Standard Operating Procedure

SOP ID C14

Version 1.0

Title Power Heart G3 Automated External Defibrillator

Approved by Clinical Effectiveness Group

Date Issued 1st February 2013

Review Date 31st January 2015

Directorate Clinical

Clinical
Publication Mandatory - No deviation from document permissible
Category

1. Scope
1.1 This Standard Operating Procedure (SOP) outlines the correct procedure for the use of
the Power Heart G3 automated external defibrillator (AED). This SOP must be read in
conjunction with Clinical Guideline (CG03) - Airway Management and Clinical Guideline
(CG07) - Cardiac Arrest.

2. Responsibility

2.1 It is the responsibility of all Ambulance Care Assistants (ACAs) to adhere to this SOP.

3. Introduction
3.1 The Power Heart G3 AED is provided on Patient Transport Service (PTS) vehicles within
East and West Division. The provision of defibrillators within North Division is currently
under review.

3.2 The AED is intended to be used by ACAs who have been trained in its operation in
addition to basic life support for the treatment of patients experiencing a cardiac arrest.
Resuscitation must be delivered according to Clinical Guideline (CG07) - Cardiac Arrest.

3.3 If the patient experiences a return of spontaneous breathing post-resuscitation, the AED
should be left attached to allow for acquisition and detection of the ECG rhythm.
3.4 PTS vehicles within East and West division must carry the following equipment:

• AED - Cardiac Science Powerheart G3

• Electrodes - 1x set plugged in case, 1x spare set
• 1x Razor, 1x cloth, 1x pocket mask to be stored in the carry case
• Response bag - Equipped to the PTS vehicle specification
• Oxygen cylinder

3.5 When not in use the AED must be stored securely in a suitable cupboard.

4. Daily Unit Check

4.1 A daily check of the device must be undertaken at the commencement of each shift, or at the
earliest possible opportunity. The ACA must sign the Vehicle Log Book to evidence the
check.

4.2 The AED (including case, display and accessories) must be kept clean using detergent
wipes; do not use Chlor-clean solution, bleach, abrasive or flammable cleaning agents.

4.3 On the commencement of each shift, the unit should be checked for any external damage
(e.g. cracks). The G3 has a readiness indicator within the handle, which is green when the
unit is ready for use; this is called the ‘Rescue Ready’ light. A green Rescue Ready light
verifies the AED has an adequate charge in the battery, the electrodes connected are
functional and the integrity of the internal circuitry is good. The unit performs an automatic
self-test at 03:00 every day; if a fault is detected the Rescue Ready light will turn red with a
black cross. The unit will bleep every 30 seconds until the fault is rectified.

4.4 If a fault is detected the unit lid must be opened, which will enable it to complete a further
more detailed self-test. If a low battery is detected the unit will announce ‘check battery’. A
replacement battery should be fitted as soon as practically possible. If an electrode issue is
identified the unit will announce ‘check pads’. An inspection of the electrodes should take
place to check that they are connected correctly and in-date. If an internal circuitry fault is
identified, the unit will advise ‘service required’; remove the unit from service immediately.

5. Device Features
5.1 Operating Mode - Defined as having the battery installed and the lid open. This is the
mode the AED would be in during an actual rescue situation.

5.2 Standby Mode - When the battery is installed, but the lid is closed. In this mode the AED
is not being used in a rescue. The device will conduct its routine self-tests to ensure
proper operation.
5.3 The device has a diagnostic panel:

• Smartgauge Battery Indicator (A) - See Section 7.

• Pads Indicator (B) illuminates when the pads are either not properly connected to
the AED, not within operational specifications (cold, dried, damaged) or
disconnected from the patient during a resuscitation.
• Service Indicator (C) illuminates when the AED requires maintenance that can only
be performed by qualified service personnel.
• Shock Button (D)
6. Defibrillator Pads
6.1 The defibrillation pads come in a ready-to-use sealed package, containing one pair of
self-adhesive pads with an attached cable and connector. The pads are disposable and
should be discarded after each rescue. The pads have a limited shelf life and should not
be used beyond their expiry date. Keep a fresh, unopened pair of pads plugged into the
AED at all times. An audible and visual alert will indicate after the self-test if the pads are
missing, unplugged or damaged.

6.2 Pad insertion:

1. Open the lid of the AED.

2. Place the pad package into the lid so that the expiry label is visible through the
clear window on the lid.
3. Match the colour of the connectors (red to red), then plug the pad connector into
the AED case.
4. Once the pad connector is plugged into the AED, the PAD indicator should
extinguish.
5. Tuck the excess cable length in the bottom and close the lid.
6. Check to make sure that the status indicator is green.

7. Operation
7.1 Commence resuscitation according to Clinical Guideline (CG07) - Cardiac Arrest. One
ACA must immediately contact the Clinical Hub via the Airwaves radio as a priority message,
or via mobile telephone stating that the patient is in ‘cardiac arrest’ and request back-up.

7.2 Remove clothing from the patient’s chest. Ensure the skin site is clean and dry; dry the
patient’s chest and shave excessive hair if necessary.

7.3 Open the AED lid and wait until the LEDs are lit.

7.4 The AED will issue the prompt “Tear Open Package and Remove Pads.” Keep the pads
connected to the AED, tear the pad package along the dotted line and remove the pads
from the package. Leave the package attached to the pad wires. After the prompt “Peel
one pad from plastic liner,” with a firm, steady pull, carefully peel one pad away from the
plastic liner. Then, after the prompt “Place one pad on bare upper chest,” place the pad
with the sticky side of on the patient’s skin on the upper right chest, placing the top of the
pad on the collarbone. Avoid placing the pad directly over the sternum. Finally, after the
prompt “Peel second pad and place on bare lower chest” as shown above, pull the
second pad from the plastic liner and place it on the lower left chest, below and left of the
breast (Figure 1).
7.5 Figure 1 - Pad Placement:

7.6 Once the pads are connected, the device will advise ‘Do not touch patient - analysing
rhythm’. Ensure that no one is touching the patient, and any oxygen is disconnected.

7.7 If the device states ‘shock advised’ it continues to monitor the patient’s ECG rhythm and
then repeats ‘charging’ whilst the unit charges up. Once the unit advises ‘stand clear –
push button to shock’ and the red indicator flashes, press the shock button. The unit will
then advise ‘shock delivered’; immediately continue CPR.

7.8 If the patient’s rhythm is non-shockable the unit will state ‘no shock advised’. If the rhythm
changes to non-shockable immediately after the unit starts to charge it will detect this,
advise ‘rhythm changed, shock cancelled’ and dump the charge.

7.9 Defibrillation presents a serious electrical shock hazard; the following safe practice must
be applied:

• Do not touch the patient unless performance of CPR is indicated.

• Do not touch metal objects in contact with the patient during defibrillation.
• Keep defibrillation pads clear of other pads or metal parts in contact with the
patient.
• Disconnect all non-defibrillator proof equipment from patient before defibrillation.

7.10 Defibrillation also presents a potential fire and explosion hazard. Remove oxygen before
defibrillation and exercise caution when operating AED close to other flammable gases.

8. Batteries
8.1 The Cardiac Science AED batteries have a shelf life of five years. Shelf life is defined as
the length of time a battery can be stored, prior to installation into AED, without degrading
its performance.

8.2 The lithium battery has a typical shock delivery capability of up to 290 shocks.
8.3 To fit a new battery place it with the label on the battery facing the AED battery
compartment and insert the battery as shown in the drawing:

8.4 Push the latched end of the battery firmly into the AED, until the battery snaps into place.
The exposed side of the battery should be flush with the outside of the AED case.

8.5 The Smartgauge Battery Status Indicator has five LEDs; four green and one red.
The right four green LEDs display the remaining capacity of the battery much like a fuel
gauge. With use, the green LEDs gradually go out, from right to left, as battery capacity
decreases. When the green LEDs go out and the red LED lights up, replace the battery.

8.6 When the red LED initially lights up upon lid opening or at any time during use a ‘Battery
Low’ prompt will be issued. However, the AED is capable of delivering at least 9 more
defibrillation shocks after the first “Battery Low” prompt is issued. When the AED battery
cannot deliver any more shocks, the AED display will show ‘BATTERY LOW’, the status
indicator will be red, and the device will beep every 30 seconds.

8.7 In order to maintain operational use of the AED, battery replacement must be organised
as soon as the single green light is illuminated.

9. Documentation
9.1 If the AED is used, a standard Patient Clinical Record (PCR) must be completed and
emergency back-up requested at the earliest opportunity.

9.2 Additionally an adverse incident report (DATIX) must be completed, providing the time,
date, location and patient details.