Guidelines and Proposed Model for Healthcare Facilities
 | | At least four professional healthcare organizations have issued recommendations for improved resuscitation practice. First, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that effective resuscitation and data review services are systematically available throughout the hospital.
Second, the AHA/ECC committee has several recommendations for achieving a consistent rapid defibrillation standard of care:
- “Healthcare providers with a duty to perform CPR should be trained, equipped, and authorized to perform defibrillation (Class IIa). Class IIa means “good to very good” evidence, a “standard of care” and an “intervention of choice” by most experts.
- “Health professionals with a duty to respond to a person in cardiac arrest should have a defibrillator available immediately or within 1-2 minutes.”
- “The goal of early defibrillation by first responders is a collapse-to-first-shock interval, when appropriate, of less than three minutes in all areas of the hospital and ambulatory care facilities (Class I). Class I means “excellent” evidence, “always acceptable, proven safe, and definitely useful.”
| | | Third, Emergency Medical Treatment and Active Labor Act (EMTALA) regulations now require facilities to achieve consistent resuscitation practice both in the hospital and at remote locations. Finally, the Veteran’s Health Administration has issued a directive regarding AEDs. Specifically, Directive 2001 advocates placement of AEDs to achieve defibrillator access within one minute and delivery of the first shock within three to four minutes. |
Proposed tiered resuscitation model An effective resuscitation model would be one in which an AED can be at the patient's side within 1 minute, an ACLS manual defibrillator and crash cart to the patient within 2 to 3 minutes (or as soon as needed), and the first shock delivered within 3 minutes by an expanded number of trained first-response personnel. Proposed Resuscitation Model: within 1 minute *AED at the patient’s side (“fire extinguisher model”) within 2-3 minutes
*ALS manual defibrillator at patient’s side within 3 minutes
First shock delivered *(or as soon as feasible, where ALS equipment is indicated) |
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