July 2002
To:         District Superintendents                Superintendents Principals of Public Schools                Directors of County Vocational Education and Extension Boards                Principals of Charter Schools
From:    James R. Butterworth                Office of Regional School and Community Services
Subject: Cardias Automated External Defibrillators (AEDs) in Public School Facilities
In May 2002 legislation was enacted to add a new section 917 to the Education Law requiring school districts, BOCES, county vocational education and extension boards, and charter schools to provide and maintain on-site, in each instructional school facility, at least one functional automated external defibrillator (AED) for use during emergencies. The legislation also requires public school officials and administrators responsible for such school facilities to ensure the presence of at least one staff person who is trained in the operation and use of an AED. Legislation Education Law section 917 becomes effective September 1, 2002. However, in July 2002, the New York State Legislature passed an amendment to that law which allows school districts, BOCES, county vocational and extension boards, and charter schools that are unable to comply with the AED legislation by September 1, 2002 to delay implementation until December 1, 2002. The legislation has been sent to the Governor and is expected to be signed on August 6, 2002. After the legislation is signed, those wishing to delay implementation should certify to the Commissioner of Education that they are unable to comply by sending a letter to Commissioner Mills. See Attachment 1 for sample letter. Emergency Regulations On July 18, 2002, the Board of Regents approved emergency regulations relating to AEDs in public school facilities. The emergency regulations are provided in Attachment 2 and are available on the SED Comprehensive Health and Pupil Services (CHAPS) Team website at www.emsc.nysed.gov/rscs/ chaps/chapshome.htm. They will be published in the State Register on August 7, 2002. Please submit comments in writing to Deputy Commissioner James Kadamus, New York State Education Department, Room 875 EBA, Albany, New York 12234. The following BASIC INFORMATION is provided to assist schools in their implementation of the AED legislation: PAD Provider The AED legislation requires public school facilities and staff who will operate the AED equipment to become a public access defibrillation (PAD) provider as defined in the Public Health Law and subject to its provisions. Attachment 3, the New York State Department of Health, Bureau of Emergency Medical Services Policy Statement on Public Access Defibrillation (PAD), identifies the requirements and necessary steps to take to become a PAD provider. Requirements The legislation requires public school officials and administrators responsible for public school facilities to ensure the presence of at least one staff person who is trained in the operation and use of an AED: – whenever public school facilities are used for school-sponsored or school-approved             curricular or extracurricular events or activities, or – whenever a school-sponsored athletic contest is held at any location. Where a school-sponsored competitive athletic event is held at a site other than a public school facility, the public school officials must assure that AED equipment is provided on-site. See Attachment 2, the Emergency Regulations, for definitions of terms used in the Requirements above. AEDs The Food and Drug Administration (FDA) has approved a number of AED devices for individuals eight years of age or older. Currently, the FDA has approved a pediatric-modified AED for children under age eight that allows the device to deliver a lower dose of electricity. Schools using pediatric-modified AEDs should adhere to the State Emergency Medical Advisory Committee (SEMAC) Advisory (Attachment 4). Note: At this time, there is no approved PAD training course which includes the use ofpediatric-modified AEDs. However, the New York State Department of Health, Bureau of Emergency Medical Services, has indicated that PAD training that includes Infant CPR, Child CPR, Adult AED, along with the manufacturer’s guidelines on the use of the defibrillator with children under the age of 8, is sufficient to meet the requirements for PAD programs using an FDA approved pediatric-modified AED

The law requires that AED equipment be provided and maintained on-site in each instructional school facility in quantities adequate to ensure ready and appropriate access for use during emergencies. Schools also need to consider the provision of covering competitive athletic events held at a site other than a public school facility.

• Each instructional school facility should have as its goal a specific response plan that targets a victim’s collapse to defibrillation time less than or equal to 4 to 5 minutes. (Source: International Consensus on Science, Guidelines 2000 for Cardio-pulmonary Resuscitation and Emergency Cardiovascular Care. Vol. 102, #8. American Heart Association. August 2000.)
  
• An internal communication/notification system should be established to assure early notification of a cardiac arrest (victim’s collapse). Good internal communication may lower response time and can result in a system that depends on fewer AEDs and trained staff.
  
• When determining the number of AEDs needed, the following should be considered:

– size and physical layout of the building,
– number and ages of individuals in the building,
– types and locations of athletic events,
– location of curricular and extracurricular events, and
– other design features that might be unique to the public school facility.

• Strategic placement and availability of AEDs, as well as trained staff, are critical to the school’s PAD program.

Training

• Any school staff member who successfully completes an approved PAD training course for AED users may use an AED. This could include school nurses, coaches, athletic directors and physical education staff who normally may have emergency care response as part of their role; other employees who have training and function as emergency responders in the community; or any other staff member interested in participating in the PAD program.

• Approved one half day training courses in CPR/AED skills are offered by the:

– American Heart Association
– American Red Cross
– National Safety Council
– New York City Regional Emergency Medical Services Council
– American Safety and Health Institute
– Emergency Services Institute

• While the law requires at least one person trained in the use of an AED, it is recommended that as many staff as possible be trained.

Note: At this time, there is no approved PAD training course which includes the use of pediatric-modified AEDs. However, the New York State Department of Health, Bureau of Emergency Medical Services, has indicated that PAD training that includes Infant CPR, Child CPR, Adult AED, along with the manufacturer’s guidelines on the use of the defibrillator with children under the age of 8, is sufficient to meet the requirements for PAD programs using an FDA approved pediatric-modified AED.

Physician Oversight

• As a PAD provider, each public school facility must identify a physician or hospital knowledgeable and experienced in emergency cardiac care to serve as an "emergency health care provider (EHCP)" and participate in a collaborative agreement. In many instances, a district’s school physician may serve as the emergency health care provider for the buildings in the district. For the components of the written collaborative agreement, please see Attachment 3.

Cooperative Service Agreements (CO-SERs)

• School districts may use Cooperative Bidding Coordination CO-SER No. 7011 to facilitate the purchase of AEDs. Safety/Risk Management CO-SER No. 7470 may be used to provide train-ing, conduct building assessments and conduct drills. Additional information on CO-SERs may be found on the SED web at http://www.emsc.nysed.gov/mgtserv/BOCES/.

Technical Assistance

• The CHAPS website, located at www.emsc.nysed.gov/rscs/chaps/chapshome.htm, includes the following items:
  
• Relevant Legislation and Regulations

– Section 917 – Chapter 61
– Emergency Regulations – CR 136.4
– Public Health Law Article 30 – Emergency Medical Services
-- Section 3000-a – Emergency Medical Treatment (Good Samaritan)
-- Section 3000-b – Automated Defibrillators: Public Access Providers

• Funding Options – CO-SER Information

– Purchase of equipment
– Training

• Additional Resources

– Public Health Advisory – AED for Pediatric Patients
– Public Access Defibrillation (PAD) in Schools
– NYS Department of Health Emergency Medical Services Bureau Homepage - link
– NYSDOH Emergency Medical Services Policy Statement for all PAD providersders
– Notice of Intent to Provide PAD – DOH required form 4135
– Regional EMS Councils in New York State

• Links to the Statewide School Health Services Center and to CHAPS
  
• Questions/Answers – Coming the week of August 5, 2002
  
• Technical Assistance Workshops will be offered beginning in August 2002 by the Coordinated School Health Network (CSHN) and the BOCES Health and Safety Coordinators. Watch the CHAPS website for a schedule, as well as information about workshop agendas, presenters, participants, and issues.

• Additional information can be obtained from:

New York State Public Access School Implementation
Defibrillation Program:
Bureau of Emergency Medical Services 
433 River Street, Suite 303
Troy, New York 12180
Phone: (518) 402-0996

School Implementation:
New York State Education Department
Comprehensive Health and Pupil Services Team
Room 318M EB
89 Washington Avenue
Albany, New York 12234
Phone: (518) 486-6090
mchaps@mail.nysed.gov

Attachments