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by Will Evans
Automatic External Defibrillators (AEDs) are portable units used to electrically
stimulate the heart during cardiac arrest. In the camp environment, cardiac
arrest usually involves older staff, older guests attending during parent
visitation days, or spring or fall rental groups. Although cardiac arrest
can happen without an outside event or prior health problems, there is
usually a contributing cause. Cardiac arrest has been reported in campers
for a variety of health reasons such as a congenital heart defect, electrical
shock, a blow to the chest during a fight or being hit with a baseball,
or from respiratory arrest that results in cardiac arrest from drowning.
According to research conducted by Project Adventure on challenge course-related
deaths, cardiac arrest was the leading cause involving men over the age
of thirty. There have been a number of cases where school athletes have
suffered cardiac arrest during events such as running. In some of these
cases, the immediate availability and use of an AED might have saved a
life.
Adult and Pediatric AEDs
AEDs come in various styles and functions, but there are two different
types of pads used to deliver the shock: adult and pediatric. A pediatric
AED pad delivers a lower energy dose by the use of a modified defibrillation
pad and cable component. In July 2003, The American Heart Association
came out with a statement that adult AEDs could be used on a child younger
than eight years old. Some AEDs have voice rhythm-shock-recorders that
record not only the shocks delivered but also the conversation of the
rescuers. These recorders could be of great benefit or great hindrance
to a lawsuit, depending on how well the rescuers performed.
Purchase Requirements
The FDA requires that before a camp can purchase an AED, you must first
get a prescription from a physician. Although state regulations vary,
the AED should be used within a defibrillation program that includes these
elements:
- Training for all users in CPR and AED operation
- Physician oversight to ensure appropriate maintenance and use of
the AED
- Notification of local EMS of type and location of the AED
Many camps no longer face the question of whether or not to purchase
AEDs, but how to find the funding and how to best utilize a limited number
of AEDs. At approximately $2,700 to $3,000 each, this could quickly add
up for a large camp. A number of state and federal programs fund the purchase
of AEDs and training on their use. Talk to your regional American Heart
Association or American Red Cross to see if they know of a funding source
in your region. Be aware that some “one-time-use” AEDs are
available on the market in the price range of $800–$1,000. Most
of these models are not designed for the rigors (temperature and moisture
exposures, being dropped, etc.) of a camp environment. Also talk to your
insurance agent to make sure the AEDs are added to your insurance policies
in case of theft or vandalism.
Some camp administrators may think they don’t need AEDs because
of their camp’s close proximity to a rescue station. That is a very
risky proposition. Success with an AED is time critical. The American
Heart Association says that when a person suffers a sudden cardiac arrest,
their chances of survival decrease by 7 percent to 10 percent for every
minute that passes without defibrillation. At most camps, the absolute
minimum time between the occurrence of a cardiac arrest and the arrival
of an ambulance is at least five to ten minutes.
Training and Potential Regulations
AED training is readily available from the American Red Cross, National
Safety Council, and American Heart Association in their adult CPR courses.
An informal study of AED use found that untrained sixth graders could
effectively use an AED in time tests and that they were only 23 seconds
slower than trained EMTs. In 2003, New York began requiring AEDs in schools.
In the future, Health Department, OSHA, or other regulatory standards
may require AEDs on-site at camps and conference centers. The cardiac
emergency itself generally does not create liability. The failure to properly
address the emergency in accordance with common practices, regulations,
or standards that cause the condition to worsen into injuries such as
brain damage, permanent disability, or death, would pose a liability.
Other Considerations
Availability
The number of AEDs your camp needs depends on the size and operations
of the camp. In general, an AED should be available within two to three
minutes anywhere on camp grounds, but particularly around athletic areas
(e.g., swimming pools, athletic fields, basketball courts), challenge
course, and public gathering areas such as the dining hall. In certain
areas, such as athletic fields, AEDs cannot be stored on a permanent basis.
Camps many need to establish guidelines as to how the AED should be carried
or transported. Installing the AED onto a golf cart in a waterproof case
with other “fast response” medical equipment would be a good
idea for many camps.
Maintenance and Storage
Most AEDs have a battery life of around four to five years, but the camp
should assign someone to verify in writing monthly that the unit is functioning
(follow the manufacturer’s guidelines). Many camps have had success
with installing the AEDs in a security box that has an alarm that sounds
when the door is opened. Some of these security boxes can be linked to
dial 911 automatically and play a pre-recorded message if the door is
opened.
Rescue Breathing
Another consideration in placing AEDs is the reasonable expectation of
having to perform rescue breathing. There are a number of safety concerns
related to the proper storage and use of portable oxygen units. A reputable
vendor will help address these. A portable oxygen tank (prescription from
an MD required in most states) and a bag-valve mask would provide 100
percent oxygen as opposed to the 16 percent delivered by rescue breathing
through a pocket mask or face shield. A bag valve mask by itself (without
the oxygen tank will deliver 21 percent oxygen. Increasing the oxygen
delivery in rescue breathing can reduce brain and cardiac damage, so it
is important to provide both the electrical stimulus from the AED in conjunction
with oxygen. Proper use of a bag valve mask and portable oxygen requires
practice. This would be a good precamp and in-service skill to practice
with the staff , including interaction with EMS, in the use of the equipment.
Most lifeguarding courses specifically address the use of this equipment,
so consider making your lifeguarding team an integral part of your planning
and implementation. You should also add non-latex gloves and a blood-borne
pathogen kit. Protect your staff and satisfy OSHA requirements at the
same time by putting this additional equipment with the AED.
Finally, you should obtain advice from legal counsel and research your
state and local regulations that might affect your program, including
training requirements, medical control, notification of AED use, or location
and immunity provisions.
Originally published in the 2004 Fall issue
of The CampLine.
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