l'eidluneannacht na Seirbhise SIilinte

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1 l'eidluneannacht na Seirbhise SIilinte Health Service Executive TITLE: Manual Handsfree & Automated External Defibrillation Policy Mid-Western Regional Hospital Limerick, Mid-Western Regional Orthopaedic Hospital, Croom, and Mid-Western Regional Maternity Hospital, Limerick Document MP RC P4 Document Ann Kenny Ryan and Reference Drafted By Marie O'Hora Number Resuscitation Officers. Revision 4 Document Gareth Quin Number Approved By Chairperson, Resuscitation Committee Approval August 29 Responsibility Resuscitation Committee, Date For Marie O'Hora and Ann Kenny Implementation Ryan Resuscitation Officers Revision May 211 Responsibility Resuscitation Committee, Date For Evaluation Marie O'Hora and Ann Kenny And Audit Ryan Resuscitation Officers Pages 13 Title: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRH), Limerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Groom and Mid-Western Regional Maternity Hospital (MWRMH) Limerick Page I of i3

2 TABLE OF CONTENTS PAGE 1. Scope of policy 2. Definitions 3. Policy Statement 4. Criteria to be eligible for certification in Manual Handsfree or AED Defibrillation 5. Aims of Policy 6. Roles and Responsibilities 7. Training 8. Procedure for Safe and Effective Manual Handsfree Defibrillation 9. Second Rescuer available Manual Handsfree Defibrillation 1. Paediatric Manual Handsfree Defibrillation 11. Procedure for Safe and Effective Automated External Defibrillation (AED) 12. Evaluation and Audit 13. Implementation Plan References Appendices Appendix 1: Audit sample tool Appendix 2: Manual Handsfree Defibrillation Algorithm Appendix 3: Automated External Defibrillation Algorithm Title: Manual Handsfree & Automated External Oefibn'flation Policy at Mid-West9m Regional Hospital, (MWRH), Limerick, Mid Westem Regional Orthopaedic Hospffal (MWROH) Croom and Mid Weslem Regional Malemity Hospital (MWRMH) Limerick Page 2 of 13

3 1. Scope of policy: 1.1 This policy refers to unsynchronised DC shocks which are used to terminate ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), both of which are life-threatening, cardiac arrest rhythms. The purpose of defibrillation is to produce temporary asystole. The shock attempts to completely depolarise the myocardium and thus provide an opportunity for natural pacemaker centres of the heart to resume normal electrical activity (American Heart Association, 25). 1.2 This policy applies to designated Healthcare Providers working in Mid-Westem Regional Hospital, Limerick (MWRH), Mid-Western Regional Matemity Hospital (MWRMH), Mid-Western Regional Orthopaedic Hospnal (MWROH). 1.3 This policy does not cover the use of electrical therapy in the termination of tachyarrythmias in elective situations e.g. Synchronised Cardioversion. 2. Definitions: 2.1 Defibrillation is defined as the therapeutic use of electric current delivered to the patient in large amounts over very brief periods of time. (American Heart Association, 25). 2.2 Manual Handsfree Defibrillation is defined as the operator controlling the process of defibrillation by assessing the patient's Electrocardiograph (ECG) and selecting the energy setting for defibrillation if necessary. This process is carried out through placing external multifunction defibrillation electrode pads on the patient's chest (Philips, 25). 2.3 Automated External Defibrillation is defined as the process by which the defibrillator analyses the patient's ECG and advises the operator whether or not to deliver a shock. Voice prompts guide the operator through the defibrillation process by providing instructions and patient information. This process is carried out through placing external multifunction defibrillation electrode pads on the patient's chest (Philips, 25). 3. Policy Statement 3.1 Designated Healthcare Providers working in areas where a biphasic Heartstart XL defibrillator is available will be trained to operate this defibrillator in either Manual Handsfree mode or Automated External Defibrillator (AED) mode as appropriate. 3.2 To facilitate the provision of early defibrillation for the patient in the event of such an emergency occurring whilst awaiting arrival of the Cardiac Arrest Team or other medical personnel. Early defibrillation is critical to survival from VF/ pulseless Ventricular Tachycardia (VT) cardiac arrest. The probability of successful defibrillation diminishes rapidly over time. 3.3 The American Heart Association and European Resuscitation Council endorse the concept of early Cardio Pulmonary Resuscnation, (CPR) and early defibrillation as the standard of care for patients who develop sudden Ventricular Fibrillation (VF)/pulseless VT (American Heart ASSOCiation, 25). 3.4 The American Heart Association (25) recommends that self-adhesive pads should be used routinely instead of standard paddles to facilitate rapid administration of a shock when necessary. Title: Manual Handsfree & Automated External Defibrillation Po/icy at Mid-Western Regional Hospital, (MWRH), Umerick, Mid-Western Regional Or/hopaedlc Hospffal (MWROH) Croom and Mid-Western Regional Maternity Hospffal (MWRMH) Limerick Page 3 of 13

4 4. Criteria to be eligible for certification in Manual Handsfree or AED Defibrillation 4.1 Be a Healthcare Provider (e.g. Nurse. Cardiac Technician. Physiotherapist). 4.2 Have completed a Basic Life Support for Healthcare Providers Course w~hin the previous two years and provide certificate of same to the local Resusc~ation Officers when booking for Manual Handsfree or AED defibrillation training. Retraining is required every two years. 4.3ACLS Providers trained w~hin the previous two years and Heanhcare Providers following training in the Mid-Westem Regional Hospitals, Limerick will be expected to undertake the procedure in emergency events whilst acting within histher scope of practice. 4.4 Medical doctors attending cardiac arrests do not require formal certification in defibrillation. However, they are expected to ensure that they are competent in Manual Handsfree defibrillation. 5.Aims of Policy 5.1 To outline the criteria required to perform Manual Handsfree or AED defibrillation. 5.2To outline the procedure for designated staff to safely and effectively perform Manual Handsfree or AED defibrillation for patients who develop ventricular fibrillation/pulse less ventricular tachycardia. 5.3To implement a training programme to support the introduction of Manual Handsfree or AED defibrillation for designated staff. 5.4 To specify the process required to mon~or the effectiveness of the introduction of the practice of Manual Handsfree or AED defibrillation by designated staff. 6. Roles and Responsibilities 6.1 Staff performing Manual Handsfree Defibrillation must fulfil the criteria in section 4 of this policy. 6.2 All Nursing and Allied to Medical staff must attend a 4-hour training programme in Manual Handsfree Defibrillation and/or Automated External Defibrillation in the Resuscitation Training Department of the Mid- Western Regional Hospital, Limerick. 6.3 Trainees must successfully complete simulated handsfree defibrillation scenarios and assessments as appropriate. 6.4 A score of 84% or greater must be achieved in a multiple-choice questionnaire. 6.5 Ward Managers are responsible to ensure that their staff have appropriate training. 6.6 All staff who receive certified training are responsible to ensure that they maintain their training in accordance with this policy. Title: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRH). Urnerick, Mid-Western Regionat Orthopaedic Hospftat (MWROH) Croom and Mid-Western Regional Maternity Hospftal (MWRMH) Limerick Page 4 of 13

5 7. Training 7.1 Accredited Training is provided by the Resuscitation Department. 8. Procedure for Safe and Effective Manual Handsfree Defibrillation 8.1 On finding an unresponsive victim, the competent Healthcare Provider will perform the following steps: Establish that the patient is unresponsive and call for help and a defibrillator. The emergency response system and cardiac arrest team will be activated by dialling Commence C.P.R and continue until the defibrillator arrives When the defibrillator is brought, it should be placed on the left side of the victim whenever possible to ensure safe operation and application The defibrillator is switched to 'manual on' at the dial marked '1' on the front of the machine and turned to the appropriate energy setting,15 J in adult victims, 2 J/kg for the first shock in paediatric victims, follow with 4J/kg for second and subsequent shocks (American Heart Association 25) The Advanced Paediatric Life Support Group recommend 4J/Kg in paediatric victims for first and all subsequent shocks (Advanced Paediatric Life Support Group 25) The Healthcare Provider performing defibrillation ensures the victim's chest is checked for the presence of factors which may impede effective defibrillation such as the following (The 'P's) prior to application of multifunction pads: a) Perspiration or any moisture on the victim's chest. (Dry off chest wall, as a wet chest is not conducive to the effective conduction of the electrical current to the myocardium). b) Patches (Remove patch with gloved hand and wipe clean as the metallic backing on the patch can lead to arcing of the electrical current and thus contribute to transthoracic impedance). c) Pendants (Remove jewellery or metallic objects from area of pads site to prevent arcing of electrical current and to minimise risk of burns to the patient). d) Pacemakers/lCD (Apply pads inches (3-5cm) away from site to prevent arcing of current or damage to pacemaker). e) Playtex Ipiercings (Remove restrictive underwear. Apply pads inches (3-5cm) away from piercings). f) Remove excessive chest hair (Clip with scissors to allow good pad contact) If the victim is not already attached to a cardiac monitor, rhythm analysis is performed by application of multifunction pads to the patient Correct positioning of the pads should be ensured: Place one pad under the right clavicle to the right side of the victim's sternal border (follow diagram on pad) Title: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRH), Umerick, Mid-Western Regional Orlhopaedic Hospital (MWROH) Croom and Mid-Western Regional Maternity Hospital (MWRMH) Limerick Page 5 of 13

6 Place the remaining pad on the left hand side of the victim's chest in the mid-axillary line, below the left nipple and to the left of the sternum Connect the pads to the handsfree cable. Commence rhythm analysis and if appropriate proceed to defibrillate. 8.2The competent Healthcare Provider is responsible for ensuring a safe environment is maintained prior to charging the defibrillator and prior to defibrillation with no direct contact (e.g. touching victim) or indirect contact (e.g. touching BVM) made with the victimlbed while the victim is being defibrillated. 8.3 The Healthcare Provider operating the defibrillator achieves this by visually checking that all personnel are clear and verbalising the need to stand clear. CPR stops prior to analysis to facilitate accurate rhythm analysis. 8.4 When a shockable rhythm is interpreted and the victim is safely cleared, charge the defibrillator to the preselected energy level (15 J for adult patients, 2Jlkg for first shock in paediatrics, followed by 4J/kg for second and subsequent shocks (American Heart Association, 25) or 4J/K for first and all subsequent shocks (Advanced Paediatric Life Support Group 25) by pressing button number '2' at the front of the machine. 8.5Verbalise intention to defibrillate by clearly stating: "I'm clear, you are clear, everybody clear" or a similar clearing chant. 8.6 Wait for the audible indication from the machine that the defibrillator is charged and confinn that there has been no change in rhythm prior to pressing button number '3' (shock button) at the front of the machine. 8.7When the first shock has been given ensure that chest compressions are immediately resumed and that CPR continues uninterrupted for two minutes (5 cycles at a 3:2 compression!ventilation ratio, 1 cycles at 15: 2 if a second rescuer is available in paediatrics). See Appendix 2 8.8The E.C.G. leads should be attached to the patient's chest if not already done and the appropriate lead select option chosen. 8.9After completion of two minutes of CPR, chest compressions should be stopped and the rhythm on the monitor reassessed. 8.1 If the patient's cardiac rhythm remains unchanged, the patient should be defibrillated at intervals as per ACLS/PALS algorithm/guidelines (American Heart Association, 25) or APLS algorithm/guidelines (Advanced Paediatric Life Support Group 25) as appropriate wtth minimum interruptions to chest compressions. Visual and verbal checks will be carried out prior to the delivery of every shock to ensure safety for all personnel including the operator and clearing chants repeated If an organised rhythm is detected on the monitor when a rhythm analysis is perfonned at the end of two minutes of CPR, the pulse should be checked. If the patient has a pulse, but is not breathing ventilation should be supported at the rate of one breath every five to six seconds in the patient who does not have an advanced airway (every six to eight seconds in a patient with an advanced airway). Tftle: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRH), Limerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Croom and Mid-Western Regional Maternity Hospital (MWRMH) Limerick Page 6 of 13

7 8.121f no pulse is detected, CPR should be immediately commenced and the appropriate ACLS/PALS/APLS algorithm applied. See Appendix If a nat line is detected the nat line protocol should be completed as per ACLS guidelines and once confirmed follow appropriate ACLS IPALS Algorithm (American Heart Association, 25) or APLS algorithm (Advanced Paediatric Life Support Group 25) 8.14 If at any stage during defibrillation the defibrillator is charged and a shock is not indicated the disarm button at the front of the machine should be pressed to safely discharge the electricity not required. 9. Second Rescuer available Manual Handsfree Defibrillation 9.11f a second rescuer, competent in CPR, is available, CPR should be continued up to the point of rhy1hm analysis. 9.21f the patient is already attached to a cardiac monitor the rhy1hm will be immediately assessed and if shockable, multifunction pads then applied as outlined above. 9.3CPR continues while the pads are being applied 1. Paediatric Manual Handsfree Defibrillation 1.1 In the paediatric setting, for Manual Handsfree defibrillation, if the child is greater thanlkgs (greater than lyr old), use standard adult multifunction pads. At this point in time it is not recommended to use an AED in the in children less than 8 yrs old. (Philips Medical Systems, 25) 1.2 The adult multifunction pads may be placed in an anterior/posterior position if the multifunction pads are touching. (Philips Medical Systems, 25) 1.3 If the infant is less than 1 kg (less than 1 yr old), use the paediatricsize multifunction pads, which may need to be placed in an anterior/posterior position if the multifunction pads are touching.(philips Medical Systems, 25) 11. Procedure for Safe and Effective Automated External Defibrillation (AED): 11.1 Staff performing AED must fulfil the criteria in section 4 of this policy On finding an unresponsive victim, perform the following steps: 11.3 Establish that the patient is unresponsive and call for help and a defibrillator. The emergency response system and cardiac arrest team will be activated by dialling Commence C.P.R and continue until the defibrillator arrives When the defibrillator is brought, it should be placed on the left side of the victim whenever possible to ensure safe operation and application Turn the dial marked '1 ' at the front of the machine in an anti clock-wise direction to AED The Healthcare Provider performing AED defibrillation ensures the victim's chest is checked for the presence of factors which may impede effective defibrillation such as the following (The 'P's) prior to application of multifunction pads: Title: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRH), Umerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Croom and Mid-Western Regional Maternity Hosp#al (MWRMH) Limerick Page 7 of 13

8 Perspiration or any moisture on the victim's chest. (Dry off chest wall, as a wet chest is not conducive to the effective conduction of the electrical current to the myocardium) Patches (Remove patch with gloved hand and wipe clean as the metallic backing on the patch can lead to arcing of the electrical current and thus contribute to transthoracic impedance) Pendants (Remove jewellery or metallic objects from area of pads site to prevent arcing of electrical current and to minimise risk of burns to patient) Pacemakers/ICD (Apply pads inches (3- Scm) away from site to prevent arcing of current or damage to pacemaker) S Playtexipiercings (Remove restrictive underwear. Apply pads 1.S - 2 inches (3-Scm) away from piercings) Remove excessive chest hair (Clip with scissors to allow good pad contact) Apply multifunction pads to patient's chest ensuring correct pad placement. Place one pad under the right clavicle to the right side of the victim's sternal border (follow diagram on pad) Place the remaining pad on the left hand side of the victim's chest in the mid-axillary line, below the left nipple and to the left of the sternum. The machine will display a diagram to advise correct pad placement In the Paediatric setting, at this point in time it is not recommended to use an AED in children less than 8 years of age (Philips Medical Systems, 25), 11.1 If a second rescuer, competent in CPR, is available, CPR should be continued up to the point that the machine verbalises "analysing, do not touch patient" For Automated External Defibrillation, analysis will occur automatically once the multifunction pads are applied and connected to the handsfree cable. The machine will automatically charge if a shockable rhythm is detected The competent Healthcare Provider is responsible for ensuring a safe environment is maintained prior to the charging of the defibrillator and prior to defibrillation with no direct contact (e.g. touching victim) or indirect contact (e.g. touching BVM) made with the victim/bed while the victim is being defibrillated. The Healthcare Provider operating the defibrillator achieves this by visually checking that all personnel are clear and verbalising the need to stand clear The competent Healthcare Provider will verba lise intention to defibrillate by clearly stating: "I'm clear, you are clear, everybody clear" or a similar clearing chant Press button '3' to deliver shock when advised to do so by the machine. Title: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRH), Limerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Croom and Mid-Western Regional Maternity Hospital (MWRMH) Limerick Page 8 of \3

9 Press the pause button when prompted by the defibrillator after delivering a shock. When this button is pressed the machine will commence timing over a 12 second period When the shock has been given the Healthcare Provider will ensure that chest compressions are immediately resumed and that CPR continues uninterrupted for two minutes (5 cycles at a 3:2 compression /ventilation ratio, 1 cycles at 15: 2 ~ a second rescuer is available in paediatrics). See Appendix When the defibrillator prompts that the 2 minutes are up, beeps are heard. Check patient, if no pulse, press "analyze" button '2' If another shock is advised perform the above steps , 11.13, 11.14, 11.15, and If a "no shock advised" prompt is issued by the machine after analysis follow the voice prompts to "check patient" Check the patient's pulse and press pause button when prompted by the defibrillator. If there is no pulse present commence 2 minutes of CPR immediately. See Appendix If the pulse is present do not press the analyse button Check adequacy of breathing. If the patient is breathing inadequately, commence 1 breath every 5-6 seconds (1 breath every 6-8 seconds if an advanced airway is in place) reassessing the pulse after 2 minutes. See Appendix Continue the above steps as appropriate until advanced support assistance takes over. 12, Evaluation and Audit The Resuscitation Committee is responsible to ensure that audits are carried out at least once a year (See Appendix 1) The staff of the Resuscitation Training Dept. will carry out and/or lead the audits. 13. Implementation Plan 13.1 This revised policy will be distributed to all wards and departments by August 2 h 29 on beha~ of the Resuscitation Committee The Resuscitation Officers are responsible for ensuring all copies of the policy are distributed to each area and old copies of this policy retrieved from areas where applicable Changes in this policy will be disseminated through Resusc~at ion Training and by resusc~ation trainers to Clinical Managers who must ensure that all staff in their area are aware and read this policy This policy has been revised to incorporate MWROH and MWRMH Training will continue to be provided as before. Title: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRH), Umerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Croom and Mid-Western Regional Maternity Haspffal (MWRMH) Limerick Page 9 of 13

10 Bibliography and References: American Heart Association, (25). ACLS Provider Manual. Dallas: American Heart Association. American Heart Association, (25). PALS Provider Manual. Dallas: American Heart Association. American Heart Association, (25). Guidelines for CPR and ECC. Dallas: American Heart Association. Advanced Paediatric Life Support Group (25) The Practical Approach 4th Edition BMJ Books London An Bord Altranais, (2). Review of Scope of Practice for Nursing and Midwifery Final Report. Dublin: An Bord Altranais. Irish Heart Foundation, (26). Advanced Cardiac Life Support Guidelines G25. Dublin: Irish Heart Foundation. Philips Medical Systems (25). Philips Heartstart XL M4735A Instructions Manual MA USA Philips. Medical Systems Title: Manual Handsfree & Automated External Defibriffation Policy at Mid-Western Regional Hospital, (MWRH), Limerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Croom and Mid-Western Regional Maternity Hospital (MWRMH) Limerick Page 1 of 13

11 ApDtndixl AUPlllOOL proc;tdurj fur Safe and Effective Automated External Defibrillation /AEPlj P"slFall Cdteda' Audit failed if, all relevant questions below are not ticked as 1% Pass, Action in the event of fail: Retrain, retest and r&-evaluate at the earliest possible time and date Was it established that the patient was unresponsive and was there a call for helpj2777 and a defibrillator? Was C.P.R Comme!"lCed and continued until the defibrillator arrived? dial marked' I'turned in an anti- lock-wise direction to AED? i ii~~~~of~the~'~p~"~ch~ed<~~e<i~~ 11 objects of pads Inches (3-5cm) underwear. ~ w.n inches (3-5cm) away from plercings excessive chest hair I pads to patient's chest ensuring correct pad placement to the handsfree cable Cleared for analysis If a shog:ab!e rhythm was detected Ensured a safe environmen1 was maintained prior to pressing button 3 Ensured that chest compressions were immediately resumed Ensured CPR continued uninterrupted for two minutes If a "no shog: advised" prompt was Issued by the machine after analysjs' Checked the patienfs pulse Pressed the pause button when prompted by the defibrillator If no pulse was present commenced 2 minutes of CPR Immediately If the pulse was present: checked adequacy of breathing. If the patient was breathing inadequately, commenced 1 breath every 5-6 seconds If advanced airway was in situ: gave I breath every 6-8 seconds Reassessed the pulse after 2 minutes pu' Fail Audit failed if, all relevant questions below are not ticked as Action In the event of fail: Retrain, retest and ~aluate at the earliest possible tine and date Was it established that the patient was unresponsive and was there a call for helpl2m and a defibrillator? Was C.P.R Commenced and continued until the defibrillator arrived? Was the dial marked ~I" turned In a clock-wise direction to 15 Joules? Was the presence of the 'Ps' checked prior to application of pads? Perspiration or any moisture on the ylctlm's chest Dried off chest wall. ~: Removed patch with gloved hand and wiped clean pendants Removed jewellery or metallic objects from area of pads Pacemakers/lCD Applied pads inches (3-5cm) ~ Removed restrictive underwear. Piercings Applied pads Inches (3-5cr"n) away from piercings Hairy Chest: Removed excessive chest hair Applied multifunction pads to patienrs chest ensuring correct pad placement Conneded to the handsfree cable Cleared for analysis If a shockable rhythm was detected Ensured that environment was clear prior to charging and pressing button 2 Ensured a safe environment was maintained before shocking pressing button 3 Ensured that chest compressions were Immediately resumed following shock Ensured CPR continued uninterrupted for!ylo minutes If "an oraanlud rhythm Wil detected after analysis: Checked the patienrs pulse If no pulse was present: commenced 2 minutes of CPR immediately If the pulse was present checked adequacy of breathing. If the patient was breathing Inadequately, commenced 1 breath every 5-6 seconds If advanced airway was in situ: gave I breath every 6-8 seconds Reassessed the pulse after 2 minutes If a "flat-line" was detected after anatysj.: The flat-line protocol was completed as per ACLS guidelines If asystole was confirmed, ensured chest compressions continued for 2 minutes E:i!U Eiilil TiVe: Manual Handsfree & Automated Extemal Defibrillation Policy at Mid-Westem Regional Hospital, (MWRH), Limerick, Mid-Westem Regional Orthopaedic Hospital (MWROH) Croom and Mid-Westem Regional Matemity Hospital (MWRMH) Limerick Pagellofl3

12 Appendix 2 Manual Handsfree Defibrillation Algorithm No movement or response Phone Cardiac Arrest No; Get or send second rescuer (if available) Commence CPR and continue until arrival of the defibrillator If a second rescuer is available and doinq CPR continue CPR until point of analysis Switch Defibrillator to 'manual'on using dial 1 to the appropriate energy setting 15J Adult, 2 or 4J/Kg Paediatrics Check the victim's chest for the presence of 'P's' Apply the multifunction Dads in the correct position Connect the pads to the handsfree cable Analvse the rhythm Shockable rhythm? Title: Manual Handsfree & Automated External Defibrillation Po/icy at Mid-Western Regional Hospital, (MWRH), Limerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Groom and Mid-Western Regional Maternity Hospital (MWRMH) Limerick Page 12 of 13

13 Appendix3 Automated External Defibrillation Algorithm No movement or response Phone Cardiac Arrest No: Get Defibrillator or send second rescuer (if available) Commence CPR and continue until arrival of the defibrillator If a second rescuer is available and doina CPR continue CPR until Doint of analvsis Switch Defibrillator to 'AED'on usina dial 1 Check the victim's chest for the presence of 'P's' Applv the multifunction pads in the correct position Connect the pads to the handsfree cable Allow the defibrillator to analyse the rhythm Tff/e: Manual Handsfree & Automated External Defibrillation Policy at Mid-Western Regional Hospital, (MWRHJ, Umerick, Mid-Western Regional Orthopaedic Hospital (MWROH) Croom and Mid-Western Regional Maternity Hospital (MWRMH) Limerick Page l3ofl3

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15 1...;..., ' SciIWor!WiooP TITLE: Manual Handsfree & Automated External Defibrillation Policy Mid-Western Regional Hospital Limerick, Mid-Western Regional Orthopaedic Hospital, Croom, and Mid-Western Regional Maternity Hospital, Limerick I have read and understand this Guideline Name Area Date

16 TITLE: Manual Handsfree & Automated External Defibrillation Policy Mid-Western Regional Hospital Limerick, Mid-Western Regional Orthopaedic Hospital, Croom, and Mid-Western Regional Maternity Hospital, Limerick I have read and understand this Guideline Name Area Date