SDPHB Universal Keys to Establishing & Sustaining PAD Programs

1. SDPHB Universal Keys to Establishing & Sustaining PAD Programs San Diego Project Heart Beat Paramedic Dan Beebe San Diego Fire-Rescue

2. San Diego Project Heart Beat • Established on November 1, 2001 • Has helped place nearly 4000 AEDs • Staff of 4 • Over 210 Deployments (uses) • 78 Lives saved as of Sept. 26 2010

3. “ Great things from small beginnings” Sir Francis Drake

4. Unlock your Lifesaving Opportunity • We hope to provide some helpful keys to establishing & sustaining a Public Access Defibrillation (PAD) Program

5. 3 Important Keys • Create Partnerships • Meet Regional and State Requirements • Training

6. First KeyCREATE PARTNERSHIPS • Build a Team • Involve Local EMS • Involve local Hospitals • Involve Local Government • Involve Advocates • Involve Civic Groups

7. AED Manufactures as Partners • Consider an agreement with a manufacturer of choice to provide seamless service & discount pricing • Possible seed / start up funds • Any quality product should be considered

8. AED Manufactures & Distributors • Any person or entity that supplies an AED shall do all of the following: • (1) Notify an agent of the local EMS agency of the existence, location, and type of AED acquired. • (2) Provide to the acquirer of the AED all information governing the use, installation, operation, training, and maintenance of the AED.

9. Second KeyMeet Regional / State Requirements State Assembly Bill AB254 • State The people of the State of California do enact as follows: • SECTION 1. Section 1797.196 of the Health and Safety • Code, as amended by Section 181 of Chapter 62 of the Statutes • of 2003, is amended to read: • 1797.196. (a) For purposes of this section, “AED” or “defibrillator” means an automated or automatic external defibrillator. • (b) In order to ensure public safety, any person or entity that acquires an AED is not liable for any civil damages resulting from any acts or omissions in the rendering of the emergency care under subdivision (b) of Section 1714.21 of the Civil Code, if that person or entity does all of the following: • (1) Complies with all regulations governing the placement of an AED. • (2) Ensures all of the following:

10. Maintenance Documentation • (A) That the AED is maintained and regularly tested according to the operation and maintenance guidelines set forth by the manufacturer, the American Heart Association, and the American Red Cross, and according to any applicable rules and regulations set forth by the governmental authority under the federal Food and Drug Administration and any other applicable state and federal authority.

11. Maintenance Continued • (B) That the AED is checked for readiness after each use and • at least once every 30 days if the AED has not been used in the preceding 30 days. • Records of these checks shall be maintained.

12. Incident Management & Medical Oversight • C) That any person who renders emergency care or treatment on a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible, andreports any use of the AED to the licensed physician and to the local EMS agency.

15. Third KeyTRAINING • (D) For every AED unit acquired up to five units,no less than one employeeper AEDunitshall complete a training course in cardiopulmonary resuscitation and AEDuse that complies with the regulations adopted by the Emergency Medical Service Authority and the standards of the American Heart Association or the American Red Cross.

16. Training Continued • After the first five AED units are acquired, for each additional five AED units acquired, one employee shall be trained beginning with the first AED unit acquired.Acquirers of AED units shall have trained employees who should be available to respond to an emergency that may involve the use of an AED unit during normal operating hours.

17. Program Management • (E) That there is a written plan that describes the procedures to be followed in the event of an emergency that may involve the use of an AED, to ensure compliance with the requirements of this section. • The written plan shall include, but not be limited to,immediate notification of 911 and trained office personnel at the start of AED procedures. • (3) Building When an AED is placed in a commercial,residential, or industrial building, building owners ensure thattenants annually receive a brochure, approved as to content and style by the American Heart Association or American Red Cross, which describes the proper use of an AED, and also ensure that similar information is posted next to any installed AED.

18. California’s Requirements for AEDs in Health clubs • ASSEMBLY BILL No. 1507 • Introduced by Assembly Member Pavley • (Coauthor: Assembly Member Vargas) • February 22, 2005 • An act to add Section 104113 to the Health and Safety Code,relating to public health. • legislative counsel’s digest • AB 1507, as introduced, Pavley. Cardiac health: automatic external • defibrillators: health studios. • This bill would require every health studio to have an automatic external defibrillator, would provide immunity for providing the devices, and would, notwithstanding existing law, establish standards

19. City of San Diego’s Building Ordinance for AEDs • San Diego Municipal Code Chapter 14: General Regulations • (12-2008) • Article 5: Building Regulations • Division 39: Automated External Defibrillators • (Added 12-16-2008 by O-19820 N.S; effective 2-14-2009.) • [Editors Note: Sections 145.3901, 145.3905, 145.3910, 145.3915, 145.3920, • 145.3925, 145.3930, and 145.3935, as adopted by O-19820 N. S. shall be effective on • February 14, 2009, and shall remain in effect until January 1, 2013, unless the sunset • date of the Good Samaritan Law (California Health and Safety Code section • 1797.196) is extended or made permanent, in which case, the ordinance shall remain • in effect as long as the Good Samaritan Law is in effect.] • §145.3901 Purpose • The purpose of this Division is to promote public health, safety, and welfare by • improving emergency care response times to those suffering from sudden cardiac • arrest, thereby improving chances of survival. The requirements of this Division are • intended to provide for faster emergency response in large buildings, multi-story • buildings, and/or buildings with large numbers of occupants where first responder • access may be impeded due to building use, occupancy, location, layout, • construction, or other reasons. This Division is not intended to create a new standard • of care. • (Added 12-16-2008 by O-19820 N.S; effective 2-14-2009.) • [Editors

20. City of San Diego Building Ordinance for AEDs • §145.3910 New Construction Requiring AEDs • (a) Prior to issuance of a certificate of occupancy or approval of final inspection, • AEDs shall be placed in all newly constructed buildings in the occupancy groups and with occupant loads in excess of that shown in Table 145-3910. • The occupant load shall be determined based on the occupant load factors in the California Building Code. Occupancy groups shall be determined based on Chapter 3 of the California Building Code. • (b) AEDs shall be conspicuously placed and readily accessible in the event of an emergency. AEDs shall be mounted such that the top of the AED is no more • than five (5) feet above floor level.

21. SD City Building Ordinance Cont. • §145.3915 Location of AEDs • (a) When required pursuant to this Division, AEDs shall be located in buildings to optimally achieve a three minute response time to the person in need of emergency care using the AED. • (b) When required on every floor of a building pursuant to section 145.3910 and • Table 145-3910, AEDs shall be located as follows: • (1) One AED shall be placed at the main entrance of every floor; • (2) AEDs shall be located on each floor such that the maximum length of travel measured from the most remote point on a floor to any AED, shall not exceed 300 feet; and • (3) AEDs shall be located on each floor such that the maximum length of travel between any two AEDs shall not exceed 600 feet.

22. There are many examples of successful PAD Programs • Airports • Casinos • Health Clubs

23. Challenges to Establishing & Sustaining PAD Programs in Theme Parks & Mass Gatherings

25. THEME PARKSSome common challenges • Access to the victim • Access to the AED • Public vs Immediate Access AEDs

26. How Many AEDs and where to place them? • Resuscitation. 2005 Jun;65(3):309-14. Epub 2005 Jan 21. • Method for determining automatic external defibrillator need at mass gatherings. • Motyka TM, Winslow JE, Newton K, Brice JH. • University of North Carolina Hospitals, Chapel Hill, NC, USA. • Abstract • OBJECTIVES: A method for determining the number of automatic external defibrillators (AEDs) required for a 3-min response at mass gatherings has been described previously. Our study sought to modify the method, replicate it, then validate the results. • METHODS: Emergency medical technicians (EMTs) were timed walking defined courses in a football stadium. Velocities were obtained for a horizontal distance and ascending/descending upper and lower decks. This was replicated in a basketball arena. To validate, actual response times were compared to predicted times for predetermined distances in each venue. Predicted response times were calculated using the second standard deviation velocities as the most pessimistic. Numbers of AEDs needed were calculated using predicted response times for each venue's longest distance. • RESULTS: Average velocities in m/s (football) were horizontal 1.7, lower deck 1.6 ascending and 1.4 descending, upper deck 1.0 ascending and 1.1 descending. Average velocities (basketball) were horizontal 1.7, lower deck 1.2 ascending and descending, upper deck 0.9 ascending and descending. In the validation phase, every EMT completed the four predetermined courses within the predicted intervals. Predicted response times were 363 s for the longest football stadium distance, and 187 s for the basketball arena. For a 3-min (180 s) response, the number of AEDs required can be calculated. • CONCLUSION: This method was easily replicated and appears to be useful for determining the number of AEDs at mass gatherings. The number of AEDs needed for any desired response interval can be calculated using the predicted response time for the longest distance within an arena.

27. What type of Mass Event is it? • Entertainment (Concert) • Athletic Event • Political Rally • Parade Each environment creates it’s own set of challenges from crowd behavior to flow of traffic.

28. How can we incorporate the 3 Keys into these types of challenges? • Create Partnerships with those vested in your success. Leadership, Managers, Local EMS, Etc. • Be sure local requirements are met. Utilize a method for determining the number of AEDs at mass gatherings. • Have trained personnel available and consider providing awareness presentations on site.

29. Marathons and 10k Runs, Etc. • Finish Lines appear to be critical locations for AED placement. • An established Loaner Program can be just the right answer for these large but temporary events. • Create a budget to systematically replace older AEDs (every 5 to 8 years) in your program and keep the older units for loaner units (which can be rented to help offset the cost.

30. REMEMBERSuccess in any PAD program may be found in these 3 Keys • Create Partnerships • Meet Regional and State Requirements • Training

31. We wish you great success with your own PAD programs Questions or Comments ?