Automated External Defibrillators (AED)s: Pediatric & Infant Use

People who are familiar with AEDs and defibrillators know that both adult and pediatric pads had to be considered pre-2010 AHA science updates[separate pads are required to allow the AED to administer different shock dosage to the heart, lower for pediatric events of course].  Having both pads available creates extra costs as both have an expiry date and need replacement after 2 years usually. We often get asked, ” Do we really need pediatric pads?”

With the 2010 Emergency Cardiovascular Care (ECC) and American Heart Association (AHA) Guidelines Updates there comes new published science on the use of AEDs on infants and children. 

Former science [pre-2010 and post-2005] suggested not to use AEDs on infants and to use pediatric pads on children under 8 years of age or under 55 pounds.  Evidence of this from prior blogs or internet posts includes: http://www.wikihow.com/Use-a-Defibrillator, which contains old outdated information summarized below.

OLD INFORMATION: Do not put adult pads on a pediatric patient and vice versa! Pediatric pads are used on children who are ages 12 and under. [this is pre-2005 information]

NEW GUIDELINES INFORMATION: http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf   clearly updates the guidelines to show that it is acceptable to use AEDs and even adult pads on pediatric patients, including infants.  The KEY is anterior and posterior placement.  For more details, see the information below pulled directly from the recent guidelines update.

AED Use in Children Now Includes Infants

2010 (New): For attempted defibrillation of children 1 to 8

years of age with an AED, the rescuer should use a pediatric

dose-attenuator system if one is available. If the rescuer

provides CPR to a child in cardiac arrest and does not have an

AED with a pediatric dose-attenuator system, the rescuer should

use a standard AED. For infants (<1 year of age), a manual

defibrillator is preferred. If a manual defibrillator is not available,

an AED with pediatric dose attenuation is desirable. If neither is

available, an AED without a dose attenuator may be used.

2005 (Old): For children 1 to 8 years of age, the rescuer

should use a pediatric dose-attenuator system if one is

available. If the rescuer provides CPR to a child in cardiac

arrest and does not have an AED with a pediatric attenuator

system, the rescuer should use a standard AED. There are

insufficient data to make a recommendation for or against the

use of AEDs for infants <1 year of age.

Why: The lowest energy dose for effective defibrillation in

infants and children is not known. The upper limit for safe

defibrillation is also not known, but doses >4 J/kg (as high

as 9 J/kg) have effectively defibrillated children and animal

models of pediatric arrest with no significant adverse effects.

Automated external defibrillators with relatively high-energy

doses have been used successfully in infants in cardiac arrest

with no clear adverse effects.

If you are a school or camp or childcare provider, what does this mean?  Until new science [in 2013 or after] is released you should consider looking at your current AED program.  Do you have pediatric pads currently?  Those will expire in 2 years or less – should you replace them?  In these economic times, there are many non-profits and schools who will not have adequate budgetary capacity and it may be a topic of consideration.  Due to the new science, strong consideration can be given to this — IF you can accommodate for proper AED use communication to responders or the public who would use the device with ADULT PADS on a child under 8 years or 55 pounds.

How do you accommodate?  A simple solution: a  sticker/decal set that can be attached to your AED case and responder supplies to remind responders on WHAT TO DO for pediatric events.  The set includes directions on where to find illustrations with 2010 instructions and how to apply the ADULT pads (complete with pictures) anterior [front] and posterior [back] for pediatric events and why.  Call 888-473-1777 for more technical information on this solution.

The reason for anterior and posterior placement, simply put, is to allow the pads to shock the heart WITHOUT the pads touching – the surface area of a pediatric victim’s chest is not large enough usually to allow normal ADULT pad placement.

Simple directions and illustrations and quick references on the AED, AED instruction manual or guides, AED policy and AED protocols and CPR/AED poster you keep at your facility all will help with communication of this simple change for pediatric vs. adult use.

The ONLY exception are customers who have Philips FRx (the ONLY model to allow switching of shock level with an Infant/Child Key inserted into the AED while using the SAME SET OF PADS).  Philips FRx models offer a wonderful solution for facilities that want to be able to accommodate pediatric or adult situations without a large CONSUMABLE cost from 2 yr disposable pads for each event.  The FRx is a more expensive model with a higher purchase price – however, IF you know you are going to be primarily using the device on pediatric patients, this model would be a leading device to consider.

We are here to help.  First Voice can provide a sticker/decal/ template set to easily show on your AED and responder supplies WHAT TO DO for pediatric events.  The set includes directions on where to find illustrations with 2010 instructions and how to apply the ADULT pads (complete with pictures) anterior [front] and posterior [back] for pediatric events and why.  Call 888-473-1777 or contact your dealer for First Voice products for more information – Part number PED-DECAL01.  Pricing is only $10.00 including shipping.  Please provide your AED brand so we can make sure to ship the right decal set.

First Voice EID upgrades NOW AVAILABLE!

Talking First Aid Book / First Aid Calculator

ECC / AHA & National First Aid Science Upgrades were released in late 2010.  For more information on this see our blog post from October:

http://thinksafe.wordpress.com/2010/10/19/the-2010-guidelines-for-cpr%E2%80%A6/

Think Safe’s First Voice EID is ready for CPR/First Aid upgrades to be sent to you, our dealers and customers!

Part No. DC01: The $29 upgrade is sent in a datacard and can be easily inserted/changed by following the user instructions sent with the upgrade.  

Dealers please contact us for further information on how to provide your customers easy upgrades (email:mmaly@think-safe.com).

The First Voice EID is the only Emergency Instruction Device / Talking First Aid Book / First Aid Calculator on the market for business use, containing all first aid & CPR AHA manual current protocols.  The device is easy to upgrade through an accessible dataport on the back of the device as first aid & CPR protocols do change every 3-5 years through scientific studies and advances in first aid / CPR science.

2010 updates implemented in 2011 on the EID protocols include:  CPR updates to include compression depth & C-A-B changes for trained rescuers and hands only CPR for untrained rescuers, education & recognition of gasping vs. normal breathing, and advised AED use for infants.  First Aid updates include additional heat stroke advice, jellyfish sting updated care,  clarification on aspirin use for heart attack symptoms, both US and Canadian Poison Control contact information, bleeding wound care updates (elevation, pressure points, tourniquet, compression bandage use), additional information on when to suspect head, neck or spinal injuries, and snakebite first aid care updates.

Please contact us today for your upgrade:

(email:pwickham@think-safe.com or 888/473/1777)

SafetyMate Trade-in: $50 Value!

Or, if you have an outdated SafetyMate model

NOW is the time to upgrade to First Voice:

$50 REBATE on ANY SafetyMate exchanged

& First Voice EID (AVU5001) ordered!

Expires:  3/31/2011

What are the reoccurring budget items for my AED program?

There are 5 potential budget items that affect your AED program.  Note that any non-compliance, where necessary, leads to a break down in your AED program and does open you to potential for legalities.  Once you have an AED program, remember to budget for these items where applicable!

1)       Electrode Pads – The majority of the AED models on the market have a 2 year electrode pad life.  The date of the expiration is clearly marked on the pad package, an example is shown on this posting for the Philips FRx Rugged AED.  Some AED models do have 3.5 yr expiry dates up to 5 yr expiry dates, however. Dates vary due to packaging mechanisms but be sure to follow manufacturer guidelines and expiration dates provided.  The electrode pads will dry out and prevent proper AED functioning/use if they are not replaced as needed.  Pads range in price from $35-$120, depending on make and model owned.

2)       Batteries – The majority of the AED models on the market have a 3-5 year warranty and lifespan.  The date of the expiration is also clearly marked on the battery.  Various models will warranty the devices for xx years AFTER initial install so be sure to clearly mark your records on WHEN you install the battery for these models.  Also, the HeartSine Samaritan and Physio Conrol / Medtronic CR Plus Lifepak or Lifepak Express models have a combo pack you purchase with battery/pads being replaced simultaneously.  Defibtech / Cintas does sell a model that has a suggested annual replacement of an off-shelf 9V battery (this ensures their AED performs proper self-testing).  AED batteries range in price from $75-$400, depending on make and model owned.

3)       Training – AED acquirer state laws many times dictate that you have to ensure expected users are trained in American Heart or Red Cross or equal CPR & AED certified courses (American Safety & Health Institute, Medic First, Health & Safety Institute, Emergency Care & Safety Institute, American Health Association, etc).  These certifications range depending on which training org you use but every 1-2 years the certification expires and needs to be renewed.  Courses can be obtained locally at Red Cross locations or through the American Heart Association network but also there are over 100,000 instructor throughout the US alone and there are local training centers that can provide a competitive price for CPR & AED, First Aid, and Bloodborne Pathogen or Universal Precautions plus other more advanced or supplemental add-on training classes.  Various online solutions are also available.  Think Safe has a listing of US training centers and online solutions; contact us at or info@think-safe.com if you would like to contact a local trainer in your area.

4)       Program Manager Software / Database – AED acquirer state laws many times also dictate that the AED has to be maintained to manufacturer and industry standards.  This standard generally a 30 day check.  Many companies have their own database solution for ensuring equipment is checked regularly and records of these checks are kept on file (big companies).  If you do not, there are online solutions that are inexpensive but key in helping to not only auto-notify your AEDs are checked to standards but also the log and records of all AEDs are filed and backed up regularly for legal protection.  A nice comprehensive  UNLIMITED user solution at $25-$50/location (customer) can be seen here, showing it’s full capabilities:  http://www.firstvoice.us/FirstVoiceAEDManagerVideo/tabid/751/Default.aspx

5)       Medical Oversight – AED acquirer state laws in approximately 20 states requires a licensed physician or “certified healthcare provider” to oversee the AED program.  This is NOT an Rx!  Proper Medical Oversight includes sign-off by the appropriate license owner referred to in that state law on:  AED/CPR training of the organization (who is trained, how often, what they are trained on); AED placement and markings; AED communication; AED policy; AED maintenance & upkeep procedures.  Contact Think Safe at if you are not sure if your state requires medical oversight.  Medical Oversight costs anywhere from $75/AED to $350/AED or some companies chose to hire medical direction and pay a retainer annually.  Think Safe has a national network of medical directors and can provide a quote for efficient medical oversight for your organization, charging you for locations ONLY where mandates require it. In some cases, we can connect you with a local FREE source for medical oversight.  Call for more details.  AED distributors/dealers are encouraged to call as well.

Think Safe [VIEW OUR BIO] is a certified Women-Owned Business (WBENC) providing first aid & defibrillator expertise to clients since 2004. Known for technical assistance to customers on: [State AED acquirer laws] [AED funding sources and grants] [AED program management solutions] including [Medical Oversight] [& Online AED database / record-keeping compliance software].

References available or drop us a line  [888.473.1777]

The 2010 guidelines for CPR….

The American Heart Association (AHA) on October 18, 2010 has unveiled its new guidelines on Cardiopulmonary Resuscitation (CPR), which aim to improve rescue time and make the process easier. The “2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care” went online on October 18, 2010 in AHA’s publication, Circulation (http://circ.ahajournals.org/).

No worries, your First Voice manufactured equipment is not obsolete! All First Voice manufactured products and software are fully upgradeable.

Think Safe will work diligently to update our First Voice audio and text prompts, instruction manuals, and any other materials for the 2010 CPR guideline updates.  It will take all major training organizations 6-9 months to release updated training materials to instructors.  All First Voice modifications and updates will be available before December 31, 2010 and we will post updates on our blog and provide email notifications of any upgrade completions and how to notify your customers for their upgrade.

What are the changes in CPR?  Here is a summary of the CPR updates to help you understand differences in protocol and new training requirements.

Starting CPR with chest compressions helps save lives

Emphasizing that every second counts, the new guidelines recommend that instead of first opening an unconscious person’s airway and breathing into his mouth, rescuers—whether onlookers or emergency experts—should initiate chest compressions immediately to revive victims of a sudden cardiac arrest.

The stress on the primacy of chest compressions over oral resuscitation led the AHA to revise the standard CPR procedure from the familiar ABC (Airway-Breathing-Compressions) to CAB (Compressions-Airway-Breathing).

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” Michael Sayre, M.D., co-author of the guidelines and chairman of the American Heart Association’s Emergency Cardiovascular Care Committee, said in an AHA press release. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away.”

C-A-B takes into account that, in the first few minutes of a cardiac arrest, some amount of oxygen remains in the lungs and bloodstream of the patient. Chest compressions can pump that blood to the victim’s brain and heart sooner. In contrast, the traditional “old” A-B-C method delays the start of chest compressions; the rescuer has to tilt the victim’s head to open up the airway and apply breaths to commence mouth-to-mouth.

Giving initial chest compressions was found to trim off 30 critical seconds in rescue time and potentially helps save the patient’s life.

Hands On

A couple years ago, the American Heart Association recommended that untrained bystanders use hands-only CPR for an adult victim who suddenly collapses. The new guidelines make this the official policy and include health-care professionals as well. The process also applies for children and infants but excludes newborns.

The AHA hopes that with the updated rules, more people will volunteer to help a heart attack victim. Experts have noted the reluctance of passersby to give aid out of panic, uncertainty about their lifesaving skills, and squeamishness of mouth-to-mouth breathing. With hands-only CPR, the steps are streamlined: Call 911 and push hard and fast on the center of the chest until help arrives.

NEW Guidelines Summary

Here are the new 2010 guidelines from the AHA:

1. Before starting, shake the victim’s shoulders and shout to get his reaction. If the victim is unresponsive, call 911, which should now instruct callers by phone to start chest compressions when cardiac arrest is suspected.

2. Removal of “look, listen, and feel for breathing” from the sequence.  Instead, Begin chest compressions. At least 100 per minute from the previous instruction of close to 100. Compressions must also be strong enough to depress the chest by at least 2 inches in adults and 1.5 inches in infants. This will allow blood and oxygen to keep flowing to the brain until medics arrive.

3. Make sure to fully release the chest before beginning the next compression. Avoid leaning on the victim’s chest so it can return to the starting position.

4. For rescuers with no CPR training, continue chest compressions until help comes.

5. For trained health professionals, open the airway after 30 chest compressions and begin mouth-to-mouth breathing. Give two breaths and then resume chest compressions. Continue sets of 30 chest compressions and two breaths until help arrives.

The last resuscitation guidelines were publicized in 2005. For more information on the new rules, check out the heart association’s video “2010 Guidelines for CPR” on YouTube.

There are devices, like the First Voice Emergency Instruction Device (EID) that provide instruction via audio and text for emergencies including CPR – from scene safety to assessment to administration of chest compressions and breaths (if appropriate) to proper PPE for rescuers and cleanup.  The First Voice EID retails at $249US and is available from safety and first aid dealers nationally.  Visit www.firstvoice.us for more information or:

http://www.firstvoice.us/Products/EmergencyInstructionDevice/tabid/285/Default.aspx

Various Think Safe EID brands/models can be purchased in over 6 languages and with US or European protocols (compliant with all major training organizations and easily updateable via datacard replacement ports).  Please contact us for full details on model/part numbers and language configurations at or email us at info@think-safe.com for more information.  Think Safe – Making Minutes Matter and saving more lives with effective CPR and CPR Training!

Sources:Circulation (http://circ.ahajournals.org/)

What to look for when choosing a new health club

Did you make a New Year’s resolution to improve your health? Does your plan include joining a fitness club and getting some exercise?

If so, you might want to think twice about which club you join. There’s more to think about than which is closest and which costs the least.

I know from my industry expertise, if you choose a club that is not careful about safety, sanitation, and service, there can be some unpleasant and dangerous, consequences.

Security

Is your stuff safe? Locker rooms are a bad place to leave valuables. It’s just too easy for a thief to get into your locker. Don’t rely on the fitness center to safeguard your valuables.

Is the parking lot well lit? Especially for clubs that are open very early or very late. Daylight hours are shorter many months of the year and you could easily find yourself going to and from your car in the dark.

Sanitary

A good health club will have a clean locker room and restroom. If these areas look or smell bad, let that be a red flag to you.

The exercise equipment should be disinfected between users. The club should provide paper towels and disinfectant, along with posted instructions on how to sanitize the equipment after use.

Safety

Are first aid kits stocked and available at all times? Does the club have a portable defibrillator on hand? These defibrillators, commonly called AED’s (automated external defibrillator), can be the difference between life and death for someone who experiences a sudden heart attack. Over 250,000 people die of heart attacks in the U.S. each year and fitness clubs are one of the high-risk areas.

The American Heart Association urges all fitness centers, including those in schools, to have at least one AED. As of 2001, all 50 states have at least some kind of AED law, but only a few actually mandate them. For instance, Illinois requires every fitness club to have at least one AED and a trained user on the premises.

How can you be sure?

If you can’t tell, then ask! If you’re not sure about some of the above issues, be sure to ask. A quality health club will be happy to tell you where the first aid kits are, what their staff’s training is, and where they keep the defibrillator.

Consider all the factors when choosing a fitness club. If your gym does not have all of the above, you should demand it for your business you are giving them.  Stand up for your rights!

Having AEDs in School is VERY Important

I don’t know about other parents or teachers but I find this article and research (published by Circulation: Journal of the American Heart Association January  2010) annoying.

It is an article on how schools that don’t have funding perhaps should not worry about not being able to fund an AED because the chances of getting a return on the equipment are not proven.  Here is some of the content:

“A nationwide push to put portable defibrillators in every school, a response to several high-profile student deaths, may not be worth the cost, a new study in Seattle concludes. The survey of emergency response to schools in the Seattle area over 16 years found that students suffered cardiac arrests only 12 times and a third of these children had known heart problems.”  The article then goes on to say, “According to the study, schools are one of the best places for adults to suffer cardiac arrest.”

Protecting the teachers does not matter nor does it matter if I or family member will suffer a heart attack while watching my child participate in a school sporting event?  What if you are a parent that has one of those kids with a known heart problem or the 1 unfortunate unknown heart problem that year?

Figure out how to buy the AED.  There are ways to fund them.  The facts are that Sudden Cardiac Arrest is the biggest killer in America, killing around 300,000 people per year.  If an AED is not used within 2-4 minutes the chances of survival go from 65-70% to 5%.

Are you ready to be champion for AEDs at your school and help your PTO raise money? Go to Think Safe’s GivingTree for easy online fundraising or download this or visit the website of the Sudden Cardiac Arrest Association and download this paper on how you can become a champion for AEDs at your school.

You Can Save a Life at School PDF