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Swain County School`s Policy and Procedure Manual

1. 1 2 sets of intent child Pediatric defibrillator pads Post Incident report amp AED Operator Service Manual Can be found behind the AED in the AED cabinet NOTE For Swain County s AED Policy and Procedure Manual Mostly filled in information can be found in a pink binder with the school s nurse at each school s site and a pink binder can also be found with Swain County s Superintendent and Swain County EMS Director ALL filled in information can be found with the AED Program Coordinators and the AED Medical Director Non filled in information is kept on the School s website 70 APPENDIX C Daily and Monthly Annual AED Check off COVER LETTER Attached is the annual cover letter that is to go along with the Daily and Monthly Annual AED Check off for one AED and for more the one AED schools For daily and monthly checks only one person has to initial For annual checks there needs to be two qualified people that is check the AED together All the contact information of each primary and alternate people is kept in the pink binder at each site A copy of people for all sites is kept with the AED Program Coordinators and AED Medicinal Director Contact the AED Program Coordinator if you need this information The Program Manager often the School Nurse or director for each school is to report all contact information to the AED Program Coordinator a copy will also be given to the Alternate Program Coordinator and AED Me
2. See attached page from Appendix C for this Schools daily monthly yearly primary and alternate people that are to check the AED as well as their contact information If you need this information regarding another Swain County School please contact the Program Coordinator 55 All of Swain County s AED s and associated information Below is a list of all Swain County AED s all AED SN expiration dates of all adult and child infant electrode pads and information on all Swain County s AED s battery levels ALL filled in information can be found in a binder with the school nurse at each school s site and with the AED program coordinators Non filled in information is kept on line and with each AED Swain County Schools AED assignment AED Item Description YN On BW NLR Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Where Main High School office Home Side of Basketball Volleyball gym With the Athletic Trainer ATC Main Middle School office Main East Elem School office Main West Elem School office Main Entrance Pre Kindergarten Bright Adventures What School Swain High School Swain High School Swain High School Swain Middle School Swain East Elementary Swain West Elementary Swain County Pre Kindergarten Bright
3. AED Manufacturer Model Powerheart AED G3 Plus Automatic model 9390A 501P AED Manufacturer Representative XXX XXXX Territory Manager Carolinas Cardiac Science Corporation Phone Cell XXX XXX XXXX How to Access AED Open the AED case where AED is kept there is no alarm Times AED is available Normal School Hours of Operation Swain County Schools AED Policy and Procedure Effective Date is As of Date XXXX XX 20XX the following people are active as Swan County AED Medical Director Dr XXXX XXXXX MD Swan County AED Primary AED Program Coordinator XXXX XXXX Swan County AED Alternate AED Program Coordinator XXXX XXXX 75 APPENDIX I AED Post Incident Report Form two copies are to be kept with each AED Incident Date Incident time Incident Location What Happened Write on back or attach additional sheet if necessary Patient Information Name if known Age Male OR Female Patient Condition Upon Your Arrival circle all that apply Conscious Breathing Pulse No CPR Unconscious Not Breathing No Pulse CPR in progress What Did You Do circle all that apply Established Unresponsiveness Call 911 Start CPR Get AED Monitored Patient Other describe AED operator AED Assistant Did the AED say shock was needed Yes No Was shock delivered Yes No Estimated time from patient s collapse until CRP begun Was cardiac arrest witnessed Time Yes No Unknown Was CPR started Time Yes
4. David Breedlove All of Swain County Schools Automated External Defibrillator AED Policy and Procedure Manual e A Pink binder with all completed information including contact information e including but not limited to Appendix B Equipment location and Appendix H Written EMS notice of AED Program 17 AED Overview American Heart Association recommends that an AED be available and implementing the first shock within 3 minutes of collapse This will give the victim a 7096 chance of survival For each minute from the time of collapse a victim loses 10 chance of survival This document applies to the school s use of the Automatic External Defibrillator AED specifically the Powerheart AED G3 Plus Automatic model 9390A 501P mentioned in Section 4 0 See Appendix B for Equipment Location for Swain County Schools Any and all use of the AED training requirements policies and procedures reviews and post event reviews will be under the auspices of the Medical Director Prescribing Physician a licensed physician in North Carolina Definitions This section defines terms related to AED policies and procedures Definitions 1 AED shall refer to the automatic external defibrillator capable of cardiac rhythm analysis which will charge and deliver a shock after electronically detecting and assessing ventricular fibrillation or rapid ventricular tachycardia when applied to an unconscious patient with absent respiration
5. Health Department b To provide structure to programs implementing automatic external defibrillators AED for use by lay persons treating victims of cardiac arrest c To provide for integration of public access defibrillation PAD programs with the established emergency medical services system d To provide a mechanism for PAD Quality Improvement activities across the Bryson City North Carolina EMS System e Public Access Defibrillation or PAD refers to the utilization of AEDs by layperson rescuers to treat victims of cardiac arrest in public or private venues f PAD Site refers to the agency Swain County Schools SCHS SMS East Elem West Elem and Swain Pre K organization or company that sponsors a PAD program and allows placement of an AED on their premises PROGRAM REQUIREMENTS a Swain High School Swain Middle School East Elementary West Elementary and Swain County Pre Kindergarten Bright Adventures i The Program Coordinator for each PAD Site will notify the Bryson City North Carolina EMS Section of any changes i e Medical Director and AED that occur ii A memorandum of agreement must be accomplished between the medical director and the organization wishing to establish the PAD program b Staff i Medical Director The medical director must be a licensed physician This individual is responsible for assuring the quality integrity and legal compliance of the PAD program ii Program Coordinator A pr
6. Lot XXX XXX XXX XX REF XXX XXX Old battery XXX 20XX XXX 20XX Lot XXX XXX XX 20XX REF XXX XXX Swain County EAST Elementary School 1 Main East Elementary School office SN Office AXXXXX 1 XXXX 20XX Adult or Ped 2 XXXX 20XX Adult or Ped 3 Aug 2014 Adult or Ped 4 Aug 2014 Adult or Ped fofbars 0 1 2 3 4 fiof bars 0 1 2 3 4 ofbars 0 1 2 3 4 As of date XXX 20XX As of date XXX 20XX As of date XXX 20XX fofbars 0 1 2 3 4 fi ofbars 0 1 2 3 4 ft ofbars 0 1 2 3 4 As of date As of date As of date New battery Lot XXX XXX XXX XX REF XXX XXX Old battery XXX 20XX XXX 20XX Lot XXX XXX XX 20XX REF XXX XXX 58 Where AED SN Pad Expiration Date Battery level Note s Where AED SN Pad Expiration Date Battery level Note s Swain County WEST Elementary School 1 Main WEST Elementary School office SN Office AXXXXXX Adult or Ped Adult or Ped Adult or Ped Adult or Ped 1 XXXX 20XX 2 XXXX 20XX 3 XXXX 20XX 4 XXXX 20XX fofbars 0 1 2 3 4 As of date XXX 20XX fofbars 0 1 2 3 4 As of date Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date New battery Lot XXX XXX XXX XX REF XXX XXX Old battery XXX 20XX XXX 20XX Lot XXX XXX XX 20XX REF XXX XXX Swain County Pre Kindergarten Bright Adventures 1 Swain County Pre Kindergarten Bright Adventures SN Main
7. Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed Send bystander to meet EMS at the unlocked gate or if locked meet at the top steps along the entrance of the Middle School football practice field Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to field make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain Middle Office 828 488 3480 1 800 273 TALK with HS athletic trainer Home side HS basketball volleyball gym HS Main
8. going to the middle school go straight then turn at the 2 left the two Pre K buildings are on the left hand side at the end 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher e Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed e Send bystander to meet EMS at the entrance of the Pre K building Provide appropriate emergency care until EMS arrives Have teacher parent meet ambulance at entry to Pre Kindergarten Bright Adventures building make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828
9. 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain Park amp Rec Office 828 488 6159 1 800 273 TALK Automated External Defibrillators AED There is NO AED at this location 37 Swain County Park amp Rec Pool Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain Middle School and meet at the volleyball basketball gym we have an injured Student athlete bystander in need of emergency medical treatment 30 Recreation Park Drive Bryson City NC 28713 Directions Take Highway 74 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City exits At the first light make a right same side as Bojangles Restaurant at next light Everett Street turn left Go through town over railroad tracks and immediately turn right onto Depot Street at stop sign turn left then immediate right onto Deep Creek Rd at split bare left onto West Deep Creek Rd turn left 0 2 miles past split onto Recreation Park Drive Pool parking lot on right 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arriv
10. 28713 Program Manager XXXX XXXXX RN West Elementary School Nurse Program Manager Cell 4 Work Fax E Mail Address XXX XXX XXXX 828 488 2119 Same as facility fax XXXXX swainmail org Number of Employees XXX as of Fall 20XX Hours of Operation Number of Students XXX as of Fall 20XX Normal School Hours of Operation AED Brand amp Model AED Serial Purchased date Cardiac Science Powerheart 3G Plus Office ZXXXXXX XXXXX 20XX Automatic model 9390A 501P CPR AED Training Organization Information if applicable Name XXXXX XXXXX RN West Elementary School Nurse Address See above for contact information Point of Contact See above for contact information Phone ft See above for contact information Fax See above for contact information 11 PAD Program Site Information Bright Adventures Facility Name Swain County Pre Kindergarten Facility Director XXXX XXXX Facility Phone ft 828 488 1494 Facility Fax 828 488 1345 Facility Address 249 School Drive P O Box 2340 City Bryson City State NC Zip 28713 Program Manager XXXX XXXX Program Director of Pre K Program Manager Cell XXX XXX XXXX Work tt 828 488 1494 Fax Same as facility fax E Mail Address XXXXX swainmail org Number of Employees XXX as of Fall 20XX Number of Students XXX as of Fall 2
11. 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher e Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed e Send bystander to meet EMS at the main entrance of Swain East Elementary School close to the volleyball basketball gym Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to gym make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain East Elem Office 828 488 0939 1 800 273 TALK Swain East Elementary Sc
12. 488 4205 Suicide Hotline 1 800 SUICIDE Swain Pre K 828 488 1494 1 800 273 TALK PreK Main Entrance MS Main office 44 Photo Location of ALL Swain County AEDs The AED Program Coordinator is to inspect ALL colored AED photo locator signs for EACH site and will preprint IN COLOR and laminated any sign s that has been destroyed or faded by the sun and re hang signs as needed by August 1 annually Swain County High School AED Locator Swain County Middle School AED Locator Swain County East Elementary AED Locator Swain County West Elementary AED Locator Swain County Pre Kindergarten Bright Adventures AED Locator 45 Swain County High School AED Locator There are THREE 3 AEDs located at SCHS VAL Ga mi pr 46 Swain County Middle School AED Locator There is ONE 1 AED located at SCMS AED 1 Located in the Main office of the Middle school on the front wall as you walk in 47 Swain County EAST Elementary AED Locator There is ONE 1 AED located at Swain County East Elementary AED 1 Located in the Main office of EAST Elementary on the front wall as you walk in 48 Swain County WEST Elementary AED Locator There is ONE 1 AED located at Swain County West Elementary AED amp 1 Located in the Main office of WEST Elementary on the front wall as you walk in 49 Swain County Pre Kindergarten Bright Adventures AED Locator There is ONE 1 AE
13. AED High School Home Side Basketball volleyball Gym 3 AED With the athletic trainer UNITS at Swain Middle School Swain East Elementary Swain West Elementary Pre K 1 AED Main School Office Who can access the AED Anyone How will they be contacted Any way possible Who could use the AED in an emergency situation Anyone However a roster of people certified and authorized should will be kept with the school nurse kept on site in the pink AED binder and updated regularly If a certified person is available during the time of emergency they are the primary person to perform CPR AED action A copy of each of the follow is kept with each AED in a yellow folder Maintenance and Testing AED Post Incident Report Form x 2 APPENDIX I AED Post Incident Check List x 1 APPENDIX J Powerheart G3 Plus User Manual This and an additional information is to be kept in a pink binder at each site with the Nurse at each school pink binders with this information is also kept with Swain County Superintendent Program Coordinator s supervising physician Medical Director and Swain County EMS Director 51 E 8 9 Automated External Defibrillator Action Plan Possible Cardiac Arrest or Medical Emergency Recognized AED Accessed EMS 911 Activated Send personnel to escort EMS to victim if possible AED Delivered to Victim Establish unresponsiveness Use AED if unresponsive breathless and pulseless Perf
14. Adventures 56 Where AED SN Pad Expiration Date Battery level Note s Where AED SN Swain County HIGH School 1 Main High School office SN Office AXXXXX Adult or Ped Adult or Ped Adult or Ped Adult or Ped 1 XXXX 20XX 2 XXXX 20XX 3 N A 4 N A Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date Hofbars 0 1 2 3 4 As of date Hofbars 0 1 2 3 4 As of date New battery Lot XXXX XXX XXX XX REF XXXX XXX Old battery XXX 20XX XXX 20XX Lot XXX XXX XX 20XX REF XXX XXX 2 Home Side of Basketball Volleyball gym SN Gym ZXXXXX Adult or Ped Adult or Ped Adult or Ped Adult or Ped 1 XXXX 20XX 2 XXXX 20XX 3 N A 4 N A Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date Hof bars 0 1 As of date Hof bars 0 1 As of date 2 3 4 2 3 4 New battery Lot XXXX XXX XXX XX REF XXXX XXX Old battery XXX 20XX XXX 20XX Lot XXX XXX XX 20XX REF XXX XXX Swain County HIGH School Cont 4 N A SN N A Pad Expiration Date 1 N A 2 N A 3 N A 4 N A of bars 0 1 As of date of bars 0 1 As of date Battery level Note s 2 3 4 2 3 4 Adult or Ped Adult or Ped Adult or Ped Adult or Ped Hofbars 0 1
15. HS basketball volleyball gym HS Main office b MS Main office 30 Swain High School Volleyball Basketball Gym Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain High and meet at the Volleyball Basketball Gym we have an injured Student athlete bystander in need of emergency medical treatment 1415 Fontana Road Bryson City NC 28713 Directions Take 19 23 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City exits At the first light make a right same side as Bojangles Restaurant at next light Everett Street turn left Go through town over railroad tracks and up the hill about 4 1 2 miles Turn left into the High School down below road level Drive past the front entrance of the High School go over two speed bumps The basketball gym is on your left hand side next to the SCHS fine arts building 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as ne
16. Heart Association AHA or American Red Cross ARC standards The required hours for an AED training program can be reduced by no more than two hours for students who can show they have been certified in a basic CPR course in the past year and demonstrate that they are proficient in the current techniques of CPR 1 The full four hour course will include the following topics and skills a Basic CPR skills b Proper use maintenance and periodic inspection of an AED c The importance of CPR defibrillation advanced life support adequate airway care and internal emergency response system d How to recognize the warning signs of heart attack and stroke 20 2 Overview of the local EMS system including 9 1 1 access and interaction with EMS a Assessment of an unconscious patient to include evaluation of airway breathing and circulation to determine if cardiac arrest has occurred and the appropriateness of applying and activation of an AED b Information relating to defibrillator safety precautions to enable the individual to administer shocks without jeopardizing the safety of the patient or the authorized individual or other nearby persons to include but not limited to 1 Age and weight restrictions for the use of the AED 2 Presence of water of liquid on or around the victim 3 Presence of transdermal medications implanted pacemakers or automatic implanted cardioverter defirbrillators c Recognition that an electrical sh
17. a Swain County facility SCHS SCMS East Elementary West Elementary Pre K that has been trained in the use of the Automated External Defibrillator and CPR Adult child and infant according to American Heart Association Heartsaver AHA or something equivalent to AHA Contact that facility SCHS SCMS East Elementary West Elementary Pre K for that information Contact the Swain County Primary or Alternate Program Coordinator for the following information if needed e Post AED use incident procedures manual for the AED Coordinators e Any incidents which an AED from one of Swain County facilities SCHS SCMS East Elementary West Elementary Pre K was used kept for seven years e Receipts kept for seven years e Annual daily monthly yearly check off names and the annual check off records kept for seven years LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLDLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL The following people amp places is where you can find a PINK AED binder amp flash drive Equipment With who School place 1 Swain County AED pink 1 7 binder Dr XXXX XXXX MD AED Medical Coordinator amp one flash drive with all AED info 2 Swain County AED pink 2 binder XXXX XXXX Primary Program Coordinator amp one flash drive with all AED info 3 Swain County AED pink 2 binder XXXX XXXX Alternate Program Coordinator amp one flash drive with all AED info 4 Swain County AED pink 1 binder XXXX XXXX Swain Count
18. and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Swain High Office 828 488 2152 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Suicide Hotline 1 800 SUICIDE Swain Medical Center 828 488 4205 1 800 273 TALK Camp Living Water 828 488 6012 828 508 2297 with HS athletic trainer Home side HS basketball volleyball gym HS Main office 5 MS Main office 33 Swain Middle School Football Practice Field Middle School Field Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain Middle School and meet at the football practice field Middle School field we have an injured Student athlete bystander in need of emergency medical treatment 135 Arlington Ave Bryson City NC 28713 Directions Take 19 23 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City Exits At the first light make a left turn on the same side as Shell Gas Station then bear to the right Travel approximately 300 yards up a hill to the school The football practice field Middle school field is on the right hand side adjacent to the school Swain Middle school is on Arlington Avenue 3 Provide necessary information to EMS personnel e Name address telephone number of caller
19. changes the program coordinator should be notified within 72 hou Title Name Cell number Work number Home number Email address Medical Director Dr XXXX Contact Pro Bs am Contact Pro bd m Contact Pro de m Conta odis m XXXX MD Coordin Coordin Coordin Coordin Primary XXXX XXXX XXX XXX XXXX XXX XXX XXXX XXX XXX XXKX XXXX O swainmail org Program Coordinator Alternate XXXX XXXX XXX XXX XXXX AXX XXX XXXX XXX XXK XXXX XXXX Gswainmail org Program Coordinator The Program Coordinator or Alternate Program Coordinator will contact the following as needed Middle School XXXX XXXX XXX XXX XXXX 828 488 3480 XXX XXX XXXX XXX swainmail org EAST Elem XXXX XXXX XXX XXX XXXX 828 488 0030 XXX XXX XXXX XXX swainmail org WEST Elem XXXX XXXX XXX XXX XXXX 828 488 2110 XXX XXX XXXX XXX swainmail org Pre K director See above under See above See above See above See above Pre K Other See attached page from Appendix this Scho de arkade rly pr imary and alternate pone e to check the AED as well as their c ud If you need this sr regarding another Swai a Cou unty Scho aloes D RI ordinator APPENDIX B EQUIPMENT LOCATION Refer to AED photo locator in pink binder of where AED s is are located for all Swain County School s AED photo locator contact the Program Coordinator for a copy Equipment Building Location School 1 Powerheart AED G3 Plus Main High Scho
20. injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain High Office 828 488 2152 1 800 273 TALK with HS athletic trainer Home side HS basketball volleyball gym HS Main office MS Main office 32 iw Swain High School Soccer Complex at Camp Living Water Emergency Action Plan In case of an emergency please do the following 1 Call 911 1 Instruct emergency medical services EMS personnel to Report to Camp Living water and meet at the front parking lot we have an injured Student athlete bystander in need of emergency medical treatment 1510 West Deep Creek Road Bryson City NC 28713 Directions Take 19 23 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City exits Turn downhill off the ramp onto Veterans Blvd and go through Bryson City two stoplights and one bridge Go through town over railroad tracks turn right at the flashing red light then left at the stop
21. level 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed Send bystander to meet EMS at the unlocked gate if possible closest to the injured person Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to field make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain High Office 828 488 2152 1 800 273 TALK with HS athletic trainer e Home side
22. shock the AED take the rescuer into CPR Prompts Remember that the AED will not advise to defibrillate all pulse less patients Some cardiac rhythms do not respond to defibrillation Call 911 at this time if not already done 8 Rescuer Gives CPR for Two Minutes AED will prompt Start CPR Give 30 compressions Then give two breaths e Y 1 Ux 9 Repeat Analyze Charge Defibrillation Pulse After two minutes of CPR the voice prompt will say AED will prompt Do not touch patient Analyzing rhythm If the cardiac rhythm is shockable the AED will guide the rescuer through another defibrillation pulse sequence followed by two minutes of CPR This sequence should continue until e No shockable rhythm is detected or e The pads are disconnected or e Until ambulance personnel arrive on the scene 65 10 Patient Converts to a Non Shockable Rhythm If at some point during the rescue the patient converts to a heart rhythm that does not require defibrillation AED will prompt Start CPR Give 30 compressions Then give two breaths At this point call 911 or the local emergency access phone number if not already done If a pulse is found on the patient and the patient is not breathing continue rescue breathing Leave pads in place and follow voice prompts If the patient regains consciousness leave AED pads in place and make patient as comfortable as possible until ambulance personnel arrive on scene LLLL
23. sign onto Everett Street Take an immediate right hand fork onto Toot Hollow Circle Stay on Toot Hollow Circle for about 2 miles to a stop sign Turn left at the stop sign onto West Deep Creek Road The complex is 100 yds up the road a short gravel drive on the right There s a big sign Living Water Ministries and a flagpole The Lodge and soccer complex is right in the middle of the camp Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher e Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed e Send bystander to meet EMS at the front sign if possible closest to the injured person e Provide appropriate emergency care until EMS arrives e Have coach parent meet ambulance at entry to field make sure all gates are unlocked and cars are not in the way e Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed e Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident e Have copy of emergency consent
24. 0XX Hours of Operation Normal School Hours of Operation AED Brand amp Model Cardiac Science Powerheart 3G Plus Automatic model 9390A 501P AED Serial Purchased date Main Entrance AXXXXX XXXX 20XX CPR AED Training Organization Information if applicable Name XXXXXX XXXXX Program Director of Pre K Address See above for contact information Point of Contact See above for contact information Phone See above for contact information Fax See above for contact information 12 Signature Page Signatures by the appropriate representatives put these policies and procedures into effect The policies and procedures will stay binding until revised with a new signature page or the program is terminated and the policy and procedure will be considered null and void Deviation from policy and procedures may cause physician to rescind authorization of the program The policies and procedures will be initiated and put into effect on the date below An annual review and revision will be conducted if necessary Any changes to these Policies and Procedures require prior approval by the parties signing below Signing and submitting this application represents that you have read understand and will comply with the requirements of North Carolina Revised Statutes and BCNC EMS Section Rules and Regulations Your signature also represents that all information on this appli
25. 2 3 4 N A As of date ofbars 0 1 As of date N A N A 2 3 4 NA 3 With the Certified Athletic Trainer ATC LAT SN ATC ZXXXXX Adult or Ped Adult or Ped Adult or Ped Adult or Ped 1 XXXX 20XX 2 XXXX 20XX 3 N A 4 N A 4ofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date ofbars 0 1 As of date ofbars 0 1 As of date 2 3 4 2 3 4 New battery Lot XXXX XXX XXX XX REF XXXX XXX Old battery XXX 20XX XXX 20XX Lotf XXX XXX XX 20XX REF XXX XXX ofbars 0 1 2 3 4 N A As of date ofbars 0 1 As of date 2 3 4 NA 57 Where AED SN Pad Expiration Date Battery level REF 9146 302 Lot 13495 032 2013 08 Note s Where AED SN Pad Expiration Date Battery level Note s Swain County MIDDLE School 1 Main MIDDLE School office SN Office AXXXXX 1 XXXX 20XX Adult or Ped 2 XXXX 20XX Adult or Ped 3 N A Adult or Ped 4 N A Adult or Ped ofbars 0 1 2 3 4 fofbars 0 1 2 3 4 As of date XXX 20XX As of date ofbars 0 1 2 3 4 fofbars 0 1 2 3 4 As of date XXX 20XX As of date fofbars 0 1 2 3 4 fofbars 0 1 2 3 4 As of date XXX 20XX As of date fofbars 0 1 2 3 4 fofbars 0 1 2 3 4 As of date As of date fofbars 0 1 2 3 4 fofbars 0 1 2 3 4 As of date As of date ofbars 0 1 2 3 4 fofbars 0 1 2 3 4 As of date As of date New battery
26. AED and follow the prompts Dry shave chest with disposable razor if indicated Discard razor in a safe manner Wipe chest if it is wet Apply defibrillation pads Make sure the AED pads are placed in the proper location and that they make good skin contact with the chest Do not place AED pads over the nipple medication patches or implanted devices Deliver a shock to the patient when advised by the AED after first clearing the patient area Administer additional shocks as prompted by the AED until the AED advises no shock or a series of three consecutive shocks has been delivered When advised by the AED check the patient s airway breathing and signs of circulation and initiate CPR if signs are absent Continue to follow AED prompts and perform CPR until EMS takes over 27 When EMS Arrives 1 Authorized individual working on the patient should document and communicate important information to the EMS provider such as a Patient s name b Time patient was found c Initial and current condition of the victim 2 Assist as requested by EMS personnel Post use Procedure 1 One of the individuals working on or involved with the patient s care at the time of the event should complete the documentation AED Post Incident Report Form of the sudden cardiac arrest event and give to this School s Principal and School Nurse no later than 24 hours following the event The School s Principal and or School Nurse is to conta
27. Alternate Program Coordinator for that information 23 Automated External Defibrillator Use in the School Setting SWAIN COUNTY POLICY Swain County Schools SCHS SCMS East Elementary West Elementary Pre Kindergarten Bright Adventures are committed to the health and safety of the students faculty staff and visitors Due to technological improvements and lower costs automated external defibrillators AEDs may now be safely acquired installed and used by schools to save victims of sudden cardiac arrest this is a condition in which the heart suddenly and unexpectedly stops beating the person is unresponsive suddenly has no pulse and is not breathing An AED is used to urgently diagnose and treat ventricular fibrillation The goal of this policy is to ensure that AEDs installed on a Swain County school campus SCHS SCMS East Elementary West Elementary Pre Kindergarten Bright Adventures are safely maintained and used and to promote training and easy access to installed AEDs Swain County Schools chose to acquire AEDs and will comply with this policy Schools that acquired an AED will designate a responsible person to oversee the use of the AED LIABILITY AND GOOD SAMARITAN LAWS North Carolina law allows for the use of an AED during an emergency for the purpose of attempting to save the life of another person who is or who appears to be in cardiac arrest Accordingly North Carolina law also expressly provides immunity f
28. D located at Swain County Pre Kindergarten Bright Adventures AED 1 Located in the Main Entrance of Pre Kindergarten Bright Adventures building on the RIGHT wall approximately 15 feet from the front door 50 Automated External Defibrillator Written Plan This plan is designed to outline the key components of the implementation of the AED program Answers to yes or no are in BOLD CAPS Date XXXX XX 20XX See Appendix B for Equipment Location for Swain County Schools Training Course American Heart Association AHA or American Red Cross ARC standards for CPR AED AED Device Powerheart AED G3 Plus Automatic model 9390A 501 P Representative XXXX XXXX Territory Manager Carolinas Cardiac Science Corporation Phone Cell XXX XXX XXXX Address XXXX XXXX XXXX XXXX NC XXXXX Main Cardiac Science Phone 425 402 2000 is answered during business hours 8 4 30 weekdays also have a toll free number in the U S 1 800 426 0337 Cardiac Science main fax number 425 402 2001 email XXXX cardiacscience com Cardiac Science website http www cardiacscience com AED Maintenance and Testing Schedule Per manufacturer Written records must be kept EMS MUST be notified as soon as an emergency exists EMS will be Activated by Dialing 911 Other Telephone ft N A This program is registered with EMS Yes No Where will the unit be stored UNITS at Swain High School 1 AED Main High School Office 2
29. Entrance ZXXXXX Adult or Ped Adult or Ped Adult or Ped Adult or Ped 1 XXXX 20XX 2 XXXX 20XX 3 XXXX 20XX 4 XXXX 20XX fofbars 0 1 2 3 4 As of date XXX 20XX fofbars 0 1 2 3 4 As of date fofbars 0 1 2 3 4 As of date XXX 20XX Hofbars 0 1 2 3 4 As of date fofbars 0 1 2 3 4 As of date XXX 20XX fofbars 0 1 2 3 4 As of date New battery Lot XXX XXX XXX XX REF XXX XXX Old battery XXX 20XX XXX 20XX Lotf XXX XXX XX 20XX REF XXX XXX 59 Minimum Manufacturer Recommendations BASIC AED MAINTENANCE Daily Scheduled Maintenance For the Powerheart AED G3 series check the STATUS INDICATOR to ensure that it is GREEN When the indicator is GREEN the Powerheart AED G3 is ready for a rescue If the indicator is RED refer to the Troubleshooting Table in the manual Monthly Maintenance 1 Open the AED lid 2 Wait for the AED to indicate status For the Powerheart AED G3 series observe the change of the STATUS INDICATOR to RED After less than 5 seconds verify that the STATUS INDICATOR returns to GREEN 3 Observe the expiration date on the pads 4 Listen for the voice prompts 5 Close the lid and confirm that STATUS INDICATOR remains GREEN for Powerheart AED G3 series only e Check supplies accessories ie ready kit forms with AED e AED alarmed box lift the AED out of the box making sure the alarm goes off If it does replace the AED back in the box stopping the alarm Annual Mai
30. H Written EMS Notice of Automated External Defibrillator AED Program This is sent to EMS director of Bryson city with the local EMS department of Swain County This plan is designed to outline the key components of the implementation of the AED program Entity Swain High School Swain Middle School East Elementary West Elementary Swain Pre K Location in facility where AED s are kept with attach AED photo locator of AED s on site Equipment 1 Powerheart AED G3 Plus 2 Powerheart AED G3 Plus 3 Powerheart AED G3 Plus 4 Powerheart AED G3 Plus 5 Powerheart AED G3 Plus 6 Powerheart AED G3 Plus 7 Powerheart AED G3 Plus Building Main High School office Basketball Volleyball gym N A Main Middle School office Main East Elem School office Main West Elem School office Main Entrance Pre Kindergarten Bright Adventures Location On Left wall in the Main office just pass the HS secretary s desk On the Home side near front door and Home concession stand With certified athletic trainer On the wall in front of you as you walk through the Main office door On wall in front of you as you walk through the Main office door On wall in front of you as you walk through the Main office door On the RIGHT wall approximately 15 feet from the front door School High School High School High School Middle School East Elementary West Elementary Pre K Bright Adv
31. IN COLOR and given to EACH site and for EACH AED by May 15 annually Date amp completed by whom AED1 AED2 AED3 AED 4 Contact each site School s Principal and School Nurse by phone or in person to update any changes in primary and alternate daily and monthly yearly assigned AED check off people As well as make sure the School s Principal and School Nurse has in print and located in their office with easy access to the AED Program Coordinator and Alternate AED Program Coordinator contact information and make sure they understand the post AED use procedure this is to be done by August 1 annually Date amp completed by whom AED1 AED2 AED3 AED4 Send via email document called Swain County AED info for ALL facility amp staff which is AED video information and also includes an attachment of the school s AED photo locator sent to the Superintendent or someone higher up in the Central office to send out to ALL facility and staff HS MS East and West via email so the information can be reviewed at the date as they return from break this is to be done by August 1 or Jan 1 annually Date amp completed by whom Check and have the appropriate site school s IT computer tech update if needed the School s website regarding that school s AED this is to be done by August 1 annually Date amp completed by whom AED1 AED2 AED3 AED 4 The AED Program Coordinator is to check with the certified athletic trainer ATC regarding S
32. LLLLDLLLLLLLLLLLLLLLLLLLDLLLLLLLDLLLDLLLLLLDLLLDLLLLLLLDLLDLDLLLLLLLLLDLLLLLLLDLLDLDLLLII Post resuscitation if the victim begins to breathe and has a pulse again the AED pads should be left attached to the victim do NOT take the AED pads off the chest Let a paramedic or doctor do that 66 Automated External Defibrillation AED Treatment Algorithm Adult ONLY PHONE 911 or emergency number Get AED or send second rescuer if available to do this D E m D Definite I If no response check pulse Pulse Do you DEFINITELY feel pulse within 10 seconds No Pulse Cis ett AED defibrillator ARRIVES Check Rhythm Shockable rhythm Shockable Not Shockable This concludes the Operations manual for Powerheart AED G3 Plus Automatic 67 Powerheart AED G3 Plus Automatic model 9390A 501P Operations Manual Can be found at http www cardiacscience com assets 003 5284 pdf A hard copy of the Powerheart AED G3 Plus Automatic model 9390A 501P Operations Manual can be found attached in all pink binders and in the yellow folder with all AEDs 68 APPENDIX A CONTACT PHONE LIST For inform and a regarding the AED program the individuals listed below may be ontacted Eve ee id S ron st contac n ogram m coordinator ifu nable to contact the program ordinator through all phone numbers listed leave messages then contact the alter Mono ordinator Only the If any contact information
33. NCY s facility Circle ONE SCHS SCMS East Elementary West Elementary Pre K AHA Instructor Ann Brown AHA Instructor Training amp Renewal Date Participants amp Departments March 22 2000 John Jones math department March 22 2000 Jackie Barr librarian Recommended renewal Don South var WBKB coach March 2002 Mary Down school nurse June 2 2001 Tom Jones woodshop teacher April 5 2000 Annie Shoe school Janitor Recommended renewal Polly Center cafeteria staff April 2002 Ken Johns school principle LLLLLLLLLLLLLLLLLLDLLLLLLLLLDLLLLLLLDLLLDLLLLLLDLLLDLLLLLLLDLLDLDLLLLLLLLLDLDLLLLLLLLLDLLLLI CPR AED Training records that includes documentation of defibrillation skills proficiency will be maintained by the School Nurse kept in the pink AED binder and the School Nurse will send three copies of this Training record to the 1 AED Medical Director 2 Primary and the 3 Alternate Program Coordinators LLLLLLLLLLLLLLLLLLLLLLLLLLDLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLDLLLLLLLLLLLLLLLILI To see the actual names of personal at this Swain County facility SCHS SCMS East Elementary West Elementary Pre K that has been trained in the use of the Automated External Defibrillator and CPR Adult child and infant according to American Heart Association Heartsaver AHA or something equivalent to AHA see the white tab under the Appendix K in this pink AED binder or contact the Swain County Primary or
34. No Did the patient ever regain a pulse Time Yes No Unknown Did patient ever regain consciousness Time How many shocks were delivered Estimated total time of CPR until application of AED By whom By whom Did the patient begin breathing Yes No Unknown Hospital patient taken to Yes No Unknown Names of the people involved in the patient s care 1 3 5 7 2 4 6 8 Other treatment Transporting agency Condition of patient on EMS Arrival Conscious Breathing Pulse No CPR Unconscious Not Breathing No Pulse CPR in progress Additional Information Attached Yes No This report is completed by Phone Notify this School s Principal and School Nurse of this incident ASAP so they can contact and give this AED Post Incident Report Form to Swain County s AED Program Coordinator The person that received this data is Time 76 APPENDIX J AED Post Incident Check List Incident Date Incident time Incident Location Patient Information Name if known Age Male OR Female Was an AED Post Incident Report Form Appendix I turned into the School s Principal and or School Nurse and or Program Coordinator within 24 hours YES No Did the school Principal and or School Nurse is to contact Swain County s AED Program Coordinator within ONE hour regardless of the time day after learning of the sudden cardiac arrest event YES No Did the school give all documentation to the AED Pro
35. Plus Office ZXXXXX XXXX 20XX Automatic model 9390A 501P Gym XXXXX XXXX 20XX ATC ZXXXXX XXXX 20XX CPR AED Training Organization Information if applicable Name XXXX XXXX RN Swain High School Nurse Address See above for contact information Point of Contact See above for contact information Phone See above for contact information Fax ft See above for contact information PAD Program Site Information Facility Name Swain Middle School Facility Principal XXXX XXXX Facility Phone ft 828 488 3480 Facility Fax ft 828 488 0949 Facility Address 135 Arlington Avenue City Bryson City State NC Zip 28713 Program Manager XXXX XXXXX RN Swain Middle School Nurse Program Manager Cell ft XXX XXX XXXX Work tt 828 488 3480 Fax Same as facility fax E Mail Address XXXX swainmail org Number of Employees XXX as of Fall 20XX Number of Students XXX as of Fall 20XX Hours of Operation Normal School Hours of Operation AED Brand amp Model Cardiac Science Powerheart 3G Plus Automatic model 9390A 501P AED Serial Office ZXXXXX Purchased date XXXX 20XX CPR AED Training Organization Information if applicable Name XXXX XXXXYX RN Swain Middle School Nurse Address See above for contact information Point of Contact See above for contact information Phone
36. Special Note The following Swain County School s AED information is accurate however all personal information or contact information have been left blank XXX for the privacy of the agencies and people involved EEK EKKE oI E OS OS OS K K K K K K K K K K KKK K KK If you should need contact Swain County s Superintendent for the Swain County s AED Program Coordinator for use of such information Thank you Happy Safe and Healthy Schools Swain County Schools SCHS SCMS East Elementary West Elementary Pre K Automated External Defibrillator AED Policy and Procedure Manual Information Effective Date XXXXX XX 20XX LLLLLLLLLLLLDLLLLLLILLLLLLILILILILILIL LP OR OK OK KOK OK k Last updated XXXXX XX 20XX Disclaimer Page Swain County s AED Program Coordinator has designated _ to hold on to this pink binder information until nolonger hold their working position or if the SC AED Program Coordinator reassigns this pink binder information to someone else NOTE This pink binder and ALL containing information is strict private property and belongs to Swain County School system If you have not been designated by Swain County s AED Program Coordinator to hold on to this information PLEASE RETURN this pink binder to Swain County s Superintendent so it can be returned to Swain County s AED Program Coordinator and reassigned Swain County Central Office Att Swain County s Superint
37. XXXX 3 SN ATC XXXX 4 SN Office JXXXX 5 SN Office AXXXX 6 SN Office AXXXX 7 SN Main Entrance WXXXX Building Main High School office Basketball Volleyball gym N A Main Middle School office Main East Elem School office Main West Elem School office Main Entrance Pre Kindergarten Bright Adventures School High School Location On Left wall in just pass the high school secretary On the Home side near front High School door With athletic trainer High School On wall in front of you as you Middle School walk into the door On wall in front of you as you East Elementary walk into the door On wall in front of you as you West Elementary walk into the door On the RIGHT wall approximately 15 feet from the front door Swain County Pre Kindergarten Bright Adventures All AED sites are Swain High School Swain Middle School East Elementary West Elementary and Swain County Pre Kindergarten Bright Adventures 73 APPENDIX F ANNUAL Program Coordinator check list done for each site and for each AED Name of School AED 1 AED 2 AED 3 AED 4 Collect all Annual Maintenance which is done annually June 1 OR LAST week of school within 72 hours All annual maintenance records are kept for seven 7 years before being destroyed A new Daily and Monthly Annual AED Check off With Manufacturer Recommendations basic and AED maintenance will be printed off
38. al of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed Send bystander to meet EMS just outside of Rec Park office pool so they can direct EMS where the injured Student athlete bystander is located Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to gym make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain Park amp Rec Office 828 488 6159 1 800 273 TALK Automated External Defibrillators AED There is NO AED at this location 38 Swain West Elementary School Volleyball Basketball Gym Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain West E
39. arents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain West Elem Office 828 488 2119 1 800 273 TALK Swain West Elementary School T Swain West Elementary Main office 39 Swain West Elementary School Front Track amp Playground Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain West Elementary School and meet at the front track and playground we have an injured Student athlete bystander in need of emergency medical treatment 4142 Highway 19 West Bryson City NC 28713 Directions Take 19 23 west towards Murphy Go PAST the Alarka exit 64 The school is located less than one mile on the right West Elementary School s front track and playground area is located on the right immediately after entering West Elementary school grounds 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victim
40. ast the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City exits At the first light make a right same side as Bojangles Restaurant at next light Everett Street turn left Go through town over railroad tracks and up the hill about 4 1 2 miles Turn left into the High School down below road level Drive past the front entrance of the High School go over two speed bumps pass the basketball gym on the left Go over another speed bump pass the basketball gym on the left to the end of the parking lot Turn left onto the part paved gravel road down a little hill Softball field on the left and baseball field on the right parallel to the softball field 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed Send bystander to meet EMS at the bottom of the road just pass the concession stand Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to field make sure all gates are unlocked and cars are not in the way Provide EMS with information how
41. been destroyed or damaged and re hang 3 D sign s as needed by August 1 annually Date amp completed by whom AED1 AED2 AED3 AED 4 Inspect all clapboards ink pens color photos information the yellow folder with the AED Policy Procedure Manual amp Post Incident report kept with each AED case just behind the AED Thoroughly inspect all equipment in the Ready Kit replace ALL sizes pairs of gloves regardless if not used annually replace any destroyed or damaged or non functioning clapboards ink pens color photos information as needed by August 1 annually Date amp completed by whom AED 1 AED 2 AED 3 AED 4 Check EACH AED pads and AED battery level And check with Cardiac Science for any updates necessary and ensure all information is up to date and update as needed the Cardiac Science representative for Swain County area by August 1 annually Date amp completed by whom AED 1 AED2 AED3 AED 4 Send all daily monthly yearly check off sheets for all sites send this completed form and update MD on any AED or info changes if there was any incident during the year double check with the MD if any changes are needed Check to see if the MD thinks there needs to be any changes with the AED program Set up any walk through if needed with the AED Medical Director Update MD regarding CPR AED training of coaches Needs to be by August 15 annually Date amp completed by whom AED1 AED2 AED3 AED4 74 APPENDIX
42. cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain East Elem Office 828 488 0939 1 800 273 TALK Swain East Elementary School t Swain East Elementary Main office 43 Swain Pre Kindergarten Bright Adventures Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain Pre Kindergarten Bright Adventures and meet at the Pre K Bright Adventures building we have an injured child bystander in need of emergency medical treatment 249 School Drive Bryson City NC 28713 Directions Take 19 23 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City Exits At the first light make a left turn on the same side as Shell Gas Station then bear to the right Travel approximately 300 yards up a hill but rather then make a sharp curve to the right
43. cation is true and correct Agency Medical Director Dr XXXXX XXXX MD Swain County AED Medical Director Date Agency XXXXXXXXX SCHSPrndpa ststs S Date XXXX XXXXX SCMSPrincipl SS Date XXXXX XXXX East Elementary Principal Date XXXX XXXX West Elementary Principal Date XXXX XXXX Swain Pre K Bright Adventures Director Date Primary Program Coordinator XXXXX XXXX Primary AED Program Coordinator Date Alternate Program Coordinator XXXXX XXXX Alternate AED Program Coordinator Date EMS Director XXXX XXXXX Swain County EMS Director Date 13 NC Licensed Physician s Prescription for AED Keep copy here Swain County Account information with Cardiac Science This account information is kept with Swain County AED Program Coordinator and Medical Director If you need to check on an upgrade contact Swain County s AED Program Coordinator See Appendix E for Manufactures Information sk spoke spe desk ke sj a be oe lese be oe ok oe ke oe ok ee ae ak 2k ok ok 15 This page is left blank deliberately Notification to Local EMS Director AED vendor Cardiac Science Corporation Powerheart 3G Plus AED s AED Manufacturer Representative XXXX XXXXX Territory Manager Carolinas AED Owner Swain High School Swain Middle School Swain East Elementary Swain West Elementary Swain County Pre Kindergarten Bright Adventures Your AED vendor is responsible for no
44. ct Swain County s AED Program Coordinator within ONE hour regardless of the time day after learning of the sudden cardiac arrest event the school is also to give all documentation to the AED Program Coordinator no later then 36 hours following the event The Program Coordinator will order ALL used AED material within 24 hours after learning of the event Program Coordinator will contact the AED vendor Cardiac Science to download event data from AED Do NOT remove the battery Program Coordinator will assure that documentation is sent to Swain County s AED Medical Director and a copy of the AED Post Incident Report is sent to Swain County EMS as soon as possible and no later than one week from the date of the event Program Coordinator and School s designee should conduct emergency incident debriefing as needed PRACTICE YOUR EMERGENCY RESPONSE REGULARLY This will help you identify any problems with rapid deployment of the AED or your Emergency Response Plan There are 4 forms included in this section to help you with your Emergency Action Plan development Emergency Action Plan EAP for ALL Swain County Sport sites Location of ALL ALL Swain County AEDs Automated External Defibrillator Written Plan Automated External Defibrillator Action Plan Automated External Defibrillator Post Incident Procedure GRAN 28 Emergency Action Plan EAP for ALL Swain County Sport sites The Head Certified Athletic Trainer takes care o
45. cy please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain West Elementary School and meet at the back playground we have an injured Student athlete bystander in need of emergency medical treatment 4142 Highway 19 West Bryson City NC 28713 Directions Take 19 23 west towards Murphy Go PAST the Alarka exit 64 The school is located less than one mile on the right The back playground is located behind the main building Follow the main entrance road until you are facing the small circle in front Before entering the small circle take a left up the side road Continue to the back of the building The playground is located at the end of that road 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher e Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed e Send bystander to meet EMS at Swain West Elementary School s back playground Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to field make sure all gates are unlocked and cars a
46. demonstrations monitored by either the prescribing physician or his her designee ii Initial refresher and periodic training of all individuals authorized to operate the AED iii A plan for utilizing the AED including written protocols iv A method to record and review each incident of an AED use g AED Equipment and Maintenance Specifications i All automatic external defibrillators utilized under this policy shall meet minimum standards set forth by of the Food and Drug Administration ii All defibrillators shall be maintained and regularly tested according to the operation and maintenance guidelines set forth by the manufacturer and written in this manual iii Every AED shall be checked for readiness after each use and as discussed in this policy and procedures manual h Documentation i Certain documents should be kept on file and should be made available to the EMS Section for review upon request Documents should include but are not limited to 1 PAD Program Application 2 PAD Program Memorandum of Agreement 3 AED Protocol 4 AED Algorithm 5 Report of CPR or AED Post Incident Report 6 AED Operator Training Record 7 AED Safety Inspection Record These documents do not constitute any offer or acceptance to provide legal advice to any PAD Program or person Legal questions about documents involved in establishing a PAD Program such as the Memorandum of Agreement between the Program and its Medical Director and other re
47. dical Director 71 APPENDIX D Daily and Monthly Annual AED Check off With Manufacturer Recommendations BASIC AED MAINTENANCE Attached is the Daily and Monthly Annual AED Check off With Manufacturer Recommendations basic and AED maintenance this is two pages horizontal and is to printed off annually in color by the Program Coordinator or as needed if the original gets damaged and distributed accordingly to each site by May 15 annually Annually the filled out Daily and Monthly AED Check off is to be given within 72 hours to the AED Program Coordinator and is to be kept on fill for a minimum of 7 seven years A Daily and Monthly Annual AED Check off With Manufacturer Recommendations basic and AED maintenance are kept with EACH AED 72 APPENDIX E Automated External Defibrillator Manufacturer Information AED Model Number Powerheart AED G3 Plus Automatic model 9390A 501 P Manufacturer Representative XXX XXXX Territory Manager with Carolinas Cardiac Science Corporation Powerheart Phone Cell XXX XXX XXXX email XXXX cardiacscience com Address XXXX XXXX XXXX XXXXX NC XXXXX Main Cardiac Science Phone 425 402 2000 business hours 8 4 30 weekdays toll free number in the U S 1 800 426 0337 fax number 425 402 2001 http www cardiacscience com Alternate Manufacturer contact Powerheart Customer Care 1 800 991 5465 Equipment 1 SN Office ZXXXX 2 SN Gym
48. dle school volleyball basketball gym Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to gym make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain Middle Office 828 488 3480 1 800 273 TALK with HS athletic trainer Home side HS basketball volleyball gym HS Main office 5 MS Main office 35 Swain County Park amp Rec Baseball Softball Field Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain Middle School and meet at the volleyball basketball gym we have an injured Student athlete bystander in need of emergency medical treatment 30 Recreation Park Drive Bryson City NC 28713 Directions Take Highway 74 to Bryson City past the Cherokee and Whittier Ex
49. e Monthly and Annual check offs will be done by the School Nurse or program coordinator or alternate coordinator as assigned monthly This will be recorded using Daily and Monthly Annual AED Check off with Basic Maintenance in Appendix D e A full check must be done by two people after every use of AED this is to be done by the School Nurse and another qualified person ie another school nurse or the Medical Director if the AED Program Coordinator is unavailable o Records will be maintained using daily school calendar for daily checks and for monthly and annual checks which will be kept with each AED in Appendix D see person s and AED assignments below Swain County Schools AED assignment AED Item Description SYD nN BW j Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Powerheart AED G3 Plus Automatic Where Main High School office Basketball Volleyball gym With the Athletic Trainer ATC Main Middle School office Main East Elem School office Main West Elem School office Main Entrance Pre Kindergarten Bright Adventures What School Swain High School Swain High School Swain High School Swain Middle School Swain East Elementary Swain West Elementary Swain County Pre Kindergarten Bright Adventures Swain County Schools AED Daily Monthly Yearly Checks
50. eded Send bystander to meet EMS at the front entrance of the Gym closest door of the injured person Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to gym make sure all doors are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain High Office 828 488 2152 1 800 273 TALK with HS athletic trainer Home side HS basketball volleyball gym HS Main office MS Main office 31 Swain High School Baseball Softball Field Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain High and meet at the baseball softball field we have an injured Student athlete bystander in need of emergency medical treatment 1415 Fontana Road Bryson City NC 28713 Directions Take 19 23 to Bryson City p
51. eeled AED will prompt Place one pad on bare upper chest two times Rescuer should place pad as shown gt on pad diagram 3 AED will prompt Place second pad on bare lower chest as shown Rescuer should place the second pad as shown on pad diagram Pediatric Child pad placement For patients under 8 years of age or weighs less than 55lbs 25kg Use Pediatric Attenuated Defibrillation Electrodes model XXXX Therapy should not be delayed to determine the patient s exact age or weight Locate pediatric electrodes stored with AED which is in the zipped part RED ribbon Open pediatric electrodes Peel one electrode and place as shown on electrode diagram Peel second electrode and place as shown on electrode diagram Connect electrodes to AED oRocTP 64 Standard Pads Placement in a CHILD Recommended Alternate Pad Placement 4 Analyze Rhythm AED will prompt Do not touch patient Analyzing rhythm 5 Charges AED will prompt Shock advised charging 6 Delivers Defibrillation Pulse AED will prompt Stand clear Shock will be delivered in 3 seconds 2 1 Once the AED begins the Stand clear prompt the rescuer will state clear and make a visual head to toe check of the patient making sure that he she and any other rescuers are clear of contact with the patient prior to the completion of the countdown 7 Analyze Charge Pulse After the first defibrillation
52. eep Creek Road at split bare left onto West Deep Creek Road 0 2 miles past split on right Swain County Recreation Center before Recreation Park entrance on left 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed Send bystander to meet EMS just outside of the Park and Rec building so they can direct EMS where the injured Student athlete bystander is located Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to gym make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222
53. endent 280 School Dr P O Box 2340 Bryson City NC 28713 Phone 828 488 3129 Fax 828 488 8510 Swain County Central Office Website http www swain k12 nc us education components album default php sectiondetailid 1553 NOTE For Swain County s AED Policy and Procedure Manual Most filled in information can be found in a pink binder with the school s nurse at each school s site and a pink binder can also be found with Swain County s Superintendent and Swain County EMS Director ALL filled in information can be found with the AED Program Coordinators and the AED Medical Director Non filled in information is kept on the School s website Each AED has a yellow folder behind the AED in the AED cabinet with one copy of the Powerheart AED G3 Plus Automatic Operations Manual page 66 two copies of the AED Post Incident Report Form Appendix I and one copy of Post Incident Check List Appendix J Table of Contents 1 Automated External Defibrillator AED Purpose e Program Requirements 2 Public Access Defibrillation PED Program e PAD program application e Signature page e NC Licensed Physician s Prescription for AED 3 Notification to Local EMS Director 4 AED Overview e Definitions e Program Coordinator 5 AED Training 6 AED Protocols e AED Training example e NC AED Good Samaritan Act 7 Emergency Response e Emergency Action Plan EAP for ALL Swain County Sport sites Photo Location of ALL Swain C
54. f this annually The AED Program Coordinator is to check with the certified athletic trainer ATC regarding Swain County Schools Emergency Action Plans EAP making sure the EAP s have been reviewed updated annually printed on bright neon green paper laminated and placed in there proper locations by the principal director supervisor or ATC that is at that location this is to be checked on by August 1 annually The emergency action plans for e Swain High Football Stadium e Swain High Volleyball Basketball Gym e Swain High Baseball Softball Field e Camp Living Water Swain High Soccer complex o Swain Middle Football Field o Swain Middle Volleyball Basketball Gym Swain County Park and Rec Baseball Softball Field Swain County Park and Rec Basketball Gym weight room facility Swain County Park and Rec Pool e Swain West Elementary Volleyball Basketball Gym e Swain West Elementary Front Track and Playground e Swain West Elementary Back Playground o Swain East Elementary Volleyball Basketball Gym Swain Pre Kindergarten Bright Adventures Each emergency action plan is carefully reviewed updated annually printed on bright neon green paper and laminated and placed in the proper locations and are very visible for all to see Each action plan is NOT to be removed by anyone other than the certified athletic trainer All the action plans have been carefully reviewed any all revisions or modification have been made and a
55. ft See above for contact information Fax See above for contact information PAD Program Site Information Facility Name East Elementary Facility Principal XXXX XXXX Facility Phone ft 828 488 0939 Facility Fax ft 828 488 6635 Facility Address 4747 Ela Road City Bryson City State NC Zip 28713 Program Manager XXXX XXXX RN East Elementary School Nurse Program Manager Cell ft XXX XXX XXXX Work tt 828 488 0939 Fax fi Same as facility fax E Mail Address XXXX swainmail org Number of Employees XXX as of Fall 20XX Number of Students XXX as of Fall 20XX Hours of Operation Normal School Hours of Operation AED Brand amp Model Cardiac Science Powerheart 3G Plus Automatic model 9390A 501P AED Serial Office ZXXXXX Purchased date XXXX 20XX CPR AED Training Organization Information if applicable Name XXXX XXXXYX RN East Elementary School Nurse Address See above for contact information Point of Contact See above for contact information Phone ft See above for contact information Fax See above for contact information 10 PAD Program Site Information Facility Name West Elementary Facility Phone ft 828 488 2119 Facility Principal XXXXX XXXXX Facility Fax ft 828 488 0797 Facility Address 4142 HWY 19 West City Bryson City State NC Zip
56. gram Coordinator no later then 36 hours following the event YES No Did the Program Coordinator order all used AED material within 24 hours after learning of the event YES No Did the Program Coordinator contact the AED vendor Cardiac Science to download event data from AED Do NOT remove the battery YES No Program Coordinator send a copy of documentation AED Post Incident Report to Swain County s AED Medical Director on and Swain County EMS on within one week from the date of the event Done Program Coordinator and School s designee should conduct emergency incident debriefing as needed Done ONLY the Program Coordinator is authorized to down load AED information after AED use The Powerheart AED has built in incident reporting in its internal memory Powerheart Technical Support 888 466 8686 for technical questions on downloading data The CD ROM and cable connect to the AED and to a computer follow the directions in order to download the information sk ke ke sees Post Incident Procedure for the AED See Appendix B for Equipment Location e Done X Restock AED putting it back into the box on the wall e Done Close lid of AED and ensure the status indicator is GREEN for Powerheart AED G3 series only e Done Check the battery level to assure sufficient battery life e Done___ Fill out all documentation Automated External Defibrillator Use Report two copies are to be kept with AED is under APPENDIX I e Done Retrieve resc
57. h by the American Heart Association or equivalent 3 To establish a process that provides authorization to practice for individuals appropriately trained in the use of defibrillation equipment 4 To establish a quality assurance program that reviews all uses of the defibrillation equipment and which provides for ongoing education and the regular evaluation of skill competency necessary to maintain authorization to practice 5 To assist the AGENCY in establishing a plan to promote awareness employee education and provide a heart safe environment The AGENCY agrees 1 To maintain with the MEDICAL DIRECTOR an up to date roster of all individuals employed by the AGENCY who are authorized to practice 2 To participate in all quality assurance procedures established by the MEDICAL DIRECTOR including case reviews and skill competency evaluations as the MEDICAL DIRECTOR sees fit 3 To utilize and abide by written protocols for the use of defibrillation equipment 4 To establish policies for regular inspection and preventative maintenance of all defibrillation equipment and batteries as set out in this policy and procedure manual 5 To utilize only that equipment which is approved by the MEDICAL DIRECTOR 6 To assist the AGENCY in establishing a plan to promote awareness employee education and provide a heart safe environment 7 The PAD Program Manager of the Swain County School s SCHS SMS East Elem West Elem and Swain Pre K B
58. hool t Swain East Elementary Main office 42 Swain East Elementary School Playground amp Track Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain East Elementary School and meet at the track and playground we have an injured Student athlete bystander in need of emergency medical treatment 4747 Ela Road Bryson City NC 28713 Directions From Highway 19 23 take Exit 69 Hyatt Creek Exit Follow Hyatt Creek Road to Highway 19 Turn right In less than 100 yards turn left into Swain East Elementary School The playground amp track area is located on the right after entering the school entrance 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher e Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed e Send bystander to meet EMS at Swain East Elementary School s track and playground area Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to field make sure all gates are unlocked and
59. ing the programs approved and provided by the a American Heart Association AHA b American Red Cross AHC e Specify who is qualified to use AED e Type of training and updates required and specify frequency of training and updates as set by your institution AHA recommends full AED course every two years but recommend reviews or updates at least every 6 months e Define an update review of book watch training video policy manual review practice drills etc e Maintain written record of training and updates including instructor training dates recommended renewal dates participant s names Initial AED training for the public is a 4 hour course incorporating Heartsaver Adult from age 8 and up CPR and Choking management with safe and effective use of your AED If all possible the training of the AED will be done with training devices of the same brand of AED you purchase For example if you have the Powerheart plusTM AED you should be trained using this model For Healthcare Professionals AED training is now incorporated into the American Heart Association BLS for Healthcare Professionals AHA CPR amp AED renewal is a 2 to 3 hours course that reviews the basic skills of CPR and the use of an AED American Heart Association CPR and AED certification cards are good for 2 years American Red Cross certification cards are good for 1 year The course shall consist of not less than four hours and will comply with the American
60. its Take Exit 67 2nd of Bryson City exits At the first light make a right same side as Bojangles Restaurant at next light Everett Street turn left Go through town over railroad tracks and immediately turn right onto Depot Street at stop sign turn left then immediate right onto Deep Creek Rd at split bare left onto West Deep Creek Rd turn left 0 2 miles past split onto Recreation Park Drive The baseball softball fields are up the hill the road is adjacent to the Rec Department Building The softball field is the first field on right and the baseball fields are at the top of the hill on the far end 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed Send bystander to meet EMS along the baseball or softball field where the injured Student athlete bystander is located Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to gym make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatmen
61. lable in person or by phone within a reasonable amount of time to answer any questions or concerns of the authorized individuals The program coordinator or designee shall ensure that all issues related to training such as scheduling of basic and periodic reviews maintenance of training standards and authorized individual status and record keeping is managed on a continuing basis The program coordinator or designee will assure that all equipment stock levels are maintained and or ordered as stipulated in Equipment Requirement and readiness checks and record maintenance are done in accordance with Title XXII requirements and manufacturer s recommendations If the program coordinator or designee needs to have a quality assurance issue addressed she he may contact the Medical Director The program coordinator will have a list of the appropriate telephone numbers in compliance with above paragraphs numbers 1 and 4 Appendix A If any contact information changes the program coordinator will be notified within 72 hours The program coordinator or designee shall notify the local EMS agency of the existence location and type of AED at the company site 19 AED TRAINING The training requirements for authorized individuals are outlined below Definition by NC law means successful completion of a nationally recognized course or training program in cardiopulmonary resuscitation CPR and automated external defibrillator AED use includ
62. lator 24 PHYSICIAN RESPONSIBILITIES An AED can be purchased by prescription not required by NC State law but highly recommended and its use requires medical direction by a licensed physician This individual will provide medical expertise on the proper use of AEDs If an AED is used the physician or their designee will review its use and review downloaded data Legal References XXXX Cross References XXXX Adopted XXXX XX 20XX from Montgomery County Schools http www montgomery k12 nc us 1796108994545 147 lib 1796 108994545 147 9205 6130 pdf 25 Good Samaritan laws Good Samaritan laws e Help protect rescuers voluntarily helping a victim in distress from being successfully sued in tort 1 e for wrongdoing e Are designed to encourage people to help a stranger who needs assistance by reducing or eliminating the fear that if they do so they will suffer possible legal repercussions in the event that they inadvertently make a mistake in treating the victim e Were primarily developed for first aid situations e Differ from state to state o Most states require that the victim not object to receiving aid but do not the victim s consent which of course could not be given if the victim was unconscious The laws of some states such as Nevada apply to all citizens The laws of other states such as California are written specifically for physicians The statutes listed below use similar or identical basic standard for asses
63. lementary School and meet at the volleyball basketball gym we have an injured Student athlete bystander in need of emergency medical treatment 4142 Highway 19 West Bryson City NC 28713 Directions Take 19 23 west towards Murphy Go PAST the Alarka exit 64 The school is located less than one mile on the right Go straight towards the small circle and park there The volleyball basketball gym is the main school building on the left hand side Enter one of the three main doors on the front of the building The gym is to your left after passing the Little Theater 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher e Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed e Send bystander to meet EMS at the main entrance of Swain West Elementary School closes to the volleyball basketball gym Provide appropriate emergency care until EMS arrives Have coach parent meet ambulance at entry to gym make sure all gates are unlocked and cars are not in the way Provide EMS with information how injury occurred treatment that was given medical history p
64. ncident Report is sent to Swain County EMS as soon as possible and no later than one week from the date of the event Program Coordinator and School s designee should conduct emergency incident debriefing as needed Post Incident Procedure for the AED See Appendix B for Equipment Location e Restock AED putting it back into the box on the wall e Close lid of AED and ensure the status indicator is GREEN for Powerheart AED G3 series only e Check the battery level to assure sufficient battery life e Fill out all documentation Automated External Defibrillator Use Report two copies are to be kept with AED is under APPENDIX I e Retrieve rescue data and forward to Oversight Physician or AED Program Medical Director o Hook up the extra pad to the AED make sure you can see the expiration date then contact the program coordinator to replace AED pads Remember the AED MUST have two sets of pads at all times o Check expiration date on the pad package o Restock AED ready kit ie Replace pocket mask and other supplies used Refer to AED SUPPLIES and Warranty for details ONLY the Program Coordinator is authorized to down load AED information after AED use The Powerheart AED has built in incident reporting in its internal memory Powerheart Technical Support 888 466 8686 for technical questions on downloading data The CD ROM and cable that came with the Powerheart AED connects to the AED to a computer follow the directio
65. ned in CPR AED is not available during the time of cardiac arrest then an untrained individual in good faith will fall under the Good Samaritan Law Any authorized individual trained in CPR AED meets the following standers e Meet the training requirements set forth in these policy and procedures e Pass competency based written and skills recognition examinations e Comply with the requirements set forth in these policies and procedures Failure to comply with these requirements shall result in the suspension of the individual s authorization The authorization period for a trained responder will stay in effect as long as he she adheres to the program guidelines Authorization shall be rescinded in the event of termination of the individual s association with the company While the Good Samaritan law see this section allows AED to be applied to patients by individuals who have not been trained in CPR and AED the law also requires organizations with AEDs to have authorized individuals 22 AED CPR Training Example Theses personal are trained in the use of the Automated External Defibrillator and CPR Adult child and infant They have completed the recommended American Heart Association Heartsaver AHA or American Red Cross ARC standards for CPR AED insert the names of instructors and participants for your respective school below the See APPENDIX K for a list of actual personal of trained at this Swain County AGE
66. ns in order to download the information 53 Additional information following the use of an AED 1 In addition to information obtained from the AED documentation of the incident shall be completed as follows a Documentation shall be initiated whether or not defibrillatory shocks are delivered b The following information shall be provided if known AED Post Incident Report Appendix I Date 2 Event location 3 Person s name 4 Person s address 5 Person s telephone number 6 Person s sex 7 Estimated time elapsed from person s collapse until initiation of CPR if witnessed or heard 8 Total minutes of CPR prior to application of defibrillation 9 Person s response to treatment rendered i e regained pulse and breathing 10 Name of transporting agency 11 Name of authorized individual completing the report 2 The AED Post Incident Report is to be sent to the Medical Director 3 The medical director program coordinator and or designee will review the AED record of the event and the AED Post Incident Report and interview the authorized individuals involved in the emergency to ensure that a The authorized individuals quickly and effectively set up the necessary equipment b When indicated the initial defibrillator shock s was delivered within an appropriate amount of time given the particular circumstances c Adequate basic life support measures were maintained d Following each shock or set of shocks as a
67. ntenance Perform the following tests annually to confirm that the diagnostics are functioning properly and to verify the integrity of the case Check the Integrity of the Pads and Circuitry 1 Open the AED lid Remove the pads Close the lid Confirm that the STATUS INDICATOR turns red Powerheart AED G3 series only Open the lid and confirm that the Pad indicator is lit Reconnect the pads and close the lid Make sure the expiration date is visible through the clear window of the lid For the Powerheart AED G3 series check to make sure that the STATUS INDICATOR is GREEN 8 Open the lid and confirm that no diagnostic indicators are lit 9 Check the expiration date of the pads if expired replace them 10 Check the pad s packaging integrity 11 Close the lid ANN WNW For Swain County s AED maintenance record See Appendix D Daily and Monthly Annual AED Check off with Basic Maintenance 60 AED SUPPLIES and Warranty ALL supply ordering MUST go through the program coordinator ONLY the program coordinator can contact Sally Jones not the real name of Swain County s contact person in purchasing for purchase order Supplies MUST be in compliance with Powerheart G3 Plus Automatic model 9390A 501P Supplies Parts can be ordered through Powerheart Customer Care at 1 800 991 5465 Current state contract XXXX valid through XXXX pricing for replacement supplies are as follows ALL of the follo
68. ock has been delivered to the patient and that the debrillator is no longer charged d Rapid accurate assessment of the patient s post shock status to determine if further activation of the AED is necessary e Authorized individuals responsibility for continuation of care such as the repeated shocks if necessary and or accompaniment to the hospital if indicated or until the arrival of professional medial personnel All successful participants will receive a CPR AED course completion card The required text will meet the standards of the AHA or the ARC Basic and review sessions will be conducted according to the following schedule a CPR AED renewal will be conducted at least every other year b Periodic reviews will be at the discretion of the Medical Director with a one year minimum The program coordinator may schedule reviews more often if necessary CPR AED Training records that includes documentation of defibrillation skills proficiency will be maintained by the School Nurse kept in the pink AED binder and the School Nurse will send a copy of this Training record to the AED Medical Director and the Program Coordinators 21 AED Protocols It is highly recommended that the use of an AED on an appropriate patient is used by an authorized individual who is good standing and is trained in compliance with the American Heart Association AHA or American Red Cross ARC standards for CPR AED If such an authorized individual trai
69. office 5 MS Main office 34 Swain Middle School Volleyball Basketball Gym Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain Middle School and meet at the volleyball basketball gym we have an injured Student athlete bystander in need of emergency medical treatment 135 Arlington Ave Bryson City NC 28713 Directions Take 19 23 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City Exits At the first light make a left turn on the same side as Shell Gas Station then bear to the right Travel approximately 300 yards up a hill to the school The volleyball basketball gym is the first building on the left hand side on top of a small hill attached to the middle school Swain Middle school is on Arlington Avenue 3 Provide necessary information to EMS personnel e Name address telephone number of caller Number of victims condition of victims First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed Send bystander to meet EMS at the top of steps just outside along the entrance of the mid
70. ogram coordinator may be appointed by the medical director and agency to oversee the administration of the PAD program iii Program Manager A person at each PAD Site often the school nurse and or school Principal or Program Director that will contact the Program Coordinator if there is any issues with the AED or if there is an indent that involves the use of the AED c Program Plan i A written description of the PAD program that should include but is not limited to authorization of personnel written protocols and case by case reviews d Training i A mechanism for the training and testing of the authorized individual s in the use of an AED ii This may be accomplished by an affiliation with an appropriate training entity Contact the EMS Section at 828 488 2196 for a list of training organizations iii A list shall be maintained of individuals that have been trained and authorized by the medical director to use the AED iv All training must meet or exceed the standards of the Heartsaver AED Course set forth by the American Heart Association or equivalent v The training standards prescribed by this section shall not apply to licensed certified or other prehospital emergency medical care personnel as defined by North Carolina Revised Statutes f Quality Assurance i A quality assurance mechanism that will ensure the continued competency of the authorized individual s to include periodic training and skill proficiency
71. ol office On Left wall in just pass the High School high school secretary 2 Powerheart AED G3 Plus Basketball Volleyball gym On the Home side near the High School front door 3 Powerheart AED G3 Plus N A With certified athletic trainer High School Main Middle School office On wall in front of you as you Middle School 4 Powerheart AED G3 Plus walk into the door 5 Powerheart AED G3 Plus Main East Elem School office On wall in front of you as you walk into the door Fast Elementary 6 Powerheart AED G3 Plus Main West Elem School office 7 Powerheart AED G3 Plus Main Entrance Pre Kindergarten Bright Adventures On wall in front of you as you walk into the door On the RIGHT wall approximately 15 feet from the front door West Elementary Swain County Pre Kindergarten Bright Adventures ready kit On the side of the AED you will find an AED Ready Kit where you will find the following 1 CPR Face mask Barrier device 2 sets of medical gloves Large and Medium 1 absorbent cloth towel ONE time use ONLY 1 disposable razor s ONE time use ONLY 1 Antiseptic Towelette 2 sets of 4 x 4 gauze pad 1 Ink pen note pad 1 pair of paramedic scissors In the BACK of the AED unzipped the RED ribbon it could include the following supplies 1 extra set of Adult defibrillator pads
72. orm Life Support Measures Give verbal description of Incident to EMS upon arrival 10 AED Data Retrieval and delivery of data to medical personnel 11 Restock Supplies for AED 12 Complete Written Account of AED Use Including Data Card 13 Submit Report to Medical Director EMS Agency 52 AED Post incident Procedure After EACH use of the AED PLEASE complete the following steps These steps should be completed as SOON after the incident as possible Post use Procedure 1 One of the individuals working on or involved with the patient s care at the time of the event should complete the documentation AED Post Incident Report Form of the sudden cardiac arrest event and give to this School s Principal and School Nurse no later than 24 hours following the event The School s Principal and or School Nurse is to contact Swain County s AED Program Coordinator within ONE hour regardless of the time day after learning of the sudden cardiac arrest event the school is also to give all documentation to the AED Program Coordinator no later then 36 hours following the event The Program Coordinator will order ALL used AED material within 24 hours after learning of the event Program Coordinator will contact the AED vendor Cardiac Science to download event data from AED Do not remove the battery Program Coordinator will assure that documentation is sent to Swain County s AED Medical Director and a copy of the AED Post I
73. ounty AEDs Automatic External Defibrillator Written Plan Automated External Defibrillator Action Plan Automated External Defibrillator Post Incident Procedure 8 Maintenance e AED Assignment e Scheduled Maintenance e AED Supplies and Warranty 9 Copy of Operations Manual Cardiac Science Corporation Powerheart G3 Plus 10 Cardiac Science Operations Manual for the Powerheart G3 Plus LEREREEER EERE Ansengdices t TEETER EES Contact Phone List Equipment Location Daily and Monthly Annual AED Check off COVER LETTER Daily and Monthly Annual AED Check off with Basic Maintenance AED Manufacturer Information ANNUAL Program Coordinator check list Written EMS Notice of AED AED Post Incident Report Form AED Post Incident Check List This AGENCY s AED CPR Trained Providers Information found with Primary amp Alternate AED Program Coordinators Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix H Appendix I Appendix J Appendix K Appendix L PURPOSE a The purpose of this policy and procedure manual is to outline all the policies and procedures to be followed by all Swain County School s SCHS SMS East Elem West Elem and Swain Pre K regarding the automatic external defibrillators AED program This document is to also provide a system wide public access defibrillation standards review and oversight by the Emergency Medical Services EMS section of Bryson City North Carolina BCNC
74. ports and records should be addressed to the Program s counsel 9 AED Equipment and Maintenance Issues a Any manufacturer recommended maintenance on the AED b Any repairs performed on the AED c Required safety inspections done on the AED d Any FDA medical products reporting in the event of an AED malfunction Please call the EMS Section at 828 488 2196 or visit the FDA website at www fda gov med watch report consumer consumer htm Public Access Defibrillation Program Memorandum of Agreement This agreement is made and entered into on XXXXXX XX 20XX date And is between Dr XXXXX XXXXX MD Hereinafter known as the Swain County AED MEDICAL DIRECTOR And _ Swain High School Swain Middle School East Elementary West Elementary and Swain County Pre Kindergarten Bright Adventures hereinafter known as the AGENCY The purpose of this agreement is to establish a program for the utilization of defibrillation procedures by the authorized individual s employed by the AGENCY who will function under the supervision of the MEDICAL DIRECTOR THEREFORE THE PARTIES NOW MUTUALLY AGREE AS FOLLOWS The MEDICAL DIRECTOR agrees 1 To assume responsibility for all medical aspects of the program and to ensure in cooperation with the program manager that all administrative requirements are accomplished 2 To oversee defibrillation training programs that meet or exceed the standards of the Heartsaver AED Course set fort
75. ppropriate the person was assessed accurately and treated appropriately e The defibrillator was activated safely and correctly f The care provided was in compliance with the internal emergency response guidelines set forth in this policy and procedure manual of this document 4 The medical director will determine the occurrence and the range of action to be taken in response to identified problems or deficiencies if any as well as actions to be commended and notify the AED Program Coordinator 5 The AED Program Coordinator will send a copy of the AED Post Incident Report to Attn XXXXX XXXX Swain County EMS XXXX XXXX XXXXX XXXXX NC XXXXX XXX XXX XXXX XXXXX swaincountync gov Following the post incident review found in Appendix I a copy of all written documentation concerning the incident will be sent to the medical director and maintained on site and with the AED Program Coordinator for a period of seven 7 years from the incident date For Appendix I The AED Program Coordinator will submit one copy of this report to the EMS agency one copy to the AED Medical Director and the school nurse where the incidents took place for their records 54 Maintenance Policy on checking ready status of the AED There will be daily monthly and annually check offs of EACH AED e There will be an assigned person s to check off and record daily duties by the initials on school calendar that is kept with each AED
76. pproved by the following personnel copies if needed are given to each location by August each year Signatures needed if position s change Swain County EMS Director is made aware and has a copy of all EAP The EMS Director aware of as needed with a new copy of EAP if there are any changes made to EAP XXXXX XXXXX SCHS Principal Date XXXXX XXXXX SCMS Principal Date XXXXX XXXXX Swain County Park amp Rec Supervisor Date XXXXX XXXXX West Elementary Principal Date XXXXX XXXXX East Elementary Principal Date XXXXX XXXXX Pre K Bright Adventures Director _ Date XXXXX XXXXX Camp Living Water Director Date 29 Swain High School Football Stadium Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain High School and meet at the Football Stadium we have an injured Student athlete bystander in need of emergency medical treatment 1415 Fontana Road Bryson City NC 28713 Directions Take 19 23 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City exits At the first light make a right same side as Bojangles Restaurant at next light Everett Street turn left Go through town over railroad tracks and up the hill about 4 1 2 miles The football stadium is just past the High School on the Right hand side road level The High School is on your left down below road
77. r emergency treatment of victims exhibiting symptoms of sudden cardiac arrest who are unresponsive no pulse and not breathing Post resuscitation if the victim is breathing the AED should be left attached to allow for acquisition and detection of the ECG rhythm If a shockable ventricular tachyarrhythmia recurs the device will charge automatically and advise the operator to deliver therapy Unresponsive Not Breathing Apply the AED if Unresponsive and Not Breathing 62 PROCEDURE A Assess scene safety Is the scene free of hazards Rescuer makes sure there are no hazards to them Some examples are Electrical dangers downed power lines electrical cords etc Chemical hazardous gases liquids or solids smoke Harmful people anyone that could potentially harm you Traffic make sure you are not in the path of traffic Fire flammable gases such medical oxygen cooking gas etc B Determine if patient is Unresponsive AND Not Breathing Have someone get the closest AED and immediately begin CPR until the AED arrives then Once the AED arrives Apply the AED if the patient is still Unresponsive and Not Breathing If the patient is unresponsive and Not breathing Open Lid C Opening lid turns on the AED D Follow Voice Prompts 63 Adult pad placement 1 Place Pads AED will prompt Tear open package and remove pads followed by Peel one pad from plastic liner 2 Once pad is p
78. re not in the way Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain West Elem Office 828 488 2119 1 800 273 TALK Swain West Elementary School T Swain West Elementary Main office 41 Swain East Elementary School Volleyball Basketball Gym Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain East Elementary School and meet at the volleyball basketball gym we have an injured Student athlete bystander in need of emergency medical treatment 4747 Ela Road Bryson City NC 28713 Directions From Highway 19 23 take Exit 69 Hyatt Creek Exit Follow Hyatt Creek Road to Highway 19 Turn right In less than 100 yards turn left into Swain East Elementary School Enter one of the three main doors on the front of the building The gym located on the left side of the building after entering
79. rom civil liability for those who obtain and maintain AEDs and those who use such devices to attempt to save a life Specifically North Carolina General Statute Section 90 21 15 provides for three classes of persons or entities who are exempt from civil liability related to the procurement and maintenance of AEDs The person or entity that provides the cardiopulmonary resuscitation and AED training to a person using an AED The person or entity responsible for the site where the AED is located when Swain County Schools have provided for a program of training A North Carolina licensed physician who writes a prescription without compensation for an AED Swain County Schools will maintain AEDs Responsible school personnel as well as the physician who writes the prescription for the AED are exempt from civil liability related to the use of the device to save a life In addition North Carolina General Statute 90 21 14 provides that the person who used an AED to attempt to save a life or saved a life will be immune from civil liability unless the person was grossly negligent to intentionally engage in wrongdoing when rendering the treatment AED training is offered by the American Red Cross the American Heart Association FirstHealth of the Carolinas and certified instructors of Swain County Schools and includes recognition of cardiac arrest symptoms cardiopulmonary resuscitation CPR and the proper use of an automated external defibril
80. ryson City North Carolina will be notified by the terminating party that the agreement will be terminated This notification will be made at least 45 days prior to the date of termination It is AGREED TO BY ALL PARTIES that any party may terminate this memorandum of agreement with sixty 60 days written notice PAD Program Application S Medical Director Information Name Dr XXXXXX XXXXX MD License Contact Program Coordinator Work Address Contact Program Coordinator City Contact Program Coordinator State Contact Zip Contact Program Program Coordinator Coordinator Cell 4 Contact Program Work Contact Fax Contact E Mail Address Coordinator Program Coordinator Program Coordinator Contact Program Coordinator PAD Program Site Information Facility Name Swain High School Facility Phone 28 488 2152 Facility Principal XXXXX XXXXX Facility Fax ft 828 488 0523 Facility Address 1415 Fontana Road City Bryson City State NC Zip 28713 Program Manager XXXXX XXXXX RN Swain High School Nurse Cell Work Fax E Mail Address XXX XXX XXXX 828 488 2152 Same as facility fax XXXX swainmail org Number of Employees XXX as of Fall 20XX Hours of Operation Number of Students XXX as of Fall 20XX Normal School Hours of Operation AED Brand amp Model AED Serial Purchased date Cardiac Science Powerheart 3G
81. s First aid treatment initiated Specific directions as needed to located scene Other information as requested by dispatcher e Provide appropriate emergency care until arrival of EMS personnel on arrival of EMS personnel provide pertinent information method of injury vital signs treatment rendered medical history and assist with emergency care as needed e Send bystander to meet EMS at Swain West Elementary School s front track and playground area e Provide appropriate emergency care until EMS arrives e Have coach parent meet ambulance at entry to field make sure all gates are unlocked and cars are not in the way e Provide EMS with information how injury occurred treatment that was given medical history parents notified and assist with treatment as needed e Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident e Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain West Elem Office 828 488 2119 1 800 273 TALK Swain West Elementary School T Swain West Elementary Main office 40 Swain West Elementary School Back playground Emergency Action Plan In case of an emergen
82. s and no signs of circulation The automatic defibrillator requires user interaction in order to deliver a shock 2 Anauthorized individual refers to an individual who has successfully completed a defibrillator training program has successfully passed the appropriate competency based written and skills examinations and maintains competency by participating in periodic reviews The authorized individuals shall also adhere to policies and procedures in this manual 3 AED Service Provider means any agency business organization or individual who purchases an AED for use in a medical emergency involving an unconscious person who has no signs of circulation This definition does not apply to individuals who have been prescribed an AED by a physician for use on a specifically identified individual 4 Prescribing Physician is a physician licensed in North Carolina who issues a written order for the use of the AED by authorized individuals 5 Medical Director meets the requirement of a prescribing physician and may also be the prescribing physician The Medical Director ensures that all AED regulatory requirements are implemented 18 Program Coordinator At all times while these policies and procedures are in effect the schools will maintain a program coordinator The person is responsible for the overall coordination implementation and continued operation of the program l The program coordinator and or alternate contact will be avai
83. sing the liability of persons rendering emergency medical care Any person who in good faith renders emergency medical care or assistance to an injured person at the scene of an accident or other emergency without the expectation of receiving or intending to receive compensation from such injured person for such service shall not be liable in civil damages for any act or omission not constituting gross negligence in the course of such care or assistance Relevant individual state statutes are as follows North Carolina N C Gen Stat 90 21 14 1975 e Provides immunity for rescuers e Provides immunity for acquirers and enablers e Encourages requires CPR amp AED training 26 EMERGENCY RESPONSE Internal Emergency Response System The first person on the scene l Will initiate the Chain of Survival by calling out for help with a medical emergency The first person possible will call 911 and delegate someone to go outside to escort the paramedics to the scene The AED and other medical supplies are to be brought to the patient If trained the responder will initiate CPR until the AED arrives Initial protocol for the unconscious victim is as follows Upon arrival assess the scene safety use universal precautions 2 3 4 5 Assess patient for unresponsiveness Assess breathing Assess signs of circulation If warranted perform CPR until the AED arrives Begin AED treatment 1 2 3 4 Turn on
84. t Elementary and Swain County Pre Kindergarten Bright Adventures check expiration dates e 1 Post Incident report amp AED Policy Procedure Manual yellow folder e 1 Clipboard with Daily and Monthly AED Check off Powerheart AED G3 Plus Automatic parts and labor warranty Powerheart AEDs have a 7 year parts and labor warranty Powerheart Technical Support can be reached at 1 888 466 8686 In case it is determined that one of the Powerheart AEDs needs to be serviced appropriate shipping details will be provided by the Poweheart Technical Support Representative at that time Also see user manual 61 Powerheart G3 Plus Operations Manual The following is a COPY OF OPERATIONS FOR ONLY THE POWERHEART AED G3 PLUS AUTOMATIC model 9390A 501P TYPE OF MEDICAL EMERGENCY Sudden Cardiac Arrest Follow Indications for AED Use in section VI of the plan Other Medical Emergencies Responder should provide only the patient care that is consistent with his her training INDICATIONS FOR AED USE Your AED is intended to be used by personnel who have been trained in its operation The user should be qualified by training in basic life support or other physician authorized emergency medical response If a qualified user someone that has been trained in CPR AED is not available at the time of an emergency the user that has not been trained in the use of the AED will fall under the Good Samaritan law The device is indicated fo
85. t that was given medical history parents notified and assist with treatment as needed Send a coach if parent is Not present with EMS to hospital amp continue to call the parent to inform them of incident Have copy of emergency consent and information to send with EMS if parent is not present Emergency Telephone Numbers EMS Police and Fire 911 Harris Regional Hospital 828 586 7000 Poison Control 1 800 222 1222 Swain County Hospital 828 488 2155 Swain Medical Center 828 488 4205 Suicide Hotline 1 800 SUICIDE Swain Park amp Rec Office 828 488 6159 1 800 273 TALK Automated External Defibrillators AED There is NO AED at this location 36 Swain County Park and Rec Basketball Gym Weight room facility Emergency Action Plan In case of an emergency please do the following 1 Call911 2 Instruct emergency medical services EMS personnel to Report to Swain Middle School and meet at the volleyball basketball gym we have an injured Student athlete bystander in need of emergency medical treatment 240 West Deep Creek Road Bryson City NC 28713 Directions Take Highway 74 to Bryson City past the Cherokee and Whittier Exits Take Exit 67 2nd of Bryson City exits At the first light make a right same side as Bojangles Restaurant at next light Everett Street turn left Go through town over railroad tracks and immediately turn right onto Depot Street at stop sign turn left then immediate right onto D
86. tifying the NC State Office of the Emergency Medical System OEMS of a placement of an AED in your facility The NC Good Samaritan law states that the AED vendor via AED manufacturer representative shall notify the state department of EMS of the type of AED and placement location That is part of periodic reporting Cardiac Science Corporation reports about two 2 weeks after the end of eachquarter via Cardiac Science Corporation Powerheart sent AED notification to the state of North Carolina Due to this quarterly reporting via Cardiac Science Corporation sent AED notification on XXXX XX 20XX to the state of NC and OEMS contacted Swain County EMS regarding the general nonspecific notification of AEDs at our facility Agency The owner AGENCY via the Primary AED Program Coordinator of the AED s is responsible for notifying your local EMS services of the specific placement of an AED and the location of the AED in your facility Agency Swain High School Swain Middle School Swain East Elementary Swain West Elementary Swain County Pre Kindergarten Bright Adventures via name of person here XXXX XXXX Swain County AED Program Coordinator sent finalized information with Dr XXXX XXXX MD as the Swain County AED Medical Director on this date XXXX XX 20XX to Bryson city the local EMS department of Swain County via EMS Director David Breedlove The following was sent to the local EMS department via EMS Director
87. ue data and forward to Oversight Physician or AED Program Medical Director o Done Hook up the extra pad to the AED make sure you can see the expiration date then contact the program coordinator to replace AED pads Remember the AED MUST have two sets of pads at all times o Done Check expiration date on the pad package o Restock AED ready kit ie Replace pocket mask and other supplies used Done 1 CPR Face mask Barrier device Done____ 2 sets of medical gloves Large and Medium Done 1 absorbent cloth towel ONE time use ONLY Done 1 disposable razor s ONE time use ONLY Done____ 1 Antiseptic Towelette Done____ 2 sets of 4 x 4 gauze pad Done 1 Ink pen note pad Done____ 1 pair of paramedic scissors Does the AED have the following supplies after the incident e Done___ 2 sets of Adult defibrillator pads and 2 sets of Pediatric defibrillator pads with East Elementary West Elementary and Swain County Pre Kindergarten Bright Adventures within the expiration date e Done___ Post Incident report x 2 Post Incident check list x 1 amp AED Policy Procedure Manual x 1 in a yellow folder in the AED case hung behind the AED e Done___ 1 Clipboard with Daily and Monthly AED Check off Post Incident Procedure for the AED done together by l 2 Date School Nurse Program Coordinator 77 APPENDIX K This AGENCY s AED CPR Trained Providers Attached are the actual names of people at this Swain Count
88. wain County Schools Emergency Action Plans EAP making sure the EAP s have been reviewed updated annually printed on bright neon green paper laminated and placed in there proper locations by the ATC this is to be checked on by August 1 annually Date amp completed by whom The AED Program Coordinator is to update the USB pen drive that holds ALL AED information that is kept with the pink binder EVERYTIME ANY changes or updates are made A double check this is has been done is to be checked by August 1 annually Date amp completed by whom ALL updated print any changes and info to be placed in each assigned site s pink binder AED sites are Swain High School Swain Middle School East Elementary West Elementary and Swain County Pre Kindergarten Bright Adventures as well as pink binders that are also with The AED Medical Director Swain County Superintendent Swain County EMS Director AED Program Coordinator and Alternate AED Program Coordinator this is to be done by August 1 annually Date amp completed by whom Inspect ALL colored AED photo locator signs for EACH site and will preprint IN COLOR have laminated any sign s that has been destroyed or faded by the sun and re hang signs as needed by August 1 annually Date amp completed by whom AED1 AED2 AED3 AED4 Inspect ALL yellow 3 D AED signs that hang over each AED and will preprint IN COLOR on yellow paper have laminated any 3 D sign s that has
89. wing products are ONLY for the AED listed AED Powerheart AED G3 Plus Automatic model 9390A 501P XXXXX AED Products Powerheart Customer Care 1 800 991 5465 AED pads Adult defibrillation pads XXXX XXX XX Pediatric defibrillation pads XXXX XXX XX AED Battery XXXX XXXX XXX 4 year full operational guarantee AED ready kit XXXX XXXX XX ONE extra set of Adult defibrillation pads is Kept WITH EACH AED In case of uses of AED even if only one set of pads are used a second set Must be ordered ASAP Pediatric pads are kept with AED s at Swain East Elementary Swain West Elementary and Swain County Pre Kindergarten Bright Adventures Spare AED batteries are NOT kept on hand The Powerheart AED G3 Plus Automatic through its daily self testing will alert you when the battery is low at which point there is 30 days life remaining in the battery in order to get a replacement battery ONE 1 AED Ready Kit is with EACH AED and should always include the following supplies 1 CPR Face mask Barrier device 2 sets of medical gloves Large and Medium 1 absorbent cloth towel ONE time use ONLY 1 disposable razor s ONE time use ONLY 1 Antiseptic Towelette 2 sets of 4 x 4 gauze pad 1 Ink pen note pad 1 pair of paramedic scissors Each AED should always include the following supplies e 2 sets of Adult defibrillator pads and 2 sets of Pediatric defibrillator pads with East Elementary Wes
90. y AGENCY s facility Circle ONE SCHS SCMS East Elementary West Elementary Pre K that has been trained in the use of the Automated External Defibrillator and CPR Adult child and infant according to American Heart Association Heartsaver AHA or American Red Cross ARC standards for CPR AED or something equivalent to AHA ARC See the white tab under this Appendix K in this pink AED binder or contact the Swain County Primary or Alternate Program Coordinator for that information LLLLLLLLDLLLLLLLDLLLDLLLLLLLLLDLLLLLLLDLDLLDLLLLLLDLLLDLLLLLLLDLLDLDLLLLLLLLDLDLDLLLLLLDLLDLLLLII CPR AED Training records that includes documentation of defibrillation skills proficiency will be maintained by the School Nurse kept in the pink AED binder and the School Nurse will send three copies of this Training record to the 1 AED Medical Director 2 Primary and 3 Alternate Program Coordinators 78 APPENDIX L Information found with Primary amp Alternate AED Program Coordinators n Title Name Cell number Work number Home number Email address Primary XXXX XXXX XXX XXX XXXK XXX XXX XXXX XXX XXX XXXX XXXX G swainmail org Program Coordinator Alternate XXXX XXXX XXX XXK XXXK OUC XXX XXXX XXX XXX XXXX XXXX G swainmail org Program Coordinator The AED Primary amp Alternate Program Coordinators also kept on file the following information e To see the actual names of people at
91. y EMS Director 5 Swain County AED pink 1 binder XXXX XXXX Swain County Superintendent 6 Swain County AED pink 1 binder XXXX XXXX High School 7 Swain County AED pink 1 binder XXXX XXXX Middle School 8 Swain County AED pink 1 binder XXXX XXXX East Elementary 9 Swain County AED pink 1 binder XXXX XXXX West Elementary 10 Swain County AED pink 1 binder XXXX XXXX Pre K Bright Adventures 11 Swain County AED pink 1 binder XXXX XXXX Health Services Coordinator 12 Swain County AED pink 1 binder XXXX XXXX Safe Schools Coordinator 79

Swain County School`s Policy and Procedure Manual

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