Public Access Defibrillation
|Bureau of EMS Policy Statement|
|Policy Statement #||07-04|
|Subject||Re: Public Access Defibrillation|
The purpose of this policy is to assist a person, firm, organization or other entity in understanding the notification process for operating an automated external defibrillator pursuant to a collaborative agreement under the provisions of Chapter 552 of the Laws of 1998 authorizing Public Access Defibrillation. A Public Access Defibrillation (PAD) program is designed to encourage greater acquisition, deployment and use of automatic external defibrillators (AED) in communities around the state in an effort to reduce the numbers of deaths associated with sudden cardiac arrest. Since the enabling legislation's inception, there have been 4,140 PAD programs established, with over 135,000 people trained. This program has been successful in saving many lives across New York State.
To be authorized to use an AED under this statute an individual or organization needs to make specific notification of intent to establish a PAD program to the appropriate Regional Emergency Medical Services Council (REMSCO) and the New York State Department of Health (DOH).
There are no approvals or certifications required.
Public Access Defibrillation Program Requirements
Original Notification Process
To be authorized to have a PAD program and utilize an AED, the following steps must be completed:
- Identify a New York State licensed physician or New York State based hospital knowledgeable and experienced in emergency cardiac care to serve as Emergency Health Care Provider (EHCP) to participate in a collaborative agreement;
- Select an AED that is in compliance with the Article 30, section 3000-B (1)(A). The AED must be programmed to the current Emergency Cardiovascular Care (ECC) Guidelines, capable of defibrillating both adult and pediatric patients. Please check the shaded box on the Notice of Intent to Provide PAD (DOH-4135) if the machine is approved for pediatric use;
- Select and use a DOH approved PAD training course for AED users. The approved programs are listed on the Notice of Intent Form;
- Develop with the EHCP, a written collaborative agreement which shall include, but not be limited to the following items:
- Written practice protocols for the use of the AED;
- Written policies and procedures which include:
- Training requirements for AED users;
- A process for the immediate notification of EMS by calling of 911;
- A process for identification of the location of the AED units;
- A process for routine inspection of the AED unit(s) as well as regular maintenance and which meet or exceed manufacturers recommendations;
- Incident documentation requirements, and
- Participation in a regionally approved quality improvement program.
- Provide written notice to the 911 and/or the community equivalent ambulance dispatch entity of the availability of AED service at the organization's location,
- File the Notice of Intent to Provide PAD (DOH 4135) and a signed Collaborative Agreement with the appropriate Regional Emergency Medical Services Council (REMSCO), and
- File a new Collaborative Agreement with the REMSCO if the EHCP changes.
Signs notifying public of AED location
In July 2007, 3000-b of the New York State Public Health Law, Section 1 - Subdivision 3, was amended by adding paragraph (f) requiring a sign or notice to be posted at the main entrance of a facility or building in which the AED is stored or maintained on a regular basis.
The law is silent as to the specifications of the sign or notice used to communicate the location of the AED(s) within the structure. However, it is expected that the size, type and language(s) of the sign will be easily legible upon entrance to the structure. If there are multiple entrances that could be considered a main entrance then a sign or notice must be placed at each of those entrances.
It is the choice of the Public Access Defibrillation Provider as defined in Article 30 Section 3000-b to determine if multiple languages are necessary and where the sign or notice will be posted. The sign can be posted inside the entrance of the building, in a foyer or another location as appropriate.
Reporting a PAD AED Use
In the event that the PAD program uses the AED to defibrillate a person, the program must report the incident to the appropriate REMSCO. The REMSCO may request additional information regarding the incident, but the PAD must report, at a minimum, the following information:
- Provide written notification of AED usage to the REMSCO within 48 hours of the incident;
- The name of the PAD program;
- Location of the incident;
- The date and time of the incident;
- The age and gender of the patient;
- Estimated time from arrest to CPR and the 1st AED shock;
- The number of shocks administered to the patient:
- The name of the EMS agency that responded; and
- The hospital to which the patient was transported.
A copy of the usage report should also be provided to the EHCP.
Regional EMS Council Responsibility in Public Access Defibrillation
Each REMSCO is responsible for receiving and maintaining notification and utilization documentation. The REMSCOs must develop and implement the following policies and procedures:
- Insure that a copy of each new or updated Notice of Intent (DOH 4135) is forwarded to the Bureau of EMS;
- Maintain a copy of the Notice of Intent and the Collaborative Agreement;
- Collect utilization documentation and information;
- Provide detailed quarterly reports to the DOH on PAD programs in the region, and
- Develop Quality Assurance participation, data submission and documentation requirements for participating organizations.
Data Collection Requirements
REMSCO quality improvement programs are encouraged to use the data elements from the Utstein Guidelines for Prehospital Cardiac Arrest Research (Cumming RO, Chamberlain DA, Abramson NS, et al, Circulation 1991; 84:960-975).
The following minimum data set is to be developed and collected as a part of the regional PAD QI process. A copy of the data set is to be provided by each region to the DOH Bureau of EMS quarterly:
- Name of organization providing PAD
- Date of incident
- Time of Incident
- Patient age
- Patient gender
- Estimated time from arrest to 1st AED shock
- Estimated Time from arrest to CPR
- Number of shocks administered to the patient
- Transport ambulance service
- Patient outcome at incident site (remained unresponsive, became responsive, etc).
Ambulance and ALS First Response Services
Ambulance or ALSFR services may not participate in PAD programs for emergency response. Certified EMS agencies must apply for authority to equip and utilize AEDs through their local Regional Emergency Medical Advisory Committee (REMAC).
Please note that the Prehospital Care Report (PCR) has a check box for EMS providers to indicate that a patient has been defibrillated prior to EMS arrival by a community or by-stander PAD provider. Documenting this information is required so that the DOH may monitor the effectiveness of these community based programs.
Issued and Authorized by
Edward G. Wronski, Director, Bureau of EMS