Automatic External Defibrillators (AEDs) are portable units used to electrically stimulate the heart during cardiac arrest. In the camp environment, cardiac arrest usually involves older staff, older guests attending during parent visitation days, or spring or fall rental groups. Although cardiac arrest can happen without an outside event or prior health problems, there is usually a contributing cause. Cardiac arrest has been reported in campers for a variety of health reasons such as a congenital heart defect, electrical shock, a blow to the chest during a fight or being hit with a baseball, or from respiratory arrest that results in cardiac arrest from drowning. According to research conducted by Project Adventure on challenge course-related deaths, cardiac arrest was the leading cause involving men over the age of thirty. There have been a number of cases where school athletes have suffered cardiac arrest during events such as running. In some of these cases, the immediate availability and use of an AED might have saved a life.
Adult and Pediatric AEDs
AEDs come in various styles and functions, but there are two different types of pads used to deliver the shock: adult and pediatric. A pediatric AED pad delivers a lower energy dose by the use of a modified defibrillation pad and cable component. In July 2003, The American Heart Association came out with a statement that adult AEDs could be used on a child younger than eight years old. Some AEDs have voice rhythm-shock-recorders that record not only the shocks delivered but also the conversation of the rescuers. These recorders could be of great benefit or great hindrance to a lawsuit, depending on how well the rescuers performed.
The FDA requires that before a camp can purchase an AED, you must first get a prescription from a physician. Although state regulations vary, the AED should be used within a defibrillation program that includes these elements:
- Training for all users in CPR and AED operation
- Physician oversight to ensure appropriate maintenance and use of the AED
- Notification of local EMS of type and location of the AED
Many camps no longer face the question of whether or not to purchase AEDs, but how to find the funding and how to best utilize a limited number of AEDs. At approximately $2,700 to $3,000 each, this could quickly add up for a large camp. A number of state and federal programs fund the purchase of AEDs and training on their use. Talk to your regional American Heart Association or American Red Cross to see if they know of a funding source in your region. Be aware that some “one-time-use” AEDs are available on the market in the price range of $800–$1,000. Most of these models are not designed for the rigors (temperature and moisture exposures, being dropped, etc.) of a camp environment. Also talk to your insurance agent to make sure the AEDs are added to your insurance policies in case of theft or vandalism.
Some camp administrators may think they don’t need AEDs because of their camp’s close proximity to a rescue station. That is a very risky proposition. Success with an AED is time critical. The American Heart Association says that when a person suffers a sudden cardiac arrest, their chances of survival decrease by 7 percent to 10 percent for every minute that passes without defibrillation. At most camps, the absolute minimum time between the occurrence of a cardiac arrest and the arrival of an ambulance is at least five to ten minutes.
Training and Potential Regulations
AED training is readily available from the American Red Cross, National Safety Council, and American Heart Association in their adult CPR courses. An informal study of AED use found that untrained sixth graders could effectively use an AED in time tests and that they were only 23 seconds slower than trained EMTs. In 2003, New York began requiring AEDs in schools. In the future, Health Department, OSHA, or other regulatory standards may require AEDs on-site at camps and conference centers. The cardiac emergency itself generally does not create liability. The failure to properly address the emergency in accordance with common practices, regulations, or standards that cause the condition to worsen into injuries such as brain damage, permanent disability, or death, would pose a liability.
The number of AEDs your camp needs depends on the size and operations of the camp. In general, an AED should be available within two to three minutes anywhere on camp grounds, but particularly around athletic areas (e.g., swimming pools, athletic fields, basketball courts), challenge course, and public gathering areas such as the dining hall. In certain areas, such as athletic fields, AEDs cannot be stored on a permanent basis. Camps many need to establish guidelines as to how the AED should be carried or transported. Installing the AED onto a golf cart in a waterproof case with other “fast response” medical equipment would be a good idea for many camps.
Maintenance and Storage
Most AEDs have a battery life of around four to five years, but the camp should assign someone to verify in writing monthly that the unit is functioning (follow the manufacturer’s guidelines). Many camps have had success with installing the AEDs in a security box that has an alarm that sounds when the door is opened. Some of these security boxes can be linked to dial 911 automatically and play a pre-recorded message if the door is opened.
Another consideration in placing AEDs is the reasonable expectation of having to perform rescue breathing. There are a number of safety concerns related to the proper storage and use of portable oxygen units. A reputable vendor will help address these. A portable oxygen tank (prescription from an MD required in most states) and a bag-valve mask would provide 100 percent oxygen as opposed to the 16 percent delivered by rescue breathing through a pocket mask or face shield. A bag valve mask by itself (without the oxygen tank will deliver 21 percent oxygen. Increasing the oxygen delivery in rescue breathing can reduce brain and cardiac damage, so it is important to provide both the electrical stimulus from the AED in conjunction with oxygen. Proper use of a bag valve mask and portable oxygen requires practice. This would be a good precamp and in-service skill to practice with the staff , including interaction with EMS, in the use of the equipment. Most lifeguarding courses specifically address the use of this equipment, so consider making your lifeguarding team an integral part of your planning and implementation. You should also add non-latex gloves and a blood-borne pathogen kit. Protect your staff and satisfy OSHA requirements at the same time by putting this additional equipment with the AED.
Finally, you should obtain advice from legal counsel and research your state and local regulations that might affect your program, including training requirements, medical control, notification of AED use, or location and immunity provisions.
Originally published in the 2004 Fall issue of The CampLine.