Model Cardiac Emergency Response Plan for Schools (CERP)
This Model Cardiac Emergency Response Plan was developed for schools by Readiness Systems. It is provided without cost and with no copyright restrictions. It may be freely adapted to individual school needs.
Table of Contents
Authority
This Cardiac Emergency Response Plan (CERP) is adopted pursuant to [insert statutory citation(s) here].
Purpose and Limitations
This CERP outlines the specific steps our school takes to minimize the risk of sudden cardiac death on school premises. While prompt cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use can be beneficial for some individuals experiencing sudden cardiac arrest (SCA), the reality is that survival rates are still quite low due to the severity of the condition. Our AED program aims to increase the chances of survival, although it cannot guarantee it.
No Standard of Care: This CERP does not establish a legal standard of care and deviation from the concepts described in this CERP does not indicate or imply that our school is operating below a reasonable level of conduct.
No Nationally Recognized Guidelines Exist: Some state laws mandate that schools include in their CERPs material that is considered “nationally recognized” and/or “evidence based.” The frameworks for school cardiac emergency response plans, including those offered by the American Heart Association, do not undergo external objective evaluation or approval. Likewise, there are no national guidelines or standards that endorse the objective classification of a CERP as “nationally recognized” or “evidence based.” Furthermore, no governmental or independent third-party entities have the authority to officially acknowledge a CERP as “nationally recognized” or determine its “evidence based” status. Verifiable compliance with these types of requirements is therefore impossible.
Managing Expectations
This CERP outlines our school’s good faith efforts to adhere to best practices and fulfill community expectations for our AED program. It is crucial to understand that our school is not a hospital emergency department, and our employees are not trained healthcare professionals experienced at responding to cardiac emergencies.
It is also essential to acknowledge that SCA is a very rare and challenging risk facing all organizations that have AED programs, including our school. There are three reasons why.
- Unpredictable Incidence: SCA can strike anyone, anywhere, at any time.
- Location Infrequency: Sudden cardiac arrest events may only occur at our school perhaps once every decade or longer.
- Responder Inexperience: Responding to SCA is a daunting task for volunteer bystanders, like our employees, who may never have encountered such an emergency before.
Despite these obstacles, we are committed to being adequately prepared for SCA emergencies and responding responsibly when the need arises.
AED Program Personnel
We have established the following specific roles and responsibilities for the individuals involved in our AED program.
- Program Coordination: These are the people responsible for administering and keeping our program current. We have one overall AED program manager, and we assign AED program site management to other individuals as needed.
- SCA Response: These are the people we allow to do CPR and access, retrieve and use AEDs. Our cardiac emergency response team strategies are described later in this CERP.
- Medical Direction: If required by law, we have a physician involved in our AED program. We do not otherwise involve a physician because AED programs like ours are administrative and operational rather than medical in nature. Indeed, physicians do not respond to our SCA events, no physician/patient relationship exists, and no practice of medicine occurs.
- Equipment Inspection and Maintenance: This group is responsible for inspecting and maintaining our equipment and ensuring our AEDs remain ready for use. Our equipment inspection and maintenance strategies are described later in this CERP.
We assign people to these roles though different people may fill these roles over time and some roles may be assigned to more than one person.
AED Response Time
AED response time is the elapsed period from the time a suspected SCA collapse is first recognized to the time an AED is first used. Total AED response time involves:
- Recognizing SCA (very challenging for volunteer bystanders)
- Deciding to retrieve or asking another person to retrieve an AED
- Retrieving an AED
- Using an AED
Our school strives to retrieve and use an AED within 5-minutes of the time SCA is first reasonably recognized. This is a response time goal, not a guarantee.
This 5-minute target is consistent with published emergency cardiac care guidelines and recognizes that AED programs like ours rely on non-medical people, under no obligation to act, in a setting not primarily focused on emergency medical care. It also allows for the reasonable uncertainty that results from asking volunteer lay bystanders to recognize cardiac arrest and respond to cardiac arrest emergencies.
Response Time in Context: We established our AED response time goal based on real-world expectations about how quickly volunteer lay bystanders can be expected to retrieve and use an AED when faced with a very rare and stressful SCA situation. Numerous factors can affect response time, including the unpredictable nature of human behavior in emergency situations and the difficulties lay bystanders may encounter in recognizing SCA.
Our AED response time objective reflects our aspirational, good faith efforts to help those experiencing SCA while recognizing the inherent limitations of volunteer workplace and community AED programs. The widely cited three-minute AED use target is unrealistic for AED programs like ours, as well as for many professional healthcare organizations.
AED Response Areas and Placement Locations
AEDs Covering School Premises: We have identified AED response areas within school boundaries that can be reasonably covered by one AED within our 5-minute AED response time target. For cabinet-based AEDs, we defined our AED response areas after considering the physical characteristics of the buildings, grounds and other spaces each device is expected to safeguard. We believe each of our AEDs can effectively cover the defined AED response areas they have been assigned to.
We have also selected one cabinet placement location within each of our AED response areas. In selecting these locations, we considered factors such as AED visibility, building characteristics, people and our response time objective.
Our stationary AEDs are stored in easily accessible, unlocked wall cabinets, each marked with an AED sign. We maintain a list of our cabinet-based AED locations in the administrative office and on our website. We periodically communicate AED placement locations by email to all staff members and parents. We also provide a list of AED placement locations to organizations that we authorize to use our school property for events or activities.
AEDs Covering Athletic Activities: Portable AEDs are assigned to athletic coaches and staff and are made available near school athletic activities including athletic contests, competitions, practices and scrimmages. AED enclosures (i.e., backpacks, hard cases) are clearly marked: “AED Inside.” Information about the availability of AEDs in proximity to athletic events and activities is periodically communicated via email to all athletic and school staff, and to parents.
Equipment Inspection and Maintenance
AEDs are designed to perform periodic self-tests of internal components and have visual status indicators showing their state of readiness based on these self-tests. In addition, AED batteries and pads have specified expiration dates before which they must be replaced.
AED Inspections: We have assigned personnel who periodically inspect and test our AEDs. These periodic visual inspections involve checking each AED’s visual status indicator. We rely on manufacturer-designed AED self-tests to trigger visual status indicator changes that tell us AED servicing is required. We document each of our AED inspection results. We may consider using a remote monitoring system to periodically check our AEDs. We will update this CERP if we implement such a system.
AED maintenance: If an inspection reveals that an AED visual status indicator is showing a “not ready” status, we take steps to have the AED serviced. We track battery and pad expiration dates and replace them before the end of useful life. If one of our AEDs is used, we follow manufacturer recommendations for putting it back in service.
AED Access and Use
AED Access: We recognize that the more people we allow to access our AEDs, the more likely an AED will be quickly taken to where it is needed. Toward that end, we expressly authorize any willing volunteer Good Samaritan bystander to access and retrieve our AEDs.
AED Use: We recognize that allowing or restricting who can use AEDs affects whether and how quickly these life-saving devices are used during SCA events. Our goal is to leverage all available resources to create the best chance of success if SCA happens on school property.
With this in mind, we allow and encourage any willing volunteer Good Samaritan bystander to use any of our AEDs should one be needed. This approach is intended to empower and enable employees, students, parents and other willing bystanders to take prompt action in the event of a suspected SCA emergency. This approach is incorporated into how we structure our cardiac emergency response team, covered below.
Volunteer Bystander Limitations: It is important to recognize that our AED use strategies do not create, imply or assume a requirement or responsibility for any individual to act when faced with an SCA emergency. Generally, trained and untrained volunteer bystanders must choose to act. They cannot be compelled to act, though we hope they will.
Cardiac Emergency Response Team (CERT)
Our cardiac emergency response team (CERT) is made up of individuals who are empowered and permitted to perform CPR and access, retrieve and use AEDs. In developing our CERT approach, we considered the following factors:
CERT Membership is Dynamic: A CERT is typically not one specific group of designated individuals. Rather, it will dynamically vary in form and structure over time. This is because our staffing will necessarily change as school needs dictate and because onsite visitors may be available and willing to help.
Anyone Can Do CPR and Access, Retrieve and Use AEDs: Anyone, trained or untrained, can be allowed to do CPR and access, retrieve and use AEDs. Neither community standards nor AED laws prohibit anyone from performing these potentially life-saving skills.
Training Strategies and CPR/AED Intervention Strategies Are Different: Training strategies relate to who and how many of our staff members receive CPR/AED training that results in the issuance of a course completion card (formal training). CPR and AED intervention strategies relate to who we allow to do CPR and access, retrieve and use AEDs, regardless of training status. A CERT can include people with and without formal training because anyone can try to save a life.
AED Law Training Requirements Do Not Dictate CERT Membership: While AED laws may require people in certain roles to receive formal training (e.g., teachers, coaches, school nurses, etc.), these laws do not define or dictate CERT membership. Our AED program retains the flexibility to develop CERT strategies that best meet our needs and create the best chance of success.
It is Unrealistic to Expect CERTs to be Staffed With Only Formally Trained People: Because SCA occurrences are very rare and it is impossible to predict who, where or when SCA will strike, it is not logical, realistic or economically feasible to expect our AED program to have formally trained staff available 100 percent of the time.
Taking these factors into account, our approach recognizes two categories of CERT members:
Category 1 Responders: CERT members who have received formal CPR/AED training and who voluntarily choose to respond to suspected SCA events as Good Samaritans.
Category 2 Responders: CERT members who lack formal CPR/AED training but who have general knowledge about the benefits of CPR and AEDs; AED locations; how to respond to suspected SCA emergencies, do CPR and use AEDs; and who voluntarily choose to respond to suspected SCA events as Good Samaritans.
By leveraging a widely inclusive interventional approach, coupled with the broad AED access, retrieval and use framework described earlier, our school embraces the following tiered CERT strategy.
- Category 1 Responders are encouraged to respond to SCA emergencies if available, and are authorized to do CPR and access, retrieve and use AEDs.
- If no Category 1 Responders are immediately available or willing to act, any willing Category 2 Responder is authorized to do CPR and access, retrieve and use AEDs.
We make good faith efforts to have at least one formally trained CERT member within each AED response area during normal business and athletic activity hours. But, for the reasons explained above, it is infeasible for us to ensure a formally trained CERT member will be available 100 percent of the time. Our tiered CERT approach accounts for this limitation.
Training
Because we use a tiered CERT strategy, we formally train enough nurses, teachers and staff members so that at least one Category 1 Responder with a current course completion card will be available in each non-athletic-activity AED response area at least eighty-five percent (85%) of the time.
Our aim is to have at least one Category 1 Responder available in proximity to all athletic activities at least ninety-five percent (95%) of the time. Toward that end, the athletic director, all coaches, all athletic trainers and all school nurses are required to complete formal CPR and AED training and possess a current course completion card.
A list of formally trained CERT members is maintained in the administrative office and includes names, email addresses and cell phone numbers.
To build awareness about SCA, CPR and AEDs, and inspire confidence to act, we periodically distribute information and show short informational cardiac arrest response videos to our entire school community. The goal of this activity is to increase the chances of success by creating a large population of Category 2 Responders who learn about:
- The purpose and capabilities of AEDs.
- The AED program and its benefits.
- The presence and location of our AEDs.
- What to do in the event of a suspected sudden cardiac arrest emergency.
No Expected AED Users: Some AED laws say “expected AED users” must be trained. In our AED program, no person is an “expected AED user.” This is because volunteer lay bystanders are not required to act nor can we compel them to act. Our approach is that any willing person is permitted to do CPR and use an AED, but we cannot “expect” them to do so.
Cardiac Emergency Response Team Activation
We maintain a list of all CERT members in the administrative office and all members are added to text message and email groups accessible to administrative staff.
Our CERT activation process involves the following steps:
RECOGNIZE
Category 1 or Category 2 Responders should be on the lookout for an individual who:
- Suddenly collapses
- Appears to have no pulse
- Does not appear to be breathing normally
- Appears to be unconscious
INTERVENE
The Responder recognizing SCA should immediately:
- Begin CPR
- Use the AED when it arrives
COMMUNICATE FROM SCA LOCATION
The Responder should simultaneously ask others nearby to:
- Retrieve the closest AED
- Call 911 and the administrative office to report a suspected sudden cardiac arrest, the specific location on school grounds and whether the person experiencing SCA is an adult or child
COMMUNICATE FROM ADMINISTRATIVE OFFICE
Administrative office staff should immediately:
- Call 911 and report a suspected sudden cardiac arrest at a specific location on school grounds
- Notify the CERT via text, email and all-school public address announcement that there is a suspected sudden cardiac arrest, its specific location, and that there is a need to retrieve and deliver an AED to the location
- Notify campus security of the event
- Instruct one or more individuals to meet responding emergency medical units and guide them to the SCA location
Drills
We conduct two cardiac emergency response drills annually. One originates in a classroom setting and one originates in a sports venue.
EMS Integration
We send a copy of this CERP to local emergency medical services providers. In our CERP communications we emphasize that the primary method of EMS integration is for 911 to be called as quickly as possible after a suspected SCA is first reasonably recognized.
Annual Review
This CERP is reviewed annually by administrative, medical and security staff and updated as needed.
The Fine Print
This Model Cardiac Emergency Response Plan was developed for schools by Readiness Systems and is provided without cost and with no copyright restrictions. It may be freely adapted to individual school needs.
Readiness Systems worked to provide schools with trusted, informed and comprehensive guidance that follows best practices. But every school AED program is different, and we operate in a highly litigious environment. So, Readiness Systems is compelled to include the following “fine print” with this CERP.
Compliance with Plan
Each school is solely responsible for operating its AED program in reasonable compliance with this CERP.
Disclaimer of Liability
Readiness Systems disclaims liability for any personal injury, property or other damages of any nature whatsoever, whether special, indirect, consequential or compensatory, directly or indirectly resulting from the publication, use of, or reliance on this CERP.
Not Legal Advice
This CERP is provided for informational purposes only and is not intended to be, does not constitute, and should not be relied upon as legal advice or legal services. Readiness Systems does not offer or provide legal advice or legal services.
Limited Services Warranties
Readiness Systems makes no representations or warranties regarding the results to be achieved through implementation or operation of any AED program based on this CERP.
Not a Standard of Care
The information provided in this CERP does not establish a legal standard of care and deviation from the concepts described in this CERP does not indicate or imply that a school is operating below a reasonable level of conduct.