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11-104
Resolution No. 11-104 RESOLUTION APPROVING THE CITY OF ELGIN AUTOMATED EXTERNAL DEFIBRILLATOR(AED) GRANT PROGRAM BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN, ILLINOIS, that it hereby approves the City of Elgin Automated External Defibrillator(AED) Grant Program as outlined in the attached grant program documentation. s/David J. Kaptain David J. Kaptain, Mayor Presented: June 22, 2011 Adopted: June 22, 2011 Omnibus Vote: Yeas: 6 Nays: 0 Attest: s/Jennifer Quinton Jennifer Quinton, Acting City Clerk City of Elgin Automated External Defibrillator(AED)Grant Program The City of Elgin Automated External Defibrillator(AED)grant program will provide an approved organization with an AED. Deadline for submission of applications for the grant is July 15.All applications must be made on City approved forms.Online,emailed or hardcopy grant applications will be accepted.Grants will be limited to one unit per recipient. The grant program will be administered by the City of Elgin Fire Department. Eligibility The following entities are eligible for the grant: Fraternal,benevolent,service or faith-based not-for-profit organizations located within the City of Elgin. Program Specifications: • Awarded AED manufacturer and model will be chosen by the City of Elgin. • Only one unit per entity will be awarded per year. • Applications must be made on City approved forms and completed fully. • Deadline for submission of applications is July 15. • Notification of award will be mailed(via post or email)to each successful applicant. • Each successful applicant shall be required to enter into a grant agreement in a form approved by the City's Corporation Counsel. Post Award Requirements: Any entity awarded an automated external defibrillator under this program shall: 1. Comply in all respects with the Automated External Defibrillator Act (410 ILCS 4/1, et seq.), as amended, including, but not limited to, the maintenance, training and oversight requirements provided for therein as follows: • The automated external defibrillator is maintained and tested according to the manufacturer's guidelines; • At least four (4) persons and other person(s) considered to be an anticipated rescuers or users will have successfully completed a course of instruction in accordance with the standards of a nationally recognized organization, such as the American Red Cross or the American Heart Association to use an automated external defibrillator and to perform cardiovascular resuscitation (CPR). Classes are offered by the City of Elgin (http://www.cityofelgin.org/index.aspx?NID=604); • Any person who renders out-of-hospital emergency care or treatment to a person in cardiac arrest by using an automated external defibrillator activates the EMS system as soon as possible and reports any clinical use of the automated external defibrillator;and City of Elgin—AED Grant Program Specifications-1 • A person or organization in possession of an automated external defibrillator shall notify an agent of the local emergency communications or vehicle dispatch center of the existence, location,and type of the automated external defibrillator. 2. Adopt an AED protocol for sudden cardiac arrest emergencies;* 3. Adopt an AED policy for the maintenance, coordination, training and communication of AED procedures;* 4. Return completed and adopted AED protocol and policy to city grant administrator within 120 days of award notifications; 5. Provide volunteer services for a total of 50 hours. Volunteer activities are defined as any unpaid activities completed for a City event or task. Completed hours must be submitted to the program administrator within one year of awards. *Sample AED protocol and policy templates prepared by the manufacturer Philips are available for review. Such sample protocol and policy are provided as a guide in the development of an organization's specific protocol and policy. Such organization's specific protocol and policy should be reviewed and approved by the organization's legal representative to ensure that it meets all applicable legal requirements, as well as the specific needs of the organization. The protocol and policy should be reviewed as needed,at least annually, and revised as necessary." Any questions about this grant program should be directed to Grant Admin,Phone Number City of Elgin—AED Grant Program Specifications-2 fil ► REPORT TO MAYOR &MEMBERS OF CITY COUNCIL E LG I N THE CITY IN THE SUBURBS AGENDA ITEM: D MEETING DATE: June 8, 2011 ITEM: Creation of Automatic External Defibrillator Grant Program ($10,500) OBJECTIVE: To reduce the percentage of sudden cardiac arrests resulting in death in Elgin. RECOMMENDATION: To approve the creation of an automatic external defibrillator grant program for local organiza- tions. BACKGROUND The American Heart Association (AHA) estimates that 250,000 people in the United States die each year from sudden cardiac arrest (SCA) outside the hospital setting. Victims of SCA can sur- vive if bystanders act quickly. The AHA recommends a four step protocol for treating victims of SCA. These steps include dial- ing 9-1-1, performing CPR, using an automatic external defibrillator (AED) to deliver a shock to the heart and setting up advanced life support. With an AED, bystanders can perform three of the four steps. Performing these actions is critical to improving the chances of SCA survival. Using an AED has been proven to increase SCA survival rates. The AHA has found that victims of SCA treated with bystander CPR only had a survival rate of 14%. Victims treated with CPR and a shock delivered by an AED had a 24%survival rate. To give Elgin citizens greater access to AED's and increase the likelihood of SCA survival, the city proposes to create an AED grant program. Under this program, local organizations can receive an AED in exchange for 50 hours of volunteer service. Similar community efforts by San Diego, CA, King County, WA and Sandy Springs, GA have focused on placing AED's in public places and offering training.The city already offers AED/CPR training and has placed AED's in several public areas.This grant program allows for an even greater distribution of AED's. r • OPERATIONAL ANALYSIS The structure of this grant program allows local service organizations, non-profits and faith- based organizations to receive an AED. Eligible applicants will receive the same model AED used by the Elgin Fire Department. This allows for greater familiarity of these units around the com- munity. In return, each grantee is required to complete certain tasks: (1) grantees are required to main- tain and test their AED; (2) at least four members of their organization must complete CPR/AED training; (3) grantees must adopt an AED policy and protocol (a sample AED policy and protocol are included with the grant award); and (4) each organization must provide at least 50 hours of volunteer service at a city event within one year of award. In addition to Elgin's training oppor- tunities, the Owls Athletic Club has committed to donate four training classes (up to fifteen at- tendees per class) at no cost. INTERESTED PERSONS CONTACTED The following organizations have formally indicated interest in this program: American Legion Elgin Post#57 Owls Athletic Club Watch City VFW Post#1307 Elgin Elks Lodge#737 Elgin Riverside Club Elgin Moose Lodge#799 Elgin Turners Additionally, Dr. Neil Edelson of Sherman Hospital has reviewed and endorses this program. FINANCIAL ANALYSIS For 2011, the city will procure seven AED's for the proposed grant program. A purchase quanti- ty of seven enables the city to obtain favorable pricing. The cost of one unit will approximate $1,500 and total $10,500 for all seven units. This price includes a wall cabinet, carrying case, electrode pads, battery pack, wall sign and child/infant key among other add-ons. This is a competitive price as the retail price for these items is well over$2,000 per unit. BUDGET IMPACT FUND(S) ACCOUNT(S) PROJECT#(S) AMOUNT AMOUNT BUDGETED AVAILABLE General Fund 010-6902-719.89-02 N/A $140,000 $140,000 LEGAL IMPACT None. A) Jan 2 41111111111111111111 re.... ALTERNATIVES Council can choose not to approve this program or adjust this program to include a cost sharing option. For instance, the grantee could pay 20%of the cost. However, this could limit participa- tion, as some organizations may not be able to pay 20% of the cost. As proposed, this program benefits the city directly by obtaining volunteer hours from each organization. NEXT STEPS 1. Purchase AED's. 2. Distribute AED's to applicants. Originators: Aaron Cosentino, Management Analyst Final Review: Colleen Lavery, Chief Financial Officer William A. Cogley, Corporation Counsel/Chief Development Officer Richard G. Kozal, Assistant City Manager/Chief Operating Officer rApproved: ,iii,a Y, / ' Sea R. Stegall, City Mana:frJ ATTACHMENTS A: Proposed Grant Program Informational Materials B: AED Grant Agreement C: American Heart Association Study entitled "Lay Rescuer Automated External Defibrilla- tor ("Public Access Defibrillation") Programs r 3 City of Elgin Automated External Defibrillator(AED)Grant Program 414) The City of Elgin Automated External Defibrillator(AED)grant program will provide an approved organization with an AED. Deadline for submission of applications for the grant is June 15.All applications must be made on City approved forms.Online,emailed or hardcopy grant applications will be accepted.Grants will be limited to one unit per recipient. The grant program will be administered by the City of Elgin Fire Department. Eligibility The following entities are eligible for the grant: Fraternal,benevolent,service or faith-based not-for-profit organizations located within the City of Elgin. Program Specifications: • Awarded AED manufacturer and model will be chosen by the City of Elgin. • Only one unit per entity will be awarded per year. • Applications must be made on City approved forms and completed fully. • Deadline for submission of applications is June 15. • Notification of award will be mailed(via post or email)to each successful applicant. 4111) • Each successful applicant shall be required to enter into a grant agreement in a form approved by the City's Corporation Counsel. Post Award Requirements: Any entity awarded an automated external defibrillator under this program shall: 1. Comply in all respects with the Automated External Defibrillator Act (410 ILCS 4/1, et seq.), as amended, including, but not limited to, the maintenance, training and oversight requirements provided for therein as follows: • The automated external defibrillator is maintained and tested according to the manufacturer's guidelines; • At least four (4) persons and other person(s) considered to be an anticipated rescuers or users will have successfully completed a course of instruction in accordance with the standards of a nationally recognized organization, such as the American Red Cross or the American Heart Association to use an automated external defibrillator and to perform cardiovascular resuscitation (CPR). Classes are offered by the City of Elgin (http://www.cityofelgin.org/index.aspx?NID=604); • Any person who renders out-of-hospital emergency care or treatment to a person in cardiac arrest by using an automated external defibrillator activates the EMS system as soon as possible and reports any clinical use of the automated external defibrillator; and City of Elgin—AED Grant Program Specifications-1 • A person or organization in possession of an automated external defibrillator shall notify an agent of the local emergency communications or vehicle dispatch center of the existence, location,and type of the automated external defibrillator. 2. Adopt an AED protocol for sudden cardiac arrest emergencies;* 3. Adopt an AED policy for the maintenance, coordination, training and communication of AED procedures;* 4. Return completed and adopted AED protocol and policy to city grant administrator within 120 days of award notifications; 5. Provide volunteer services for a total of 50 hours. Volunteer activities are defined as any unpaid activities completed for a City event or task. Completed hours must be submitted to the program administrator within one year of awards. *Sample AED protocol and policy templates prepared by the manufacturer Philips are available for review. Such sample protocol and policy are provided as a guide in the development of an organization's specific protocol and policy. Such organization's specific protocol and policy should be reviewed and approved by the organization's legal representative to ensure that it meets all applicable legal requirements, as well as the specific needs of the organization. The protocol and policy should be reviewed as needed,at least annually, and revised as necessary." Any questions about this grant program should be directed to Grant Admin,Phone Number r City of Elgin—AED Grant Program Specifications-2 City of Elgin AED Grant Program Application Available for Public&Private Entities,Organizations&Individuals Entity Name Grant Application Contact Name:(administrator,staff,etc.) Contact Phone Number:(include area code) Street Address: FAX Number:(include area code) City: State: ZIP Code: Contact E-Mail Address: Second Contact Name/Phone Number: Safety/Risk Manager Name: Estimate of total number of people your organization serves daily... How many: Phone Number: Email Address: Buildings/Offices: Total Staff Number/Approx: Employees: What year was your organization established? 1.Does your agency/institution currently own an Automated 2. Does your agency/institution currently have an Emergency External Defibrillator? ❑Yes ❑ No Medical System activation protocol for Sudden Cardiac Arrest (SCA)emergencies occurring at your locations? Number of AEDs currently placed by agency/institution: ❑Yes ❑ No 3.Will your agency/institution implement an EMS activation protocol for SCA that includes the use of AEDs? (If you 4. Does your agency currently offer CPR training? answered yes to question#3,will you add AEDs to the ❑Yes ❑No protocol?) S.Would your agency be interested in CPR&AED training that ❑Yes ❑ No could be performed at your facility? Yes ❑No Agency/Institution Contact Signature Date A) ATTACH ANY ADDITIONAL INFORMATION YOU WOULD LIKE US TO CONSIDER ON A SECOND PAGE r PHILIP Sample* Early Defibrillation Program Policy for Schools This document describes the policies of[School Organization] relating to its early defibrillation program. The document is intended to provide guidance to administrators and responders of the early defibrillation program in order to ensure a rapid response to victims of sudden cardiac arrest (SCA) in [School Organization]. Reference Documents • [School Organization] emergency response policy • State and local early defibrillation program regulations • State Good Samaritan law • Early defibrillation program response protocol • Heart Start Defibrillator User's Guide Early Defibrillator Program Coordinator The Coordinator for[School Organization]'s early defibrillation program is The Early Defibrillation Program Coordinator's responsibilities are to: • communicate with the Medical Director, Emergency Response Team members, management/administrative personnel, EMS and the public regarding the early defibrillation program. • communicate with local EMS on early defibrillation program issues and patient care. • participate in case reviews, responder training and retraining, data collection, and other quality assurance activities. • ensure that the defibrillators and related response equipment are maintained. • purchase necessary supplies and accessories. • develop and maintain the emergency response plan and related company policies and procedures. • maintain a list of trained defibrillator responders. • ensure compliance with state and local regulations regarding defibrillator use. Medical Director The Medical Director for [School Organization]'s early defibrillation program is It is the responsibility of the Medical Director to: • provide the authorization for the purchase and use of the defibrillator. • provide medical consultation and expertise. • develop and/or approve protocols for the use of the defibrillator and other medical equipment. • act as a liaison between the early defibrillation program site and the local EMS organization. • approve the defibrillator training program and ensure that rescuers are properly trained. • review all incidents involving use of the defibrillator. • This sample defibrillation policy is provided as a guide in the development of your organization's specific policy. Your defibrillation policy should be reviewed and approved by your program's Medical Director and legal representative to ensure that it meets state and local requirements,as well as the specific needs of your district or school. The policy should be reviewed as needed,at least annually, and revised as necessary. 452298189881 1 of 5 • provide post-incident debriefing support. • assure that program quality is maintained. 41) Administration [School Organization]'s administrative staff shall ensure that policies and protocols for the early defibrillation program are in place at each facility. Each school office shall assure that specific emergency response procedures are in place and that all staff, students, and visitors understand how to call for help during an emergency. Additionally, during a "school hours" emergency, it shall be the responsibility of the office staff to: • ensure that someone is available at all times to receive calls for help from within the facility. • assure that EMS has been notified. • contact Emergency Response Team members to respond to the emergency location with a defibrillator. • be sure that someone is positioned to meet EMS responders and lead them to the emergency location. Each school/facility administrator shall also ensure that a plan is in place for emergencies occurring after school hours and when students and staff visit other schools in the community. Site Coordinator The Site Coordinator for [Facility Name] is . The responsibilities of the Site Coordinator are to: • oversee the early defibrillation program for the school. • communicate with the Program Coordinator, Medical Director and EMS as necessary. • identify Emergency Response Team members. • assure responder initial training and retraining as necessary. • maintain the defibrillator(s) and related response equipment. • provide documentation of and follow-up for any device use. Emergency Response Team Members Staff and students who have completed a course in CPR and defibrillation and have been approved by the Defibrillation Program Coordinator or Site Coordinator as members of the Emergency Response Team may utilize the defibrillator to respond to a victim of SCA. Emergency Response Team members' responsibilities are to: • maintain basic life support skills, including the use of a defibrillator by completing training as required and approved by [School Organization]. • understand the policy and protocol for responding to medical emergencies including SCA. • follow the procedures outlined in the early defibrillation protocol when responding to SCA victims. In addition, any person may voluntarily provide emergency care, including CPR, defibrillation, and first aid in [School Organization]facilities, provided they possess a current CPR, CPR/AED or First Aid course completion card from a recognized national training organization. Volunteer responders may only provide the care appropriate to their level of training and should turn care over upon the arrival of Emergency Response Team members unless their level of training exceeds basic life support. 2 of 5 r, Training Requirements Staff and student emergency response team members must complete a state-approved initial training course that includes CPR, defibrillation, and basic first aid. The course shall be provided for Emergency Response Team members by [School Organization]. The training shall include the use of barrier devices (universal precautions) used at [School Organization]facilities. If students younger than eight (8) years of age attend the school, the Emergency Response Team training shall also include BLS skills for children. Training records for Emergency Response Team members shall be maintained by the Site Coordinator. At least every two years - or more frequently if required by state regulation or the Medical Director - staff and student responders shall complete a CPR, defibrillation, and basic first aid retraining course to maintain knowledge and skills. In addition, Emergency Response Team responders may be required to complete more frequent training such as response drills, computer-based training, or reading/video assignments. Equipment [School Organization] has selected the Heart Start [Onsite/FR2+) defibrillator for its early defibrillation program. The defibrillator should be deployed to any medical emergency in the facility along with other emergency care equipment. When equipped with infant/child defibrillation pads in the case, the Heart Start defibrillator is ready for use on sudden cardiac arrest victims of any age. If Infant/child pads are not present, the device may be used for victims 8 years of age or older using standard adult pads. The device should be used on any victim who is: • Unresponsive • Not breathing normally Defibrillators are placed in the following locations at[Facility Name]: 1. 2. 3. 4. 5. Each of these locations is an alarmed cabinet and is marked overhead with a sign. In addition to the above stationary locations, a defibrillator(s) is/are maintained by the [athletic/physical education department/school nursing staff] for use at events away from [School Organization]facilities. Each defibrillator kit contains: El the Philips Heart Start Defibrillator, with battery installed, and case El two sets of adult defibrillator pads 2 one set of infant/child defibrillator pads El a spare battery El a data card (if using the Heart Start ForeRunner/FR2/FR2+ Defibrillator) El a pocket mask or other rescue breathing barrier device El disposable gloves El a razor El a pair of scissors El a small disposable towel El other equipment 3 of 5 Maintenance The Heart Start defibrillator requires little maintenance. The defibrillator performs daily tests to assure 41) the device is ready for use, and is equipped with a status indicator that shows if the device is ready for use. All defibrillators shall be maintained in accordance with the Heart Start Defibrillator Instructions for Use. The Site Coordinator or his/her designee shall inspect each defibrillator according to the recommendations in the defibrillator Instructions for Use, in order to assure that the device is ready for use and that all supplies are present and have not reached the use-before or install-before dates on the packaging. Any problem with the defibrillator or related emergency equipment shall be reported to the Site Coordinator immediately. If a defibrillator must be removed from service, the Site Coordinator shall notify the [School Organization] office, Emergency Response Team Members, and the Defibrillation Program Coordinator. Notification of the same group shall occur when the device is returned to service Post-Event Activities After any response to SCA with a defibrillator: • The Site Coordinator, Defibrillation Program Coordinator, and Medical Director shall be notified within 24 hours of the event. • If a Heart Start ForeRunner/FR2/FR2+ was used, remove the data card after transferring care of patient to EMS. Apply a patient ID label to the used data card and give it and the Defibrillation Incident Report to the Early Defibrillation Site Coordinator within 24 hours post-event for evaluation. • If a Heart Start OnSite was used, take the defibrillator and the Defibrillation Incident Report to the Early Defibrillation Site Coordinator within 24 hours post-event. The Coordinator will download data from the defibrillator to a PC running Heart Start Event Review data management software, then use Event Review to erase the defibrillator memory in order to ensure adequate capacity for recording data when next used. • Check the defibrillator and replace any used supplies as soon as possible following the event so that the defibrillator may be returned to service. Perform the after-patient-use maintenance on the defibrillator. • The Early Defibrillation Program Coordinator or Site Coordinator shall conduct employee incident debriefing, as needed. • The Early Defibrillation Site Coordinator shall complete the Incident Follow-Up Report and forward it to Medical Director. Defibrillator Maintenance after Each Patient Use Each time the defibrillator is used on a patient: • Inspect the exterior, pads connector port or pads cartridge well for dirt or contamination. • Check supplies, accessories, and spares for expiration dates and damage. • Check the operation of the Heart Start Defibrillator by removing and reinstalling the battery to run a battery insertion test. • If a Heart Start ForeRunner/FR2/FR2+ equipped with a data card was used, install a new data card. Early Defibrillation Program Assessment and Review Any actual SCA events shall be reviewed by the Defibrillation Program Coordinator and the Medical Director to ensure that the early defibrillation protocol was followed and to assess the response 4111) 4 of 5 • r performance of the facility. Recommendations for change or improvement should be discussed with the Site Coordinator and responders as soon as possible after an event. The Defibrillation Program Coordinator shall ensure that each Site Coordinator conducts yearly cardiac arrest response drills at his/her facility to determine the facility's readiness to respond to an SCA event. In addition to drills, the Defibrillation Program Coordinator should review each site's training and maintenance records to ensure compliance with [School Organization] policy. This policy is in effect as of and shall be reviewed yearly or as required by changes in the early defibrillation program, state/local regulation, or [School Organization] policy Defibrillation Program Coordinator Signature Date Medical Director Signature Date r r 5 of 5 PHILIPS Sample* Early Defibrillation Response Protocol for Schools DURING SCHOOL HOURS AFTER SCHOOL HOURS 1. Conduct an initial assessment. 1. Conduct an initial assessment. El Assess for scene safety; use universal Q Assess for scene safety; use universal precautions. precautions. O Assess patient for responsiveness. E( Assess patient for responsiveness. El If unresponsive, activate EMS and the El If unresponsive, activate EMS and the after- school emergency plan. Call 911 or school emergency plan. Call 911 or designated number: designated number: • O If another person is present, send him/her to E! If another person is present, send him/her to get the defibrillator and notify the school get the defibrillator and notify the school office of the location of the emergency. staff(athletic trainer, coach or other trained I21 If no other person is present, notify the responder) of the location of the emergency. school office and ask for the defibrillator. El Send someone to guide EMS to the Continue to care for the patient as location. described in steps 2 and 3 until the El If no other person is present, notify the defibrillator is available. school office and ask for the defibrillator. Continue to care for the patient as described in steps 2 and 3 until the defibrillator is available. 2. Assess breathing. El Open airway. El Look, listen and feel for breathing. O If breathing is absent, deliver two rescue breaths. 3. Assess circulation. Q If signs of circulation are absent, provide CPR. Continue CPR until defibrillator arrives. 4. Begin defibrillation treatment. EI As soon as the defibrillator is available, turn it on and follow the prompts. If the patient is an infant or child who is less than 8 years old or 55 pounds, use Infant/Child defibrillator pads if available. El Shave chest with disposable razor if needed. Discard razor in a safe manner. Wipe chest if it is wet. © Apply defibrillation pads. Look at the icons on the self-adhesive defibrillation pads, peel one pad at a time and place it as shown in its illustration. Ensure pads are making good contact with the patient's chest. Do not place the pads over the nipple, medication patches, or visible implanted devices. • This sample protocol is provided as a guide in the development of your organization's specific protocol. Your defibrillation protocol 41.1) should be reviewed and approved by your program's Medical Director and legal representative to ensure that it meets state and local requirements,as well as the specific needs of your district or school. The protocol should be reviewed as needed,at least annually, and revised as necessary. 452298189891 1 of 2 E1 Deliver a shock to the patient when advised by the defibrillator, after first clearing the patient area. Administer additional shocks as prompted by the defibrillator, until it advises no shock or has delivered a series of three consecutive shocks and prompts the responder to check the patient. 0 When advised by the defibrillator, check the patient's airway, breathing, and signs of circulation and initiate CPR if signs of circulation are absent. Continue to perform CPR until otherwise prompted by the defibrillator or EMS personnel arrive. O If breathing and other signs of circulation are present, leave the defibrillator attached and place the patient in a recovery position. Continue to monitor the patient's airway, breathing and circulation and provide any indicated care. O Continue to follow the Heart Start Defibrillator prompts until EMS arrives. 5. When EMS arrives O Responders working on the victim should document and communicate important information to the EMS provider, such as: • Victim's name • Known medical problems, allergies or medical history • Time the victim was found • Initial and current condition of the victim • Information from the ForeRunner/FR2/FR2+ Defibrillator's screen or by pushing the blue i-button on the Heart Start OnSite Defibrillator: — Number of shocks delivered — Length of time defibrillator has been on O Assist as requested by EMS providers. POST-USE PROCEDURE O If using the ForeRunner/FR2/FR2+, remove the data card when transferring care of patient to EMS. Give the data card and the Defibrillation Incident Report to the Early Defibrillation Program Coordinator within 24 hours post-event for evaluation. If using the OnSite, take the defibrillator and the Defibrillation Incident Report to the Early Defibrillation Program/Site Coordinator within 24 hours post-event for downloading data from internal memory. El Early Defibrillation Program/Site Coordinator: notify early defibrillation program Medical Director. El Check the defibrillator and replace any used supplies as soon as possible following the event so that the defibrillator may be returned to service. Perform the after-patient-use maintenance on the defibrillator. El Early Defibrillation Program/Site Coordinator: conduct employee incident debriefing, as needed. O Early Defibrillation Program Coordinator: complete the incident follow-up report and forward to Medical Director. DEFIBRILLATOR MAINTENANCE AFTER EACH PATIENT USE O Inspect the exterior, pads connector port or pads cartridge well for dirt or contamination. O Check supplies, accessories and spares for expiration dates and damage. O Check operation of the Heart Start Defibrillator by removing and reinstalling the battery and running a battery insertion test. O If using a ForeRunner/FR2/FR2+ Defibrillator, remove data card and replace it with a spare. Apply a patient ID label to the used data card and deliver to the appropriate personnel. If using a Heart Start OnSite Defibrillator, download data from defibrillator to a PC running Heart Start Event Review data management software then erase the defibrillator memory to ensure adequate capacity for recording data when next used. 2 of 2 AUTOMATED EXTERNAL DEFIBRILLATOR(AED) GRANT PROGRAM AGREEMENT THIS AGREEMENT is made and entered into this day of 20 , by and between the City of Elgin, Illinois, a municipal corporation (hereinafter referred to as the "City") and , an Illinois not-for-profit corporation organized and existing under the laws of the State of Illinois (hereinafter referred to as"Grantee"). WITNESSETH: WHEREAS, the City has created an automated external defibrillator (AED) grant program (hereinafter referred to as the"Subject AED Grant Program"); and WHEREAS, pursuant to the Subject AED Grant Program the City will provide to eligible organizations an automated external defibrillator to be maintained at the eligible organization's premises in the City of Elgin; and WHEREAS, the Grantee has applied to the City to receive an AED pursuant to the Subject AED Grant Program; and WHEREAS, the Grantee's application to participate in the Subject AED Grant Program has been approved subject to the Grantee executing this AED Grant Program agreement; and WHEREAS, the City of Elgin is a home rule unit and as a home rule unit may exercise any power and perform any function pertaining to its government and affairs; and WHEREAS, providing an AED to the Grantee who will give Elgin citizens greater access to AEDs and increase the likelihood of survival from sudden cardiac arrest and will otherwise promote and protect the public health, safety and welfare within the City which pertains to the government and affairs of the City. NOW, THEREFORE, for and in consideration of the mutual promises and undertakings contained herein, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: 1. That the City of Elgin automated external defibrillator (AED) grant program guidelines are attached hereto and made a part hereof as Exhibit 1. 2. That the Grantee represents and warrants that it complies with the eligibility guidelines for the Subject AED Grant Program including that the Grantee is a fraternal, benevolent, service or faith-based not-for-profit organization located within the City of Elgin. 3. That the Grantee shall comply in all respects with the post-award requirements as set forth in the attached program guidelines including, but not limited to, comply in all respects with the Automated External Defibrillator Act (410 ILCS 4/1, et seq.), as amended, including, but not limited to, the maintenance, training and oversight requirements provided for therein. It is further expressly agreed and understood that Grantee, in connection with the performance of this Agreement and the ownership, operation, maintenance, training and oversight requirements shall comply with all applicable federal, state, city and other requirements of law. 4. That within thirty (30) days of the entry of this Agreement the City shall provide to the Grantee an automated external defibrillator (AED) manufactured by Philips, model number (hereinafter referred to as the "Subject AED"). The execution of this Agreement by the parties hereto shall constitute a bill of sale from the City to the Grantee selling, assigning, transferring and setting over to the Grantee all of the City's right, title and interest in and to the Subject AED. All warranties of quality, fitness and merchantability from the City are hereby expressly excluded. Notwithstanding the foregoing, the City hereby assigns to the Grantee any warranties of the manufacturer for the Subject AED, if any. 5. That the Grantee agrees to maintain and keep the Subject AED at Grantee's premises located at , Elgin, Illinois. 6. That this Agreement shall not be deemed or construed to create an employment, joint venture,partnership or other agency relationship between the parties hereto. 7. That the failure by a party to enforce any provision of this Agreement against the other party shall not be deemed a waiver of their right to do so thereafter. 8. That this Agreement may be modified or amended only in writing signed by all of the parties hereto. 9. That this Agreement contains the entire agreement and understanding of the parties hereto with respect to the subject matter set forth herein, all prior agreements and understandings having been merged herein and extinguished hereby. 10. That this Agreement is and shall be deemed and construed to be a joint and collective work product of the City and the Grantee, and as such, this Agreement shall not be construed against the other party as the otherwise purported drafter of same, by any court of competent jurisdiction in order to resolve any inconsistency, ambiguity, vagueness or conflict, if any, in the terms or provisions contained herein. 11. That this Agreement is subject to and shall be governed by the laws of the State of Illinois. 12. That this Agreement shall be binding on the parties hereto and their respective successors and permitted assigns. This Agreement and the obligations herein may not be assigned by the Grantee without the express written consent of the City, which consent may be withheld at the sole discretion of the City. r -2 - 13. That the City and the Grantee agree that in the event of a default by a party, the other party shall, prior to taking such actions as may be available to it, provide written notice to the defaulting party stating that they are giving the defaulting party thirty (30) days within which to cure such default. If the default shall not be cured within the thirty (30) day period aforesaid, then the party giving such notice shall be permitted to avail itself of remedies to which it may be entitled to under this Agreement. 14. That if the Grantee violates or breaches any term of this Agreement, such violation or breach shall be deemed to constitute a default, and the City shall have the right to seek administrative, contractual, legal, or equitable remedies as may be suitable to the violation or breach. If the City violates or breaches any term of this Agreement, such violation or breach shall be deemed to constitute a default, and in the event the City fails to within thirty (30) days after notice thereof by the Grantee to comply with the conditions of this Agreement, the Grantee as its sole and exclusive remedy may terminate this Agreement. Notwithstanding anything to the contrary in this Agreement, no action shall be commenced by the Grantee, any related persons or entities, and any of their successors and/or permitted assigns, against the City for monetary damages. 15. That venue for the resolution of any disputes or the enforcement of any rights pursuant to this Agreement shall be in the Circuit Court of Kane County, Illinois. 16. That time is of the essence of this Agreement. 17. All notices pursuant to this Agreement shall be in writing and shall be mailed by first-class mail, postage prepaid, addressed as follows: As to the City: As to Grantee: City of Elgin 150 Dexter Court Elgin, Illinois 60120-5555 Attention: City Manager With a copy to: City of Elgin 150 Dexter Court Elgin, Illinois 60120-5555 Attention: Corporation Counsel 18. That to the fullest extent permitted by law, the Grantee agrees to waive and release the City, its officials, officers, employees, attorneys, agents, boards and commissions, and all related parties, from and against any and all claims, suits, judgments, costs, attorneys' fees, damage or other relief, including but not limited to workers' compensation claims, in any way resulting from or arising out of or alleged to be resulting from or arising out of this Agreement and/or the Subject AED unit to be provided by the City to the Grantee pursuant to - 3 - Aummonommin this Agreement and/or in any way resulting from or arising out of or alleged to be resulting from or arising out of any alleged negligence by the City, its officials, officers, employees, attorneys, agents,boards and commissions, in connection with this Agreement and/or the Subject AED unit to be provided by the City pursuant to this Agreement. The provisions of this paragraph shall survive any completion, expiration and/or termination of this Agreement. 19. That it is agreed and understood that this Agreement is not intended nor shall be construed to alter, limit, or constitute a waiver of any of the civil immunities afforded the City and/or its officials, officers, employees and/or agents pursuant to the Local Governmental and Governmental Employees Tort Immunity Act at 745 ILCS 10/1-101, et seq., as amended, the Emergency Telephone System Act at 50 ILCS 750/0.01 et seq., as amended, the Emergency Medical Services Systems Act at 210 ILCS 50/1 et seq., and/or otherwise provided by law, it being agreed that all the civil immunities as set forth in such Acts, as amended, and/or as otherwise provided by law, shall fully apply to any claims asserted or which might be asserted against the City and/or its officials, officers, employees and/or agents as a result of this Agreement or any of the actions of the parties pursuant to this Agreement. Notwithstanding anything to the contrary in this Agreement, it is agreed and understood that no third party beneficiaries are intended or shall be construed to be created by the provisions of this Agreement and it is the intention of the parties hereto that no action may be commenced by any third party person or entity against the City and/or the Grantee and/or their respective officials, officers, employees, agents and/or other related persons or entities for monetary damages for any alleged breach of this Agreement. The provisions of this section shall survive any expiration and/or termination of this Agreement. IN WITNESS WHEREOF, the parties have entered into and executed this Agreement as of the date and year first written above. CITY OF ELGIN GRANTEE By By City Manager Its Attest: City Clerk F:\Legal Dept\Agreement\Grant Agreement-Automated External Defibrillator(AED).docx -4 - • EXHIBIT 1 41115 AUTOMATED EXTERNAL DEFIBRILLATOR(AED) GRANT PROGRAM GUIDELINES - 5 - AHA Science Advisory rik Lay Rescuer Automated External Defibrillator ("Public Access Defibrillation") Programs Lessons Learned From an International Multicenter Trial Advisory Statement From the American Heart Association Emergency Cardiovascular Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Council on Clinical Cardiology Mary F. Hazinski, RN, MSN; Ahmed H. Idris, MD; Richard E. Kerber, MD; Andrew Epstein, MD; Dianne Atkins, MD; Wanchun Tang, MD; Keith Lurie, MD Abstract—Lay rescuer automated external defibrillator(AED)programs may increase the number of people experiencing sudden cardiac arrest who receive bystander cardiopulmonary resuscitation(CPR),can reduce time to defibrillation,and may improve survival from sudden cardiac arrest. These programs require an organized and practiced response, with rescuers trained and equipped to recognize emergencies,activate the emergency medical services system,provide CPR, and provide defibrillation.To determine the effect of public access defibrillation(PAD)programs on survival and other outcomes after SCA, the National.Heart,Lung,and Blood Institute,the American Heart Association(AHA),and others funded a large prospective randomized trial. The results of this study were recently published in The New England Journal of Medicine and support current AHA. recommendations for lay rescuer AED programs and emphasis on planning,training,and practice of CPR and use of AEDs.The purpose of this statement is to highlight important findings of the Public Access Defibrillation Trial and summarize implications of these findings for healthcare providers, healthcare policy advocates, and the AHA training network. (Circulation.2005;111:3336-3340.) r Key Words: AHA Science Advisory • defibrillation ■ heart arrest a fibrillation ■cardiopulmonary resuscitation ince 1995,the American Heart Association(AHA)has summarize implications of these findings for healthcare promoted the development of lay rescuer automated providers,healthcare policy advocates,and the AHA training external defibrillator(AED)programs to improve sur- network. vival from out-of-hospital sudden cardiac arrest (SCA).1-3 These programs are also known as "public access"defibril- Background lation (PAD) programs. The AHA has emphasized the im- Although estimates of the annual number of deaths caused by portance of organization,planning,and training to maximize out-of-hospital SCA in the United States vary widely^-5 the effectiveness of these programs' AHA estimates that x230 Q0O people diem the United States To determine the effect of PAD programs on survival and each year from SCA ourde t}e hospital setting.io At the time other outcomes after SCA, the National Heart, Lung and of'first heart rhythm analysis, —4Q% of SCA victims dem- Blood Institute(NHLBI).the AHA,and others funded a large onstrate ventricular fibrillation (VP), an abnormal heart prospective randomized trial. The results of this study were rhythm that causes the heart to quiver so that it is unable to published recently in The New England Journal of Medicine.' pump blood effectively.', It is likely that an even higher The purpose of the present statement is to highlight important proportion of people with SCA have VF at the time of collapse. findings of the Public Access Defibrillation (PAD) trial and Many people who experience sudden VF cardiac arrest can The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal,professional,or business interest of a member of the writing panel.Specifically.all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science.Advisory and Coordinating Committee on April 11.2005. A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave. Dallas,TX 752314596. Ask for reprint No. 71-0325.To purchase additional reprints: up to 999 copies.call 800-611-6083(US only)or fax 413-665-2671: 1000 or more copies. call 410-523-4121, fax 410-528-4264, or e-mail kgray@lww.com. To make photocopies for personal or educational use,call the Copyright Clearance Center,978-750-8400. rip- Expert peer review of AHA Scientific Statements is conducted at the AHA National Center.For more on AHA statements and guidelines development, visit http://www.americanheat.org/presenter.jhtrctl?identifier=3023366. ©2005 American Heart Association,Inc. Circulation is available at http://www.circulationaha.org DOI: NUM t/CIRCULA'f ION All A.1(15.165674 Downloaded from cire.ahajo?sit3>fils.org by on March 11,2011 Hazinski et al Lay Rescuer Defibrillator Programs 3337 survive if bystanders act immediately.If VF is untreated,then to defibrillation. These programs require an organized and cardiac standstill will develop. and successful resuscitation practiced response with rescuers trained and equipped to will be unlikely." recognize emergencies, activate the EMS system, provide The ABA has traditionally used 4 links in a chain to CPR,and provide defibrillation. Small studies of lay rescuer illustrate the important actions that can create a "chain of AED programs in airports"3 and casinos'""and with police survival"for victims of VF SCA)These links are as follows: ofticers14•21-2:have demonstrated a 49%to 74%survival rate from out-of-hospital witnessed VF SCA when immediate I. Early recognition of the emergency and activation of the bystander CPR is provided and defibrillation occurs within 3 emergency medical services (EMS)system("9-1-1"). to 5 minutes of collapse. These high survival rates, however, 2. Early bystander cardiopulmonary resuscitation (CPR). are attained only in programs that reduce time to 3. Early delivery of a shock with a defibrillator. defibri:llation.24 4. Early advanced life support. Bystanders can now perform 3 of the links in this chain. The FAD Trial • Bystander recognition of the emergency and EMS activation The PAD trial involved 993 facilities in 24 urban and are critical first steps in response to an SCA. ensuring that suburban regions in North America and reported outcomes basic and advanced life support providers are dispatched to from 239 episodes of out-of-hospital SCA with attempted resuscitation.3 A facility was included if it had a history of at the site of the arrest. In most communities,the time interval least l out-of-hospital cardiac arrest every 2 years or if at least from collapse to the arrival of EMS personnel is 7 to 8 1 out-of-hospital cardiac arrest was predicted during the study minutes or longer.This means that the victim depends on the actions of bystanders and local rescuers to perform the first 2 period. Each study site was required to have clearly defined or 3 links in the.chain of survival during the first minutes after geographic boundaries and a typical EMS response interval SCA. of 3 to 15 minutes. Bystanders need to provide immediate CPR for victims of Methods SCA. CPR provides blood flow to the heart and brain. In Participating sites were urban and suburban communities addition,CPR increases the likelihood that a shock delivered served by EMS systems that provide advanced life support. by a defibrillator will terminate the VF and that the heart will Each site identified distinct units within their service area(eg, resume an effective rhythm after defibrillation.These effects buildings,public areas).These units were randomly allocated of CPR appear to be particularly important if shock delivery to train and equip volunteers to provide either CPR only or does not occur for_4 minutes after collapse.';Defibrillation CPR plus AEI) response. All of the volunteer rescuers does not"restart"the heart;defibrillation stops VF and allows received rigorous,standard training to recognize SCA,phone the heart to resume a normal rhythm.In the first few minutes 9-1-1, and perform CPR according to ANA recommenda- after defibrillation, the heart rhythm may be slow and the tions.Volunteers at the sites offering CPR plus AED response heart may not pump blood effectively. CPR may be needed also were trained and equipped to use AEDs. At CPR-plus- for several minutes after defibrillation until adequate heart AED sites,AEDs were placed to enable volunteers to retrieve function resumes." and deliver an AED to a victim of SCA within 3 minutes of Lay rescuers can use computerized devices called AEDs to collapse. deliver a shock to victims of VF cardiac arrest. The rescuer The trial was conducted from July 2000 through September attaches the AED to the victim with adhesive pads or 2003. Approximately 20 000 volunteers received training in electrodes.The AED records and analyzes the victim's ECG programs that offered frequent retraining and refresher drills. rhythm,informs the rescuer if a shock is needed,and provides More than 1600 AEDs were placed to conduct the trial. Most voice and audio prompts to guide the rescuer through all steps (84%)of the study facilities were in public locations such as of AED use.The AED computerized algorithms that are used recreational facilities and shopping centers.Additional details to analyze the victim's heart rhythm are accurate. AEDs will of the study design and methodology have been published.'-` deliver a shock only when VF or its precursor,rapid ventric- ular tachycardia, is present and will not deliver a shock to a Results person with a normal heart rhythm.'s in the units providing only bystander CPR, 15 of 107 persons The success of the actions of rescuers at the scene of an experiencing definite cardiac arrest (ic, an arrest of cardiac SCA is time critical. Several studies have documented the origin with rhythm identification) survived to hospital dis- effects of time to defibrillation and the effects of bystander charge. In the units providing bystander CPR plus AED CPR on survival from SCA. For every minute that passes response,30 of 128 victims of definite,cardiac arrest survived between collapse and defibrillation, survival from witnessed to discharge. This increase in the number of survivors of VF SCA falls 7% to 10% if no CPR is provided." When definite cardiac arrest in units with CPR plus AED response bystander CPR is provided, the fall in survival is more compared with the number of survivors in the units providing gradual and averages 3%to 4%per minute from collapse to CPR response alone was statistically significant(P<0.05).2e defibrillation.",'6 CPR can doublea''6 or triple" survival in this study, nearly two thirds of all victims of SCA in from witnessed SCA at any interval to defibrillation. both groups received bystander CPR. Compared with sites Lay rescuer AED programs may increase the number of with CPR-only response, sites with CPR plus AND response SCA victims who receive bystander CPR and can reduce time had a shorter interval from collapse to first rhythm assess- Downloaded from circ.ahajoumals.org by on March 11,2011 3338 Circulation June 21, 2005 Other public locations with a high incidence or likelihood of SCA 19% _ - Airport (see the Figure).27 26% In the PAD trial, survival with structured lay rescuer . . _ programs that included bystander CPR response was higher than previously reported by traditional EMS systems.t This Shopping Malls implies that public sites that do not provide AED programs 7% " may still improve survival from SCA by training volunteers Sports �3 .r to recognize cardiac arrest,phone 9-1-1. and give bystander 8°l° , CPR before the arrival of EMS providers. Golf Clubs Lay rescuer AED programs will be most cost effective if Large Industrial likely they are present at sites where at least I witnessed SCA is likely to occur every few years. In the PAD trial, sites were 10% Health Clubs enrolled if there were at least 250 adults >50 years old 13% present at the site during waking hours(e-16 hours per day). Public locations with high incidence of SCA in Seattle and King Other criteria(eg,presence of high-risk persons)that can be County,Washington, 1990 to 1994(n=134).Adapted with per- used to select AED program sites are posted on the AED mission from Becker at al?7 Copyright 1998 American Heart website (http://www.americanheart.org/ecc/PAD). Association. It is important to note that the PAD trial was not designed to evaluate home defibrillation or defibrillation provided by ment (6 versus 8.7 minutes) and a higher incidence of VF untrained rescuers.A national study is under way to evaluate (57% versus 47%). These differences were statistically sig- home defibrillation,and the results of this study are expected nificant. No inappropriate shocks were delivered. Adverse to provide additional information about the potential benefits events were rare and consisted chiefly of stolen AEDs and of home AED programs. transient psychological stress among rescuers. The ABA recommends critical elements for lay rescuer It is important to note that residential sites represented AED programs: healthcare provider oversight and planning. 16%of the study sites and accounted for 28%of the cardiac training of anticipated rescuers in CPR and use of the AED, arrests but <5%of the survivors.The study lacked statistical link with the EMS system, and a plan for maintenance and power to detect whether lay rescuer AED programs increase quality improvement monitoring.2 The AHA has particularly survival from SCA in residential settings. emphasized the importance of training rescuers and the development and practice of a structured response plan.Even Implications for Public Policy in the PAD trial. with rescuers trained to respond to SCA, Estimates of the incidence of SCA in the United States vary resuscitation was attempted for only half of the witnessed widely because SCA is not a reportable disease or cause of SCA victims, and the on-site AED was used for only about death. In the PAD study, the observed number of cardiac one third of SCA victims. These findings suggest that arrests during the study period was substantially lower rescuers may need more training or practice than that offered (<50%) than the number predicted. This correlates with in the study and document that the mere presence of an AED recent data suggesting that the incidence of SCA may be 0.5 does not ensure that it will be used when SCA occurs. per 1000 adults>35 years old.6•7 To quantify the problem and The selection of sites for potential lay rescuer AED evaluate the effect of any interventions designed to reduce programs and the placement of the AEDs within the site are death from SCA, this cause of death must be reportable. important in the planning for the program. Published data EMS databases may enable the identification of sites of about the most likely sites of SCA in the community27 can be cardiac arrests to better pinpoint priority sites for lay rescuer used to identify potential sites for these lay rescuer AED AED programs. Although the organization of information in programs (see the Figure). The AHA recommends that the state EMS databases varies widely,recent attempts to collect AEDs be placed in the site so that they can be reached within national EMS data have been encouraging. a 1- to 1.5-minute brisk walk from any location. The PAD trials confirms the value of the elements of the chain of survival in improving the outcome of SCA.The trial implications for Future AHA Activities supports current AHA recommendations for lay rescuer AED The promotion of PAD programs is an important component programs and the emphasis on planning,training,practice of of the AHA's comprehensive strategy to prevent heart disease CPR, and use of AEDs. Early recognition, early CPR, and and stroke through risk factor prevention, identification and early defibrillation all contribute to an increased chance of control,early identification and treatment of acute events,and survival from out-of-hospital SCA. The authors note that if prevention of recurrent events.The PAD trial results validate the increased number of survivors from the PAD trial is the importance of the AHA chain of survival in improving extrapolated to all episodes of out-of-hospital SCA that occur outcome from out-of-hospital witnessed SCA. The results in public locations annually in the United States,then •2000 document the importance of program planning, rescuer train- to 4000 additional lives can he saved every year with ing, the link with the local EMS system, and a system of widespread implementation of lay rescuer community AED device maintenance and quality improvement monitoring in programs.This would require the placement of AEDs in those lay rescuer AED programs to improve outcome from SCA. Downloaded from cu-c.ahajournals.org by on March 11,2011 Hazinski et at Lay Rescuer Defibrillator Programs 3339 All states have passed legislation or regulations that allow lay The PAD trial results are being carefully reviewed by AHA rescuer AED programs,but the heterogeneity of the state laws resuscitation experts to refine recommendations for resusci- has created confusion for lay rescuers and has complicated tation and lay rescuer AED programs. In addition, the attempts to establish lay rescuer AED programs. An AHA researchers gained experience in obtaining community in- scientific statement is beine developed that will delineate critical formed consent and institutional review board approval.="For state legislative components and implementation strategies for further information about lay rescuer AED programs. see lay rescuer AED programs. http://www,americanheart.org/ecc/PAD. Writing Group Disclosures Writing Group Research Other Research Speakers Ownership Consultant/ Member Employment Grant Support Bureau/Honoraria Interest Advisory Board Other Mary F.Hazinski Vanderbilt None None None None Paid AHA None University consultant/senior science editor Ahamed H.Idris University of Medtronic;Laerdal: None None None Philips SA/3 Holds patent for Texas— Medcool:NASA; member mouth-to-mouth Southwestern Department of ventilation device Defense Richard E.Kerber University of Philips Medical None None None None None Iowa Hospital Systems;Guklant Andrew Epstein University of Boston Scientific; None Speakers bureau: None None None Alabama— twine Biomedical; AsbeZeneca,Reliant, Birmingham Besense;Medtronic; GlaxoSmithKline, Guidant St.Jude Medtronic,Guidant,St. Medical Jude Medical Dianne Atkins University of Philips Medical None None None None None Iowa Systems;Zoll Medical Ai) Corporation; Wyeth-Ayers:Berlex Medical(latter 2 completed 2001) Wanchun Tang Institute of American Heart None None None None None Critical Care Association;Philips: Medicine Zell Medical Corporation Keith Lurie University of None None None Founder and Chief None None Minnesota Medica!Officer,Advanced Circulatory Systems (manufacturer of CPR devices and CPR device technology) This fable represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire,which all members of the writing group are required to complete and submit. Reviewer Disclosures Research Grant/Other Speakers Ownership Consuttant/Advisory Reviewer Employment Research Support Bureau/Honoraria Interest Board Other Or Robert Berg University of Medtronic None None None None Arizona Health Sciences Center Dr Mickey Eisenberg University of Medtronic;Philips Medical Norte None None None Washington Systems;Laerdal Dr Terry Vanden Hoek University of None None None None None Chicago 4114) This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Reviewer Disclosure Questionnaire,which all reviewers are required to complete and submit. Downloaded from circ.abajournals.org by on March 11,2011 Aimmimmin 3340 Circulation June 21, 2005 References 15. Kerber RE, Becker LB, Bour land JD. Cummins RO, Hallstrom AP. I. Weisfeldt M,Kerber R,McGoldrick RP.Moss A.I.Nichol c;,Ornato JP, Michos MU,Nichol 0,Omato JP,Thies WH,White RD.7.uckenrran BD. 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