It is the objective of this document to establish a method through which PAD sites can be assessed to ensure a community standard for public safety. All of our programs will follow these guidelines so we can model to both the public and private sectors of our communities the best practice for a PAD site. This template has been endorsed by the Program Medical Director, Rudy Vandersluis, M.D., CCFP(EM), FRCPC.

PAD Site Recommendations

1. All Automated External Defibrillators (AEDs) must be registered with the local Emergency Medical Service (EMS) systems and the Central Ambulance Communications Centre. The Cardiac Safe Community Program for Durham Region will share this information with those agencies.
   
2. All AED / PAD programs are expected to be managed under the direction and oversight of a physician and coordinator to ensure a comprehensive education and CQI process is in place and followed.
   
3. The PAD Coordinator will be an individual with five years of clinical experience in the management of Sudden Cardiac Arrest (SCA) at a professional responder level (i.e. Advanced Care Paramedic). Further this individual will be an experienced CPR and AED instructor with the Heart and Stroke Foundation of Ontario (HSFO) or equivalent. The equivalency will be assessed by the program physician.
   
4. A site survey and a report must be done by the physician (or delegate) for each and every PAD site. The site survey should be written to outline:
      - The best placement of the AED in the facility
      - To ensure time to defibrillation from witnessed SCA does not exceed 5 minutes
      - Signs will be placed throughout the PAD site directing citizens to the closest AED
      - Instructions will be with the AED outlining its intended use and ease of operation
      - The AED must never be locked up even if there is not a trained Targeted Responder on site
      - All staff will have AED awareness education
      - Targeted Responders on site will have CPR/AED education as outlined by the HSFO
      - An Emergency Medical Action Plan specific to the site will be established and understood by all designated staff on site
      - The site will designate a lead PAD person for coordination at the site.
   
5. AED Guidelines:
      - Must be Health Canada approved
      - Have two sets of defibrillator pads
      - Have two batteries (one in the AED and one spare)
      - Barrier device (pocket mask), scissors, towel, gloves
      - Placed in an easily accessible, alarmed (visible and audible) wall mounted response case. A person or a monitoring alarm company must monitor the response case during all hours of operation. This will ensure no delay in a 911 emergency.
      - The AED must be checked once a week to ensure that it is in a state of readiness. Once a month the AED response case and its alarms (including monitoring system) must be checked and the barrier device, spare defibrillator pads, batteries, towel, and gloves must also be checked.
      - After each use, the AED must receive a biomedical engineering check within 24 hours of its use. This must be done by a certified agency capable of performing this task. If the AED has not been used within 12 months, it is recommended that the AED receive a biomedical check to ensure its state of operation.
   
6. Event data recorded in the AED must be available for down load and delivery to the hospital the SCA victim has been sent to. The manufacturers of the chosen device must be informed that they need to enable this information download by the site staff.
   
7. Event reviews will be conducted by the program physician (or delegate) after each AED use. The purpose of these reviews will be to identify:
      - Time of collapse to time of AED application
      - Time of 911 call until arrival of first professional emergency service
      - Site specific emergency medical action plan employed
   
   A report of the event detailing the positive or any opportunities for improvement will be completed after each AED use. This will be shared with the Targeted Responders and used to enhance and improve future responses for SCA.
   
8. Critical Incident Stress (CIS) Debriefing should be carried out with the Targeted Responders and other staff present 4 – 7 days after the SCA and AED use. Staff from the Cardiac Safe Community Program with knowledge and experience in conducting CIS debriefings will be available to lead the debriefing.
   
9. It is recommended that education for Targeted Responders be Heart Saver A – CPR and AED in accordance with the HSFO guidelines. Other training programs will need to be evaluated by the program physician to ascertain if the prior learning meets the HSFO certification process.
   
10. Continuing Targeted Responder education must be done once a year. This would include re-certification in Heart Saver A – CPR and AED use. It is recommended that a Targeted Responder have the opportunity to review their PAD site AED response every 90 days. The type of review we recommend is not formal education but rather an opportunity for Targeted Responders to re familiarize themselves with their Emergency Medical Action Plan and AED. This type of information review can be completed by:
       - Quarterly Newsletter that shares information about PAD
       - Computer program that reviews their AED
       - Video that reviews their AED etc.
    
11. Once a year, including the initial year, the PAD site must be audited to ensure that all 10 previous points are being achieved. This will be conducted by the program staff and a report will be generated and provided to the site’s lead PAD contact to outline points that are being achieved and ones that need to be improved upon. All 10 points must be met in order for the site to be deemed “Cardiac Safe”.

It is the intent of the Cardiac Safe Community Program that the above points are minimum standards to ensure adequate risk management, CQI initiatives and education development for a comprehensive Targeted Responder / Public Access Defibrillation Program. Programs that follow these standards will be designated as Cardiac Safe Community Program Sites.