● Ensure that occupational health staff and employees are trained and familiar with the AED. ● Establish emergency response procedures based on the current American Heart Association guidelines for determining unresponsiveness, opening the airway, assessing the individual, and beginning rescue breathing or CPR as required. (See Guideline 90, Cardiopulmonary Arrest, page 183, for information on CPR and use of AEDs.) ● Develop procedures and coordinate appropriate training protocols for AED use and maintenance. ● Examine the AED daily for signs of damage and general wear. ● Check the “ready-for-use” indicator on the AED daily. ● Perform other maintenance as required by the manufacturer. ● Ensure that adequate supplies are available, including 2 sets of spare defibrillator electrode pads, 2 pocket masks, an extra battery, 2 prep razors, alcohol wipes, gauze pads, and an absorbent cloth towel. An AED should only be used as part of the management for full cardiac arrest and only when all movement and other signs of life are absent. The devices are effective and easily and safely used however, there are situations that must be corrected before using the device, such as moving the person to a safe location if lying in or near water (to prevent burns) or on metal sur- faces (to prevent possible shock to rescuer or bystanders). Also, because the defibrillator pads are placed on bare skin, care should be taken not to place the pads on transdermal patches (also can cause a burn) or over a pacemaker or internal defibrillator. Because skin contact is necessary, the area may need to be quickly shaved to ensure good contact. In addition, accord- ing to the American College of Occupational and Environmental Medicine (ACOEM), occa- sional equipment-related errors have been reported, including failure to deliver shocks in cases of extremely fine or coarse ventricular fibrillation, incomplete cycles of analysis, failure to fol- low the manufacturer’s instructions, and conflicts with an implanted defibrillator. Also, cell phones in the vicinity should be turned off to obtain accurate reading. AEDs are considered medical devices, and its use may be restricted by state regulation, possibly requiring authorization of a physician, completion of training courses, and/or training in CPR. Because of liability concerns, many states have passed laws enabling public protection under the Good Samaritan laws that exist in almost every state however, licensed health care providers may not be granted Good Samaritan immunity but must refer to their professional licensure. See the flowchart on page 235 for the sequence of use and Guideline 90, Cardiopulmonary Arrest, page 183 for use of AEDs during cardiopulmonary arrest. The occupational health nurse practices within the boundaries of the state nurse practice act. Because AEDs are considered medical devices, the nurse should consult the state board of nurs- ing and the company or a local physician for approval and/or standing orders when necessary. The nurse should also consult with the local emergency response agency regarding AED avail- ability and the company’s emergency response protocols. A case review should be conducted following use of the AED. The reviewers should include the physician, management, involved employees, and any other identified party. The occupational health nurse should evaluate the feasibility of coordinating an AED program for the company and provide information to management regarding AEDs, their purpose, mainte- nance requirements, and required training. The occupational health nurse is in a key position to coordinate the program and ensure that effective protocols are established and conducted. A written program should be established and reviewed with the physician and local emergency response services. Protocols for prompt response to medical emergencies, including cardiac arrest, should be developed by the occupational health nurse in collaboration with the physi- cian. Nursing Roles The occupational health nurse must remain current on relevant state legislation and should review the program at least annually, modifying it, as needed, to ensure effectiveness. 234 Interdisciplinary Interactions and Collaboration