Download A Pilot Program to install Automate

Exhibit A
TOWNSHIP OF LOWER MERION
Parks & Recreation Committee
Issue Briefing
Topic:
A Pilot Program to install Automated External Defibrillator (AED) units in Township
Parks with designated Playing fields accessible for public use.
Prepared
By:
Donna L. Heller, Director of Parks & Recreation
Date:
June 8, 2016
I.
Action To Be Considered By The Board: Consider for recommendation to the Board of
Commissioners, authorizing a pilot program for the installation and monthly monitoring of
publicly accessible Automated External Defibrillators (AEDs) in Township Parks with
designated Playing fields.
II.
Why This Issue Requires Board Consideration: This would be an unbudgeted expense,
which is accompanied with ongoing operational expenses.
III.
Current Policy Or Practice (If Applicable):
There are no current policies or any requirements for AED’s to be located in Township
Parks. Park Systems nationwide, including Lower Merion Township, rely on their
emergency responders (Police/Ambulance/Fire) as they carry and are trained on the AED
system and other life saving measures. Our Police emergency response time is under 5
minutes.
IV.
Other Relevant Background Information:
Lower Merion Little League (LMLL) developed a Safety Committee for their
organization. The Chair of the Committee is Marc Altshuler, MD, Department of Family and
Community Medicine, Thomas Jefferson University. Marc and other community members
are championing an effort have AED's installed for public access.
AEDs in Parks is not a new endeavor. Many Leagues and Communities have provided
AED's in Snack Bars and other secure locations only available during the league play. The
LMLL request is for installation of the devices in open air at designated Playing fields
making them accessible to all Park users. This open to the public concept for AED’s would
be new to this region. Northbrook Park District, IL (NBPD) is the only community with 14
outdoor units that are accessible to the public at all times. NBPD's weather-proof cabinets
are installed on existing park buildings with electrical and phone hookup, which are linked to
a monitoring system that will dispatch police and paramedics when the door is opened.
NBPD's units have been installed since the Fall of 2012.
After conducting a review, it is clear few communities have placed the devices in open
unsecured locations in Parks so there is very little data available about the longevity of the
devices for this type of installation. Since the topic has been raised, other Main Line
Communities (Tredyffrin Township & Malvern Borough) have been considering this type of
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Exhibit A
installation. Comments from these communities have been that they are waiting to see what
action Lower Merion will take.
General Info:
AED’s:
• Will not send out a shock unless the arrhythmia requires a shock.
• Can be stored in temps. 14 – 122 degrees
The pilot program would include up to 13 installation locations in Township Parks with
designated Playing fields. The final number would be determined by a site visit as the
placement of the AED's should meet the criteria of retrieving an AED and return to a victim
in three minutes at only a brisk walking pace.
The Parks include: Ashburn, Bala Cynwyd, General Wayne, Gladwyne, McMoran, Penn
Wynne, Polo field, South Ardmore, and Vernon Young.
This initiative is supported by the following organizations that utilize Lower Merion
Township Parks and Recreation facilities. Some of these organizations are willing to
financially support this program, although they have yet to confirm a financial commitment.
1. Lower Merion Little League
2. Lower Merion Soccer Club
3. Ultimate Frisbee
4. Main Line Synagogue Softball League
5. Main Line Businessmen’s League
6. Harriton High School
7. Barrack Academy
8. 40/40 Baseball Academy
9. The Shipley School
10. Lower Merion High School
Below is a side by side comparison of the two durable, public access AED units. Both units
are widely used in the United States, but the GPS tracking, only available with the Philips
model, is the only AED GPS program on the market. It is successful in Europe and currently
utilized on roughly 500 devices in the United States.
The Device is designed for Public
Access Use does not require user
to be trained in CPR.
$1385.50 with CoStars Discount
Philips Onsite AED
with Basic GPS
SmartLink tracking
The Device is designed for Public
Access Use does require user to
be trained in CPR.
$1496.05 with CoStars Discount
Includes:
• Durable Carry Case
• Rescue Kit
• Adult Pads/Battery
Includes:
• Durable Carry Case
• Rescue Kit
• Adult Pads/Battery
HeartSine Samaritan 350P AED
Cost of initial
Unit
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Exhibit A
•
•
IP Rating
Warranty/
Useful Life
Parts
Replacement
Schedule
Medical
Oversight
Unscheduled
Maintenance or
Consultation
Additional
Training
Provided
Pediatric Pads/Battery
Weather tight Wall box
w/Audible Alarm when
door opens
• Installation (including
materials) of the device
2.1 rating against moisture and
dust.
10 years
8 years
Every 4 years
Every 2 years
15% discount off of fair market
value @ time of Purchase.
Installed as part of the Medical
Oversight Fee.
15% discount off of fair market
value @ time of Purchase.
Installed as part of the Medical
Oversight Fee.
Replacement Parts include:
• Adult Pads/Battery
• Pediatric Pads/Battery
$8 per device per month
Replacement Parts include:
• Adult Pads/Battery
• Pediatric Pads/Battery
$15 per device per month
Monitors:
• Purchase dates
• AED usage
• Pad & Battery Expirations
• Locations of Installation
• Recalls by the FDA or
Company
• Scheduled Maintenance &
Registration for each
device
Monitors:
• Purchase dates
• AED usage
• Pad & Battery Expirations
• Locations of Installation
• Recalls by the FDA or
Company
• Scheduled Maintenance &
Registration for each
device
$65.00 per hour
$65.00 per hour
AED/CRP Training
3 classes not to exceed 30 people
per class.
AED/CRP Training
3 classes not to exceed 30 people
per class.
GPS Tracking $199 per Unit (one
time cost)
HeartSine does not require user to
be trained in CPR.
Other Incentives
•
•
Pediatric Pads/Battery
Weather tight Wall box
w/Audible Alarm when
door opens
• Installation (including
materials) of the device
5.6 rating against moisture and
dust which is the highest rating.
A free AED donated to a charity,
organization, or individual of the
victims choosing
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Monthly GPS Fee per Unit
• $360/unit 24 months
• $430/unit 36 months
• $480/unit 48 months
• $600/unit 60 months
Exhibit A
Free Pad Pak each time the AED
is utilized on a victim of sudden
cardiac arrest
Operational Cost
over the Useful
life per device
Installation of
Mounting
Surface &
Signage per
device
Cost of each
Unit Installed
(Including
Mounting
Surface &
Signage)
Cost of Each
Unit installed
over Warranty/
Useful Life
(approximate)
Approximate
cost per unit
over Warranty/
Useful Life
Initial cost of the
Program for 13
locations
(Installed + 1st
year Med
Oversight)
GPS for use useful life (96
months)
$1030/unit
Med Oversight $180.00 per unit
for 8 years = $1440
Med Oversight $96.00 per unit for plus
10 years = $960
Replacement Part @ current
plus
Market Value 15% off $255 (2016
Replacement Part @ current
rates $300) 3 replacement needed
Market Value 15% off $340 (2016 over life. = $765
rates $400) 2 replacement needed plus
over life. = $680
GPS for use useful life (96
months)
Total Cost over life per Unit =
$1030/unit
approximately $1,640
Total Cost over life per Unit =
approximately $3,235
Installation of mounting surface
Installation of mounting surface
for each AED = $300.00 (Material for each AED = $300.00 (Material
& Labor for structure)
& Labor for structure)
Required Signage for each AED =
$150 (Cost of Signage)
Required Signage for each AED =
$150 (Cost of Signage)
Total $450
Total $450
$1,835.50
$2,145.05
$3,475.50 over 10 years
$5,380.05 over 8 years
$5,311.00 over 10 years
$7,525.10 over 8 years
$25,109.50
$30,225.65
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Exhibit A
Total Average
Annual Cost for
13 locations
$2,132 per year
$5,256.88 per year
The Township Solicitor’s opinion regarding the AED's installed for public access is that
liability exposure to the Township from providing an AED device which is used by an
unqualified person who thereby causes harm could be a concern. If the Township is going to
make devices readily available at recreation venues, I would recommend that a warning be
placed in large letters on the device and on the face of the cabinet where it is stored to the
effect that: “This automated external defibrillation device is only for use by persons who
have been trained in accordance with standards identified and approved by the Pennsylvania
Department of Health.” The Township would be held harmless if an untrained person,
believing they can follow the instructions, uses the device in good faith. There should also
be language posted that the device is serviced and maintained by the vendor and to contact
emergency medical services (911)
This is the statutory language:
§ 8331.2. Good Samaritan civil immunity for use of automated external
defibrillator
(a) General rule.--Any person who in good faith acquires and maintains an
AED or uses an AED in an emergency shall not be liable for any civil damages
as a result of any acts or omissions by an individual using the AED, except if
acts or omissions intentionally designed to harm or any grossly negligent acts
or omissions resulting in harm to the individual receiving the AED treatment.
(b) Requirements.--Any person who acquires and maintains an AED for use in
accordance with this section shall:
(1) Ensure that expected AED users receive training pursuant to subsection (c).
(2) Maintain and test the AED according to the manufacturer's operational
guidelines.
(3) Provide instruction requiring the user of the AED to utilize available means
to immediately contact and activate the emergency medical services system.
(4) Assure that any appropriate data or information is made available to
emergency medical services personnel or other health care providers as
requested.
(c) Training.--For purposes of this section, expected AED users shall complete training in
the use of an AED consistent with American Red Cross, American Heart Association or
other national standards as identified and approved by the Department of Health in
consultation with the Pennsylvania Emergency Health Services Council.
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Exhibit A
Frequently Asked Questions:
What is ventricular fibrillation?
Ventricular fibrillation is the fatal rhythm that causes sudden cardiac arrest. The heart
instantly goes from a normal heart rhythm to a chaotic rhythm called ventricular fibrillation.
When the heart goes into VF, the pulse and blood pressure is instantly lost and the person
loses consciousness in a few seconds. The only effective treatment is an electric shock across
the chest and through the heart. A shock, if delivered in time, can convert the fatal rhythm of
VF back to a normal heart rhythm. An AED is a device that automatically analyses the
heart’s rhythm and can deliver a shock if VF is present.
What is the relation of CPR to AED?
CPR cannot convert VF into a normal rhythm (only an electric shock can do this) but CPR
can circulate a small trickle of oxygenated blood to vital organs and thus slow the dying
process until an AED arrives. Thus CPR buys time until the AED arrives to deliver a shock.
How soon must I attach an AED to a person in cardiac arrest?
The sooner the better. The chances of a successful defibrillation using an AED falls by about
7% to 10% with each passing minute.
Why do I call 911 before attaching the AED?
Clearly if there are two witnesses to the cardiac arrest, one should call 911 while the other
retrieves and attaches the AED. If there is only one rescuer, that person should call 911 in
order to get EMS personnel responding to the scene. It is worth the extra minute to get help
on the way. The emergency operator can also remind you how to use the device and even
coach you through CPR if you forgot. Even if you are successful with the AED, EMS
personnel will have to administer medications (to prevent a relapse into VF) and administer
oxygen or even place a breathing tube down the person’s windpipe.
When I attach the pads to the person in cardiac arrest, how long does it take for the
AED to work?
The devices vary somewhat but in general once the pads are attached, the device takes 5-10
seconds to analyze the heart’s rhythm and another few seconds to charge itself up.
If I use an AED do Good Samaritan laws cover me?
Yes, so long as you use it properly.
What if the AED doesn’t give a shock?
Not every cardiac arrest is caused by VF. Approximately one third of the time the heart will
not be in VF and therefore the AED will not deliver a shock. In this case it will advise the
rescuer to check the patient and begin CPR.
What happens if I am touching the person when the AED shocks?
Probably nothing. You may feel a slight tingle. Try to not touch the person when the shock is
delivered. If you should have latex gloves available, this should also protect you even if you
are touching the patient's chest at the moment of shock.
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Exhibit A
What if the victim is wet or lying on a wet surface?
Try to dry the chest with a towel before applying the pads. Defibrillation is most safely
performed on a dry surface. The risks to rescuers and bystanders associated with
defibrillating on a wet surface have to be balanced against the risk to the patient of delaying
defibrillation. If the patient cannot be safely and quickly moved to a dry surface, as far as
possible all bystanders should move off the wet surface. Anyone that must be on the wet
surface should avoid direct contact with the patient, and should avoid contact between their
body - particularly above their waist - and the wet surface, as far as possible. Wearing latex
gloves will also reduce the likelihood of the rescuer being shocked in the event the rescuer is
touching the patient at the moment of defibrillation.
What if the chest is hairy and the pads won’t stick to the skin?
You might keep a disposable shaver with the AED just for this purpose.
Can the AED accidentally shock someone who doesn’t need a shock?
Not likely. The AED is designed to only shock VF. It will not shock any other heart rhythm.
Nevertheless, AEDs are not perfect and in 1% of cases it may shock a rhythm other than VF.
That’s why it should only be attached to a person who is unconscious and has collapsed.
What if the victim has a pacemaker?
Ignore the presence of the pacemaker.
What if the victim has an implanted defibrillator?
The AED is not needed for someone who has an implanted defibrillator. However, if the
implanted defibrillator is not firing, you can consider attaching an AED (it is possible the
implanted defibrillator is not working properly). The AED will not harm the implanted
defibrillator.
How do I know if the shock was delivered?
Some devices say “shock delivered” but you will also know because you will see the chest’s
muscular twitch in response to the electric shock.
Do I have to place the pads in the exact spot shown in the diagram?
As close as possible. When the pads are in the incorrect location the shock is less effective.
What if the woman has a bra on?
Lift the bra up over the breasts and let it bunch up around the neck, then attach the pads.
Will an AED save everyone in cardiac arrest?
No. Many factors such as whether the collapse was witnessed, the heart’s rhythm, and the
underlying condition of the victim determine whether the victim lives or dies.
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Exhibit A
V.
Impact On Township Finances: The devices are available through the state purchasing
cooperative CoStars. The original cost per unit was $1,500 each. The CoStars cost per unit is
$1,385.50, assuming the less expensive AED unit, that does not require user training is
purchased.
The request to install up to 13 units would cost $25,109.50 in the first year with the
maintenance and service contract.
The average annual cost over the next 9 years of the warranty for maintenance and service
would be $2,132 per year. The 2 parts replacement cycles would be $4,420 each and the
maintenance and service years would be $1,248.
VI.
Staff Recommendation: Recommend to the Board to authorize an AED pilot program at up
to 10 park locations, subject to a final determination by the Board of Commissioners on the
scope of this pilot project. The Parks for implementation would be selected based upon the
number of permits issued on an annual basis. The current order of permit volume is South
Ardmore, Vernon Young, Polo Field, McMoran, General Wayne, Bala Cynwyd, Gladwyne,
Penn Wynne, and Ashburn. The number of installations per site is yet to be determined based
on the criteria of retrieving an AED and return to a victim in three minutes at only a brisk
walking pace. A working estimate for the larger sites would be a minimum of two installs per
site. Each installation and monthly monitoring of the HeartSine Samaritan 350P would cost
$1,931.50 to initiate a pilot program in the first year.
This program would be monitored for it successes and failures, and future recommendations
would be made as to the continuation of the pilot program.
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Exhibit A
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Exhibit A
Northbrook Park District, IL
Outdoor Installation
It is equipped with a phone connection to initiates police and paramedic response and an audible alarm
which activates when the door is open.
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