Purpose: This establishes the minimum guidelines for Prehospital Automated External Defibrillator (AED) for persons functioning under the medical control authority of the North Mississippi Emergency Medical Services Authority (NMEMSA) and the Tupelo Fire Department. All persons who are identified as Prehospital AED operators shall meet the requirements of this standard.

Use of AEDs in the prehospital setting by First Responders is limited to EMRs, EMT-Bs,

EMT-Is, EMT-Ps, Nurses, Physicians who have successfully completed an approved AED

Training Program. First Responders must be certified by the NMEMSA to perform this skill.

NMEMSA "AED Authorization" forms must be signed by the First Responder, operations manager of the fire rescue service, off-line medical director(s) and NMEMSA Executive Director, to allow the First Responder to use the AED.

AED training program must adhere to guideline established by the American Heart Association (AHA), Mississippi Affiliate, and NMEMSA.

AED training is valid for 24 months at which time the full AED training program (4 hour minimum) must be repeated. Periodic AED practice (30-60 minutes) is required at least every 90 days. Successful performance of defibrillation skills on actual patients can be counted in lieu of this practice. Documentation of full training and practice training should be kept on file at the fire/rescue department.

AED devices must be a defibrillator which: (a) is capable of cardiac rhythm analysis; (b) will charge and deliver a shock after electrically detecting the presence of a cardiac dysrhythmia or is a shock-advisory device in which the defibrillator will analyze the rhythm and display a message advising the operator to press a "shock" control to deliver the shock; (c)must be capable of printing a post event summary (at a minimum the post event summary should include times, joules delivered, ECG; and (d) an on screen display of the ECG (optional).

All agencies utilizing AEDs should also be equipped with extra batteries on hand with the device and an ECG simulator to use for practice training (optional).

First Responders are prohibited from operating manual defibrillator or operating AEDs in the manual mode. If the AED is equipped with manual override, only authorized ALS providers (EMT-Ps, Rns, or Physicians) may use this feature.

The AED shall be carried to the patients' side on any call involving a cardiac and/or pulmonary related emergency. AED authorized First Responders may apply the device only if the patient is in complete cardiac arrest, is 8 years of age or older.

Once resuscitation and use of AED is initiated by an authorized First Responder, patient care efforts must continue until the First Responder is relieved by a Mississippi licensed ambulance service.

When AED trained First Responders are present along with ALS providers, the ALS trained (and authorized) providers always have the authority over the scene in accordance with the Mississippi EMS Laws, Rules, and Regulations.

EKG rhythms should not be analyzed by AEDS if the patient is in a moving vehicle. Exception: If an ALS provider, by visual interpretation, confirms the presence of a shock rhythm.

If the AED algorithm is implemented initially with subsequent intervention by a ALS provider, the ALS provider will recognize any therapy delivered under the AED algorithm and include this prior therapy as part of this ACLS protocol/algorithm.

The ALS provider is responsible for completing the patient care report including information provided by the First Responder. Information provided to the ALS provider from the First Responder shall include:

Approximate time of collapse/arrest
Time First Responder en route to scene
Time First Responder arrived at scene
Time BLS/CPR initiated
Time of all defibrillation by AED
All patient interventions performed prior to arrival of ALS

Periodic care and maintenance of AEDs shall, at a minimum, be performed in accordance with guidelines suggested by the manufacturer and printed in JAMA Vol. 264, No. 8, August 22/29, 1990, page 1024. AEDs shall be checked by an AED trained First Responder. The minimum requirements for this check shall be in accordance with guidelines established by the Defibrillator Working Group of the Center for Devices and Radiological Health, Food, and Drug Administration, rev 1.1d, 2/90.