAdam.html
Cardiac conditions/definitions/diagnostic information
• Sudden Arrhythmia Death Syndrome Foundation: www.sads.org
• Hypertrophic Cardiomyopathy Association: www.4hcm.org
• Cardiac Arrhythmia Research and Education Foundation: www.longqt.org
• Heart Rhythm Society: www.hrspatients.org
CPR/AED training
• American Heart Association: www.americanheart.org
• American Red Cross: www.redcross.org
• American Safety and Health Institute: www.ashinstitute.org
• National Safety Council: www.nsc.org
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PAD program information
• Citizen CPR Foundation, Inc.: www.citizencpr.org
• Basic Emergency Lifesaving Skills in Schools: www.uwlax.edu/belss
• Georgia Division of Public Health – Emergency Medical Services and Trauma:
www.health.state.ga.us/programs/ems/emsc/
FDA-approved AED company sites (alphabetically listed)
• Cardiac Science: www.cardiacscience.com
• Defibtech: www.defibtech.com
• Medtronic Physio-Control: www.medtronicphysiocontrol.com
• Philips Medical Systems/Heartstream: www.philips.com
• Welch-Allyn: www.welchallyn.com
• Zoll Medical Corporation: www.zoll.com
Articles and links (scholarly and general):
• Cardiovascular Health Promotion in Schools:
www.circ.ahajournals.org/cgi/content/full/110/15/2266
• Bereavement resources: www.palliative.info/pages/Bereavement.htm
• Emergency Response Planning and AED Programs at School:
www.choa.org/buildingbridges (See: Newsletter, 2004, Vol. 1)
• Cardiovascular Health in Childhood:
www.circ.ahajournals.org/cgi/content/full/106/1/143?ck=nck
• Center for Disease Control: State-specific Mortality from Sudden Cardiac Death:
www.cdc.gov/mmwr/preview/mmwrhtml/mm5106a3.htm
• American Academy of Pediatrics – several journal articles searchable regarding cardiac arrhythmias, SCA, SCD: www.aap.org
• Pre-sports screening and evaluation: www.aheartforsports.org
• Pre-sports screening statement – American Heart Association:
www.americanheart.org/presenter.jhtml?identifier=3046150
References:
Hazinski, et al. Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies: The
Medical Emergency Response Plan for Schools: A Statement for Healthcare Providers, Policymakers,
School Administrators, and Community Leaders. Circulation, 109:278-291, 2004.
Berger, S. From fetus to young adult: Contemporary topics in pediatric cardiovascular disease. Pediatric
Clinics of North America, 51(6), 2004.
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Templates
CD contents (planning templates)
• AED data sheet.
• AED decision guide worksheet.
• CPR/AED training budget template.
• CPR/AED trained responder roster/log.
• Implementation checklist.
• Policy and procedure planning sample.
• PowerPoint presentation: The need for AEDs in schools.
• Program budget worksheet.
• Readiness inventory.
• Supply inventory.
• Sample press release.
• Sample letter to parents.
• Sample letter to EMS.
• Skill drill scenarios.
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Appendix A
(Written permission has been granted for reproduction of the following document.)
A program developed by
Children’s Hospital of Wisconsin
PO Box 1997
Milwaukee, WI 53201-1997
Toll-free (877) 266-8989
chw.org
© 2009 Children’s Hospital and Health System. Previous editions 1999, 2002, 2005.
Printed in the United States of America.
CC 1209 dfc