A

A Death
Death
Defying
Defying Device
Device
 Developed by

In cooperation with

ZOLL
ZOLL Medical
Medical
Corporation
Corporation
Working to reduce Sudden Cardiac Death through
Public Access Defibrillation
The following presentation illustrates
the indications for and demonstrates
the proper use of a ZOLL AED Plus.
This presentation is intended for use
by AED and CPR instructors as
supplemental material in nationally
accepted AED training programs.
The Reality of Life…

…Someday everyone will die!

Premature
Premature
Death

Peter Safar, MD
Despite advances in medical science…
CAUSES OF DEATH
350,000
Annual Deaths (U.S.)

300,000

250,000

200,000

150,000

100,000

50,000

Sudden Stroke Lung Breast Traffic

Mur
Cardiac
AIDS/ der
Arrest
Cancer Cancer Accidents
Disease
HIV or Incident

Sudden Death continues to increase

 generating

resulting in
producing O 22
 Heart Attack
The “S-A” Node
The heart’s own
“pacemaker”

Blocked
Heartbeat Coronary
Continues Artery
to Beat
Damaged
Heart
Muscle
 Heart Attack
Signs
Signs && Symptoms
Symptoms
((Patient
Patient may
may have
have one
one or
or more…)
more…)

•• Chest
Chest Pain/Discomfort
Pain/Discomfort
•• Radiation
Radiation to to Arm,
Arm, Neck
Neck or or Jaw
Jaw
•• Profuse
Profuse Sweating
Sweating
•• Difficulty
Difficulty Breathing
Breathing
•• Fearful,
Fearful, Confused
Confused oror Irritable
Irritable
•• Denial
Denial ofof Symptoms
Symptoms
Continues
Continues to
to Have
Have Heartbeat
Heartbeat &
& Breathing
Breathing
Sudden Death
Ventricular
Ventricular
Fibrillation
Fibrillation
Chaotic
Chaotic
f i b
V- Quivering
Quivering
but
but
NO
NO Heartbeat
Heartbeat
NO
NO Breathing
Breathing
 Patient
Patient Symptoms
Symptoms whenwhen in
in
Ventricular
Ventricular Fibrillation
Fibrillation
• Unconscious
• No Effective Heart Action
• No Breathing
• Looks Terribly Sick & Discolored
Resulting in…
No Oxygen to the Brain or Body Organs

Life or Death is now a matter of

 Sudden
Sudden Death
Death
Some
Some
Oxygen
Oxygen

00 Minutes
Minutes
Brain
Brain Death
Death
No
No
Oxygen
Oxygen

10-12 Minutes
 RI
P
80-90%
of sudden
of sudden deaths
deaths
are caused
are caused by
by

V-fib
V-fib
The Only Correction for
V-fib

De-fib
 Chain of Survival

Early
Early Early
Early Early
Early Early
Early
Access
Access CPR
CPR Defibrillation
Defibrillation Advanced
Advanced
Care
Care

© American Heart Association

For each minute that defibrillation is delayed
Survival is reduced by 10%

100

80
Survival Rate (percent)

60

40

20

0
5 10 15 20 25 30
Time to Defibrillation (minutes)
Shocking
A
Solution
to Sudden Death
 Safe
 Simple Use
Use
 High
High Success
Rate
Rate
• CPR (only)
(only)
………………………
……………………… 0-2%

• EMS/ER ……………………
…………………… 5-15%

• CPR+AED……..
…….. 30-75%
For
For use
use by…
by…
 Site Survey EMS
& Needs Services Training
Analysis

Medical
AED Acquisition Control Procedures
& Maintenance & Protocols

Medical On-site Drills

Incident Review Facilities & Review
Public Access Defibrillation

Part of an On-site
Emergency
Medical
Response
Plan
 Make
Makethe
the
Right Initial
Initial
RightCall
Call
Early
Early Life
LifeSupport
Support
ABCS
ABCSCARE
CARE
Recognition
Recognition
System of Effective
Effective

Timely
Timely
Survival CPR
CPR
Definitive
Definitive
Care
Care
Continued
Continued Rapid
Rapid
Life
LifeSupport
Support Defibrillation
Defibrillation
ABCS
ABCSCARE
CARE
What if…
What if…
Someone
Someone
suddenly
suddenly
develops
develops
signs of
signs of a
a
heart attack
heart attack
Provide Initial Life Support

Call for
Call for EMS/Medical
EMS/Medical Help
Help

1 Adult
Or
4 Baby

ASA
If you see patient collapse or
or you find him down…

…you don’t know if it’s

Sudden Death
or a
Heart Attack
 eeeed
d
’
’ l
l l
l N
N
YYo
o u
u

• More than just a defibrillator

• Addresses all aspects of a rescue
 Accessing Help
 Airway Control
 CPR
 Defibrillation
“Designed for infrequent, often reluctant
• Visual
(Graphical Operator Interface)

• Audible
Is Help Needed?
• Recognize
Recognize that
that someone
someone needs
needs
emergency
emergency medical
medical help
help
•C heck T
Check he A
The Area
rea
for
for personal
personal dangers
dangers
• Is
Is person
person unresponsive?
unresponsive?
Are you
okay?
…if not already there,

• “Log-roll” patient onto his back

on a firm surface
 Stay Calm
Take aa deep
Take deep breath
breath
focus your
and focus
and your
emotional energy
emotional energy

Send
Send someone
someone for
for Help
Help
 Make the Right Call

Someone
Someone should
should
IMMEDIATELY
IMMEDIATELY
Call
Call for
for
EMS/Medical
EMS/Medical Help
Help

If you are alone…

Call EMS/911 yourself
• Send
Send someone
someone for
for
the
the AED…
AED…

…or if alone, go yourself!

 While someone
While someone goes
goes for
for the
the AED,
AED,
ifif no
no breathing
breathing nor
nor signs
signs of
of circulation…
circulation…

Begin
Begin CPR
CPR
at
at aa
Rate and Ratio
Rate and Ratio of
of

2 30
Compressio
Compressio
Breaths
Breaths
When the AED Plus is on Scene

Push the
“ON”
Button
 Open the lid

 Follow visual & voice prompts

 With its Graphic Interface
and clear voice Prompts
the ZOLL AED Plus
will remind you of
--- OR guide you through ---
all the important actions
of a resuscitation effort
 Check Responsiveness

Stay Calm
Are you
okay?

• Reconfirm
Reconfirm that
that
the
the person
person is
is
unconscious
unconscious
Is Help On the Way?

•• Be
Be sure
sure someone
someone
has
has called
called for
for
EMS/Medical
EMS/Medical Help
Help
Open Airway

• Head
Head Tilt/Chin
Tilt/Chin Lift
Lift
• Empty
Empty the
the mouth?
mouth?
Check Breathing
• Look
• Look
•• Listen
Listen
•• Feel
Feel
 ...if none is found

Provide
Provide Breathing
Breathing
• Place CPR Face Shield ???
• Pinch Patient’s Nostrils
• Take a Deep Breath
• Place Your Mouth Over
Patient’s (Make a Firm Seal)
• Give 2 Slow Breaths
(Take a Fresh Breath In Between)
 Examine for
Signs of Circulation
• Check for Neck Pulse
(If skilled to do so)
• Normal Skin Color ???
• Coughing or
Obvious Breathing
Attach Electrode Pads
ZOLL’s Unique CPR-D Padz
Right side electrode

CPR Compression Site

Gives Compression Feedback
(Depth & Rate)

Left side electrode

Pull “Red Pin” to extend

apex electrode
on large patient
One Piece
CPR-D Padz
• Simplifies proper positioning
• Eliminates potential delay
• Integrates CPR skills
• Easily remembered placement guide
• Virtually impossible to get confused
• Rapid “Release and Press” Liners
• Packaged with all accessories
Prepare the Chest for Electrodes
 Expose the patient’s bare chest
Prepare the Chest for Electrodes
(if necessary)
 Shave hair at pad sites
 Wipe/dry pad site area

ZOLL AED Plus units come with

potentially needed accessories:
Scissors
Razor
Towel
Gloves
Hand Wipes
CPR Face Shield
1. Open CPR-D PADZ

Remove CPR-D Padz

Unfold CPR-D Padz

CPR-D Padz Placement

Position center “puck”

(as shown)
 Place Electrodes on
2.Patient
2. Remove Right Pad backing
3.
3. Remove
Remove Left
Left Pad
Pad backing
backing
2. 3.
FIRMLY
Press Padz in place
Note: Left Apex Pad
can be extended
on large patients

• Pull “Pin”
• Extend Pad
• Don’t
Don’t Touch
Touch Patient
Patient During
During Analysis
Analysis
• Stay
Stay Clear
Clear of
of Patient
Patient During
During Shocks
Shocks
 Verbal
Verbal Command
Command to to Clear
Clear
 Visually
Visually Confirm
Confirm All
All Are
Are Clear
Clear
 AED Plus
AED Plus
ONLY Advises
ONLY Advises Treatment
Treatment
Deliver one
Deliver one shock
shock If
If there
there is
is aa
Shockable Rhythm
Shockable Rhythm
Push Shock Button No Shock Needed
Whether
Whether shocks
shocks are
are delivered
delivered or
or not
not advised…
advised…

Open
 Airway

Check for
 Breathing
 Signs of Circulation
If No
If No Signs
Signs of
of Circulation
Circulation …
…

Resume CPR 2 Mins

• Kneel next to patient
• Locate hand position
(on compression depth sensor)
• Position your body
• Give CPR at rate of 30:2
You will hear:
“Good compressions” or “Push harder”
Adaptive metronome will help pace you
2 30
If CPR or Shocks aren’t needed…

• Maintain Airway
 Chin Lift
 Empty Mouth?
 “Recovery Position” ?
 Place PASS ??
• Assist Breathing
• Give Emotional Support
Passive
Passive Airway
Airway Support
Support System
System
The ZOLL AED Plus offers the unique option of a
Passive Airway Support System (PASS). The
AED lid can be removed, inverted and used as a
“wedge” placed under the patient’s shoulders
 Until EMS Arrives

• Provide
Provide Life
Life Support
Support
((as
as needed…)
needed…)
 When Breathing
When Breathing &
& Pulse
Pulse
Do Not
Do Not Return
Return
• Continue CPR
• Follow Voice Prompts
 Rhythm Re-analysis
 Repeat Shock(s)

…Until EMS Arrives

 When
When Breathing & Pulse
Breathing & Pulse Return
Return

Support Life
• Airway
• Breathing
• Circulation

Be
Be as Efficient
Efficient &
& Effective
Effective as Possible
…Until EMS Arrives
Transfer of Care

• Verbal
Verbal Report
Report
Initial Condition
 Initial Condition
Care Delivered
 Care Delivered (including
(including ## of
of shocks)
shocks)
Estimated “Down
 Estimated “Down Time”
Time”
Any Changes
 Any Changes inin Patient’s
Patient’s Condition
Condition
Any available
 Any available Medical
Medical History
History
• Cooperate and Assist
Cooperate and Assist
(as necessary
(as necessary &
& requested)
requested)
Practical Skills
Practical Skills Scenarios
Scenarios
 Precautions & Concerns
Avoid Placing the Electrode Directly Over
Implanted Heart Devices
R
Pacemaker
 Precautions & Concerns
• Implanted Heart Devices
 Pacemaker
 Defibrillator
If scar or “bulge” on
right side of chest
Don’t put pad over device
Slightly “Rotate” Padz
• Medication Patches
Remove Patch – Wipe Chest Clean
 Additional
Additional Factors
Factors
When
When using
using an
an AED
AED
•• Sensitivity
Sensitivity to
to Family
Family
•• Crowd
Crowd Control
Control
•• Periods
Periods of
of “Inactivity”
“Inactivity”
•• Talk
Talk to
to the
the Patient
Patient
 When
When Not
Not to
to Use
Use an
an AED
AED
•• Patient
Patient is
is less
less than
than 88 yrs
yrs of
of age
age
•• Patient
Patient is
is under
under 80
80 pounds
pounds
•• Explosive
Explosive environment
environment
•• Patient
Patient is
is immersed
immersed in in water
water
•• Following
Following serious
serious trauma
trauma
Returning
Returning to
to AED
AED Readiness
Readiness

Logistics
 Clean
 Clean Area
Area
 Clean
 Clean AED
AED Plus
Plus
 Replace
 Replace Batteries
Batteries (if
(if necessary)
necessary)
 Replace
 Replace CPR-D
CPR-D Padz
Padz
 Repack
 Repack && Restore
Restore Unit
Unit
Battery Replacement
Re-packaging the AED Plus
 Self Testing and Alarms
• Assures constant readiness
• Both audible and visual alerts
• Unit monitors its self every week
Status indicator shows a green
•
√ to clearly indicate ready √
• When unit requires new batteries,
it sounds an audible alarm and
displays the red X
• For problems contact the ZOLL Technical Services 800-348-9011
X
X
 After Using an AED

Administration
Administration
 Download
 Download Data
Data
 Case
 Case Review
Review
Complete
 Complete Required
Required Reports
Reports
 Notify
 Notify Medical
Medical Control
Control
 ““Post
 Post Situation
Situation Ventilation”
Ventilation”
 Data Download & Review
• AED Plus utilizes standard IRDA port
(found on most laptop and desktop
computers)

• Easy data integration

(with ZOLL Data Review*)

* Free Downloadable Software

 AEDs & the Law

Physician’s Prescription/Order
Good Samaritan Law” Protection
Current
Current Case
Case Law
Law ??
Medical
Medical Control
Control

Medical Director
Medical Control
 Site Survey EMS
& Needs Services Training
Analysis

Medical
AED Acquisition Control Procedures
& Maintenance & Protocols
&

Medical On-site Drills

Incident Review Facilities & Review
When Hearts
When Hearts &
& Brains
Brains Are
Are Too
Too Good
Good to
to Die
Die

Sudden Death
Sudden Death Can
Can Be
Be
Interrupted &
Interrupted &
Life Can
Life Continued
Be Continued
Can Be
 For Your
For Your Commitment
Commitment To
To
Safety, Health && Life