Automatic External Defibrillator (AED) in the school setting

The benefits of Automated External Defibrillators (AED’s) are becoming regular headline news as lives are saved by a quick response at showcase sporting events like mass participation running events. The technology is rapidly becoming more accessible, and as a result, some school districts have been assessing the risks associated with purchasing/not purchasing AEDs or accepting/not accepting donated AEDs for use in their schools.

Certainly where large numbers of people congregate every day (offices, industrial facilities, malls, airports, arenas, casinos, etc.) public access to AEDs has proven to be helpful in emergency situations. Facilities where strenuous physical activity occurs may be more likely to experience a sudden cardiac event.

The B.C. Public Access to Defibrillation (PAD) Program Factsheet, available on the B.C. Ambulance website, defines a sudden cardiac arrest (SCA) as an event that occurs when the heart stops beating and the victim is no longer breathing. SCA can be caused by heart disease, drowning, electrocution, suffocation, motor vehicle accident, or other injury. According to this factsheet, for every one minute that passes without defibrillation, or returning the heart to a normal rhythm, the survival rate of a cardiac arrest victim decreases by as much as 10 per cent. In B.C., the current survival rate for an out-of-hospital sudden cardiac arrest is only about 12 per cent. When CPR and AEDs are used together in the first few minutes during a cardiac arrest, survival rates may increase up to 75 per cent.

The number of heart-related incidents occurring in B.C. schools is very low. In the school setting, an AED is more likely to assist an employee or adult visitor than a child.

Currently in B.C., there is no legislation in place, making AEDs mandatory at a workplace or a public place, however the Heart and Stroke Foundation is advocating to change this: https://www. bcpadprogram.ca/admin/contentx/ dpNews/launch.cfm?itemid=7.

If an AED is installed for use in a workplace, it is deemed to be a piece of first aid equipment. Employers must meet specific legal requirements relating to pieces of first aid equipment, including AEDs, due to Occupational Health & Safety requirements.

It has been widely published that AED’s are safe to use; the devices give step-by-step instructions on what to do in an emergency situation and will only deliver a shock if the heart rhythm can be corrected by defibrillation.

Should a school district make a decision to purchase or accept a donation of an AED that will be used in the workplace, there should be a plan in place to manage the equipment. From a risk management perspective, there are a number of issues a school district safety committee will need to consider, including: • Training, certification and recertification; • Location and access to the AED; • Maintenance of the AED, software updates, test programs, battery charge, repair and replacement.

If an AED is installed in a school district facility, the Advanced Coronary Treatment (ACT) Foundation (www. actfoundation.ca) is one resource available to school districts for defibrillator training, and ACT’s emphasis is on student education. They assist interested secondary schools throughout B.C. and across Canada to establish CPR and AED training programs, whereby teachers are trained to teach students CPR and how to use an AED. Training mannequins and AED training units are donated to schools. The school district will need to arrange training and refresher training as needed and ensure that there is trained staff on site. The use of the AED should be incorporated into the school’s emergency response plan (ERP).

The ACT and Heart and Stroke Foundations recommend that the AED and wall case be stored in a central location which is accessible to all while the building is open, (i.e. a well-travelled location that prevents or minimizes the potential for tampering, theft, and/ or misuse by unauthorized users). Appropriate signage should be posted throughout the school premises to assist staff and visitors in locating the AED as the optimal response time is three minutes or less.

There is a wealth of information on the B.C. Public Access to Defibrillation (PAD) Program website, and although their Community AED Toolkit references a particular AED model, this link provides some good general information on defibrillators: https://www.bcpadprogram.ca/public/ data/documents/BCPADToolkit_WebPDF_Aug30,2013.pdf.

Each defibrillator will come with a

manufacturer’s user guide, but there are some general maintenance requirements that will apply to most devices (i.e. verify that electrode pads and batteries are within their expiration date and verify that other related supplies are available for use, such as razors, masks, gloves, extra batteries, etc.). There should be a designated and certified staff member to perform a visual inspection of the AED according to the manufacturer’s guidelines and this should be recorded and dated in a log book. The school district will need to be prepared to cover the maintenance costs, which have been estimated by the ACT Foundation at $300 to $400 every three to four years for battery replacements, electrode pads and service (per AED unit). The manufacturer’s user guide should include daily, monthly, and annual maintenance guidelines, which will need to be reviewed and incorporated into the school’s procedures.

School districts should carefully consider these issues when making decisions regarding AEDs and should contact Worksafe B.C. or visit the Worksafe B.C. website for more detailed information on the requirements relating to first aid equipment, and more particularly AEDs, in the workplace. Visit http://www2.worksafebc.com/ PDFs/firstaid/Workplace_AEDs.pdf.

Feel free to contact your risk management consultant with any questions. b

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