TITLE 7
HEALTH
CHAPTER
27 EMERGENCY MEDICAL SERVICES
PART 8 CARDIAC
ARREST TARGETED RESPONSE PROGRAM
7.27.8.1 ISSUING
AGENCY: New Mexico Department of
Health, Public Health Division.
[7.27.8.1 NMAC - N, 7/1/2000]
7.27.8.2 SCOPE: These regulations are applicable
to all persons or entities operating an Automated External Defibrillator (AED)
Program within the State of New Mexico.
The regulations also apply to all AED training organizations, trainers,
Trained Targeted Responders, and Physician Medical Directors affiliated with an
AED Program.
A. Exemptions:
Certain individuals and agencies are exempted from this regulation, as outlined
below:
(1)
Individuals Authorized by Physicians: As outlined in the Cardiac Arrest
Response Act, Section 24-10C-1, et seq., NMSA 1978, nothing precludes a
physician from prescribing an AED to a patient for use by the patient’s
caregivers on an individual and the use does not require the individual to
function in an approved program.
(2)
Health Care Professionals: EMS personnel and/or other health care
professionals, who are authorized by other laws, regulations, and scopes of
practice to use and perform defibrillation in the out-of-hospital environment,
while performing official duties or within the scope of their employment.
(3) Military services: The United States
Department of Defense and the New Mexico Department of Military Affairs are
exempt from this rule when conducting official military operations.
[7.27.8.2 NMAC - N, 7/1/2000]
7.27.8.3 STATUTORY AUTHORITY: These
regulations are promulgated pursuant to the following statutory
authorities: 1) the Department of Health Act, Section
9-7-6.E., NMSA 1978, which authorizes the Secretary of the Department of Health
to “…make and adopt such reasonable and procedural rules and regulations as may
be necessary to carry out the duties of the department and its divisions”; 2)
the Cardiac Arrest Response Act, Section 24-10C-4.B., NMSA 1978, which
authorizes the Department of Health to approve training programs, and; 3) the
Emergency Medical Services Act, Section 24-10B-4.M., NMSA 1978, which
authorizes the Department of Health to adopt “rules to establish a cardiac
arrest targeted response program pursuant to the Cardiac Arrest Response Act,
…”
[7.27.8.3 NMAC - N, 7/1/2000]
7.27.8.4 DURATION: Permanent.
[7.27.8.4 NMAC - N, 7/1/2000]
7.27.8.5 EFFECTIVE DATE: July 1, 2000, unless a
later date is cited at the end of a section.
[7.27.8.5 NMAC - N, 7/1/2000]
7.27.8.6 OBJECTIVE: The purpose of these
regulations is to outline requirements for the New Mexico Cardiac Arrest
Targeted Response Program including: Establishment of a Cardiac Arrest Targeted
Response Program, AED Program registration, medical direction, training,
notification of local EMS Services and Public Safety Answering Points,
reporting, fees, and Bureau responsibilities.
[7.27.8.6 NMAC - N, 7/1/2000]
7.27.8.7 DEFINITIONS:
A. “Act” means the Cardiac Arrest
Response Act, Section 24-10C-1, et seq., NMSA 1978.
B. “Advanced Life Support (ALS)” means advanced pre-hospital and inter-facility care and treatment, including basic and intermediate life support, as prescribed by regulation, which may be performed only by a person licensed as a Paramedic by the Bureau and operating under medical control.
C. “AED Program” means a program of Trained Targeted Responders operating under the supervision of a Physician Medical Director that is registered with the Department.
D. “Basic Life Support (BLS)” means
pre-hospital and inter-facility care and treatment, as prescribed by
regulation, which can be performed by all licensed Emergency Medical
Technicians.
E. “Bureau” means the Injury Prevention and Emergency Medical Services Bureau of the Public Health Division of the New Mexico Department of Health.
F. “Defibrillation” means the administration of a controlled
electrical charge to the heart to restore a viable cardiac rhythm.
G. “Department” means the New Mexico
Department of Health.
H. “Emergency Medical Service (EMS)”
means the services rendered by licensed Emergency Medical Technicians,
certified Emergency Medical Services First Responders or Emergency Medical
Dispatchers in response to a person’s need for immediate medical care to
prevent loss of life or aggravation of physical or psychological illness or
injury.
I. “Medical Direction” means guidance
or supervision provided by a physician as outlined below:
(1) For
Emergency Medical Services (EMS): Medical Direction means guidance or
supervision to a provider or emergency medical services system and which includes
authority over and responsibility for emergency medical dispatch, direct
patient care and transport of patients, arrangements for medical control and
all other aspects of patient care delivered by a provider.
(2) For
the Cardiac Arrest Targeted Response Program: Medical Direction means guidance
or supervision for the AED Program including overseeing all aspects of the
defibrillation program. This includes
training, emergency medical services coordination, protocol approval, AED
deployment strategies, quality assurance and reporting.
J. “Physician” means a doctor of
medicine or doctor of osteopathy who is licensed or otherwise authorized to
practice medicine or osteopathic medicine in New Mexico.
K. “Protocols” means predetermined,
written medical care plans and includes standing orders.
L. “Provider” means a person or entity
delivering emergency medical services in New Mexico.
M. “Semi-Automated External Defibrillation (AED)” means a medical device heart monitor and defibrillator that:
(1) has received approval of its pre-market modification filed pursuant to United States Code, Title 21, Section 360(k), from the United States Food and Drug Administration;
(2) is capable of recognizing cardiac arrest that will respond to defibrillation, ventricular fibrillation or rapid ventricular tachycardia, and is capable of determining whether defibrillation should be performed; and,
(3) upon determining that defibrillation should
be performed, automatically charges and is capable of delivering an electrical
impulse to an individual’s heart, following activation by the equipment user.
N. “Trained Targeted Responder” means a person who has
completed an authorized AED training program and who uses an AED.
[7.27.8.7 NMAC - N, 7/1/2000]
7.27.8.8 Establishment of an AED Program:
A. Purpose:
The primary reason for establishing an AED Program is to improve response to
cardiac defibrillation of a person suffering from sudden cardiac arrest. Studies have shown that there is a better
chance for survival to hospital discharge if a person suffering from sudden
cardiac arrest is defibrillated within the first four (4) – six (6) minutes
following cardiac arrest. While
defibrillation does not automatically guarantee to restore a person’s heart
into a perfusing normal sinus rhythm, it is the only definitive care available
for this purpose. Therefore, persons
suffering from sudden cardiac arrest should be defibrillated as quickly as
possible. Defibrillation should also be
used with all other elements of the “Chain of Survival” as outlined by the
American Heart Association (AHA).
According to AHA, a break in the “Chain of Survival” will result in poor
survival rates. In addition, while
links of the “Chain of Survival” (below) must be strong, defibrillation is the
single most important factor in determining survival from adult cardiac arrest.
The elements of the “Chain of Survival” include:
(1)
Early access to emergency services;
(2)
Early initiation of cardiopulmonary resuscitation (CPR);
(3)
Early defibrillation; and,
(4)
Early advanced care by EMT-Paramedics, physicians and/or specially
trained nurses.
B. AED Program
Locations: Cardiac Arrest Targeted Response Programs may be initiated in
any venue where people gather, but should be typically targeted to public
facilities, businesses, meeting areas, buildings or any location where large
quantities of people gather.
[7.27.8.8 NMAC - N, 7/1/2000]
7.27.8.9 AED Program Requirements: Prior to
submitting an application for registration, the AED Program Director and
Medical Director shall insure that the AED Program incorporates the following
requirements:
A. AED
Program Director: A Program Director shall be identified who manages the
Cardiac Arrest Targeted Response Program.
The Program Director shall:
(1)
Identify a Physician Medical Director to oversee the AED Program;
(2)
Select and identify persons as Trained Targeted Responders;
(3)
Maintain AED training records for all Trained Targeted Responders while
they are active in the program, and for at least three (3) years thereafter;
(4)
Maintain AED Program records including AED maintenance records, Trained
Targeted Responder training records, and AED usage records;
(5)
Ensure that all Trained Targeted Responders are trained using a training
program which has been approved by the Department;
(6)
Provide evidence of coordination of the AED program with local EMS
services and emergency dispatch agencies, including 911 dispatch agencies;
(7)
Register the AED Program with the Department using the application
format outlined in Appendix A, and pay registration fees, as outlined in this
regulation;
(8)
Report all operational uses of the AED to the Department using the
reporting format outlined in Appendix B;
(9)
Assist the Physician Medical Director with quality assurance review of
all operational defibrillations; and,
(10)
Ensure AED equipment is maintained in accordance with the manufacturer’s
guidelines.
B. Physician Medical
Director: Each AED Program shall have a Physician Medical Director who
provides oversight of the AED Program.
The selected physician shall:
(1)
Provide medical leadership, expertise, and oversee the program;
(2)
Serve as an advocate and spokesperson for the AED Program;
(3)
Ensure that all Trained Targeted Responders are properly trained and
their skills are maintained;
(4)
Develop and approve medical protocols for the AED Program;
(5)
Ensure quality assurance review for all operational AED defibrillations;
and,
(6)
Assume overall responsibility for how the AED Program is planned and
conducted.
C. Trained
Targeted Responders: Individuals selected by the AED Program Director
and/or Physician Medical Director to train and use an AED are identified as
Trained Targeted Responders. Each
Trained Targeted Responder:
(1)
Prior to participating in an AED program, Trained Targeted Responders
shall complete an initial AED training course from a Department approved
training program, which is equivalent to the American Heart Association’s
Heartsaver AED Course. The course shall
include both cardiopulmonary resuscitation (CPR) and AED training.
(2) At
least every two (2) years, Trained Targeted Responders shall recertify in CPR
and AED training, by successfully completing a Department approved AED training
course, as outlined in section 9.3.1. above;
(3)
Activate the emergency medical system using pre-established methods
(contact E-911 public safety answering point or local emergency number) during
any operational response to a victim of cardiac arrest, and advise that AED is
being used;
(4)
Comply with Physician Medical Director protocols for operational
response to victims of cardiac arrest;
(5)
Report all operational responses to victims of cardiac arrest to the AED
Program Director and Physician Medical Director and complete a defibrillation report
as outlined in Appendix B. A copy of
the report shall be submitted to the Department within twenty (20) calendar
days.
(6)
Ensure AED’s are maintained and used in accordance with the
manufacturer’s guidelines, and inspect AED equipment at least monthly.
D. Registration:
All AED Programs shall be registered with the Department, as outlined below:
(1)
Initial Registration: The initial registration period shall be for a
period of four (4) years. The Program
Director for the AED Program shall complete the application provided in
Appendix A and submit it to the Department, along with the appropriate fees.
(2)
Renewal: AED Programs shall renew the AED Program every four (4) years
by completing a new application (Appendix A), submitted to the Department,
along with the appropriate fees.
(3)
Notification of Changes in Registration: The Department shall be notified when there is a :
(a)
change in AED Program Director;
(b)
change in Physician Medical Director;
(c)
change in physical address or telephone number; or,
(d)
stoppage or cancellation of the AED Program.
E. Fees: The Bureau shall establish a fee schedule for AED
Programs. A minimum of seventy five
($75) dollars shall be paid by the AED Program to the Department for initial
registration. For renewal, AED Programs
shall pay a minimum fee of fifty ($50) dollars to the Department.
F. Notification: Local EMS
services and emergency dispatch agencies shall be notified of the activation
and existence of the AED Program. The notification shall include the name of
the AED Program Director, Physician Medical Director, location of the program,
telephone number, a copy of medical director approved protocols, location of
the placement of AED(s), and the operational area where the AED(s) will be
used. The local emergency services and
dispatch agencies shall also be notified if an existing AED Program stops or
cancels the AED Program.
G. AED
Selection and Maintenance:
(1) AED Selection: AED Programs shall
acquire and use semi-automated cardiac defibrillators. These devices require the responder to deliver
the shock by pushing the shock button.
Automated defibrillators that deliver an electrical impulse to the
victim’s heart without user activation (pushing the shock button) are being
phased out and in many cases are no longer available. AED Programs that have a fully automated defibrillator (analyzes
and shocks without operator input) may petition the Bureau for a waiver to use
an automated defibrillator. A
list of manufacturers of AED’s is available from the Bureau.
(2) Maintenance: AED Programs shall maintain
the AED(s) and associated supplies and batteries in accordance with the
manufacturer’s suggested guidelines.
AED(s) and batteries shall be inspected/tested at least monthly to
insure readiness. A variance of this
inspection requirement may be granted by the Bureau for just cause. Those
AED(s) or batteries, which do not pass the monthly inspection, shall be removed
from service and the AED Program Director shall be notified immediately. Trained Targeted Responders shall also be
notified when an AED is removed from operational usage. Likewise, Trained Targeted Responders shall
be notified when an AED has been placed back into operation following
maintenance. Maintenance shall only be
performed on AED(s) by the manufacturer or their authorized service
center. Batteries shall be checked
during the monthly inspection and replaced if they are inoperable.
[7.27.8.9 NMAC - N, 7/1/2000]
H. Record
Keeping: Establish and maintain a record keeping system that is available
for audit. Include the following
information:
(1) List
of Trained Targeted Responders;
(2)
Dates of training for Trained Targeted Responders including CPR training
and AED training;
(3) Copy
of medical director approved medical protocols;
(4) Copy
of the medical director contract/agreement;
(5) Copy
of registration and EMS service notification forms;
(6) AED
usage reports/Data collection forms (Appendix C);
(7)
Quality assurance review documentation;
(8) AED
equipment purchase and maintenance records;
[7.27.8.10 NMAC - N, 7/1/2000]
7.27.8.11 Limited Immunity Protections: Limited
immunity protections are provided for persons or entities associated with an
AED Program. These protections are
provided when the AED Program is established and operated in accordance with
these regulations. AED Programs shall
meet all of the program requirements outlined in Section 9, above, to have this
limited liability coverage. The
following persons or entities who render emergency care or treatment by the use
of an AED under the provisions of the Act, shall not be subject to civil liability
provided they have acted with reasonable care and in compliance with the
requirements of the Act:
A. A physician who provides supervisory
services pursuant to the Cardiac Arrest Response Act;
B. A person or entity that provides
training in cardiopulmonary resuscitation and use of automated external
defibrillation;
C. A person or entity that acquires an
AED pursuant to the Act;
D. The owner of the property or facility where the AED is located; and,
E. The Trained Targeted Responder.
[7.27.8.11 NMAC - N, 7/1/2000]
7.27.8.12 APPENDIX
A
NEW MEXICO
CARDIAC ARREST RESPONSE AED PROGRAM
REGISTRATION
APPLICATION
APPLICATION DATE______/_____/_____ INITIAL REGISTRATION
MO/
DAY/ YR RENEWAL REGISTRATION
AED PROGRAM NAME:
AED
PROGRAM DIRECTOR: PHONE: (
) -
ADDRESS:
OPERATING LOCATION:
AED MEDICAL DIRECTOR :
ADDRESS:
PHONE: ( ) - NM LICENSE #:
Medical Director Signature ______________________________________________________________________
AED TRAINING PROGRAM:
ADDRESS:
INSTRUCTOR NAME:
PHONE: (
) - # TRAINED RESPONDERS:
(See
Required Attachments)
AED PLACEMENT LOCATION(s):
ADDRESS: PHONE: ( ) -
EMS NOTIFICATION: EMS
SERVICE EMERGENCY DISPATCH
DATE: ______/_____/_____ DATE: ______/_____/_____
MO/ DAY/ YR MO/ DAY/ YR
SERVICE
NAME:
SERVICE CONTACT:
APPENDIX A
NEW MEXICO
CARDIAC ARREST RESPONSE AED PROGRAM
REGISTRATION APPLICATION (continued)
I/We,
agree
to comply with all AED Program
Requirements as set forth in the State of New Mexico, Cardiac Arrest Targeted Response Program, Section 9. A fee of $75.00 (Initial Application)/$50.00 (Renewal Application) is attached.
DATE: ______/_____/_____
Program Director MO/ DAY/ YR
REQUIRED ATTACHMENTS:
Medical Protocols 
List of Responders, include
Name, Address, Phone #, and Training Completion Documentation
Mail your
application, fee and attachments to the address below. Make your check payable to the Injury
Prevention and EMS Bureau. If you have
questions regarding your application, contact the Bureau at 505-476-7701:
Injury Prevention and
EMS Bureau
PO Box 26110
Santa Fe, NM
87502-6110
[7.27.8.12 NMAC - N, 7/1/2000]
7.27.8.13 APPENDIX B
NOTIFICATION OF AED
PROGRAM
(Copy to be provided to local EMS Services and Emergency Dispatch Agencies)
NOTIFICATION DATE: INITIAL/RENEWAL REGISTRATION DATE:
______/_____/_____ ______/_____/_____
MO/ DAY/ YR MO/ DAY/ YR
NOTIFICATION TO: EMS Service Emergency Dispatch Agency
AED PROGRAM NAME:
AED PROGRAM DIRECTOR: PHONE: ( ) -
ADDRESS:
EFFECTIVE AED PROGRAM START DATE: _____________________________________________________
NOTIFICATION OF: (CHECK ONE)
PROGRAM
ACTIVATION (PROVIDE ALL INFORMATION BELOW)
PROGRAM
CANCELLATION
PROGRAM CHANGES
AED PROGRAM LOCATION:
ADDRESS:
PHONE: ( ) - EMS/911 NOTIFIED: YES NO
OPERATIONAL AREA:
AED
PLACEMENT:
DIRECTIONS TO LOCATION FOR EMS:
AED MEDICAL DIRECTOR : PHONE: (
) -
ADDRESS:
AED EQUIPMENT AT
SITE: LOCATION:
# of AEDs MANUFACTURER MODEL
ADDRESS:
PHONE: ( ) -
[7.27.8.13 NMAC - N, 7/1/2000]
7.27.8.14 APPENDIX
C
AED USAGE DATA COLLECTION FORM
AED RESPONSE ACTIVITY: Date: ___/____/____ Witnessed Event
MO/ DAY/ YR Non-Witnessed Event
Residential Commercial Industrial
Nursing
home Agricultural Health
Care Facility
Mass
gathering Recreation
Other,
Please identify:
NAME of AED RESPONDER(S):
EMS RESPONDING/TRANSPORTING SERVICE(S):
RESPONSE TIMES:
Estimated
Collapse/Arrest AED
Responder Scene Arrival
1st
AED Defibrillation EMS
Scene Arrival
1ST
CPR Transport
from Scene
Total time of event (Time of collapse to transport time) Hrs Min
Patient Response to AED defibrillation (indicate all that are appropriate):
Pulse restored Breathing restored Consciousness restored
Pulse Rate Respiration
Apparent
cause of arrest
Report Submitted By:
(
) -
Signature Telephone number
HOSPITAL DATA: (if obtainable from the receiving hospital)
Arrival Time:
Facility
Name: Location
(City/State):
Hospital record number____________
APPENDIX C
AED USAGE DATA COLLECTION FORM (continued)
On
Admission: Presenting rhythm Vital
Signs
ER Disposition:
Discharged to Home
Hospital admission to (list Unit)
(ICU,CCU, etc.)
Transfer to for
Facility
Name Transfer
Reason
Expired Cause of death
Diagnosed Cause of Arrest
Any
Device Failure or Injury Associated with AED Use?
COMMENTS:
Report Submitted By:
(
) -
Signature Telephone
number
[7.27.8.14 NMAC - N, 7/1/2000]
7.27.8.15 Appendix
D
Guidelines for Establishment of an AED
Program
The following guidelines may assist with establishing an AED Program for your agency, business, facility, or company.
Determine the need or support for an AED Program
in your company or facility. This
should be in the form of a letter of support from the chief executive of the
company or facility. Attach the letter
to the application.
Appoint a Physician Medical Director
as described in DOH Regulation NMAC 7.27.8, “Cardiac Arrest Targeted Response
Program” . This may or may not require
entering into a contract. It also may
require funds to pay for the medical director.
The Physician Medical Director should complete a “Medical Director
Agreement” if a contract is not used.
This written document provides the clear communication of the
expectations for the medical director and he/she acknowledges these
responsibilities by signing the agreement.
Identify individuals and establish a team to
implement the AED Program within the company or facility. If the company or business has already
established a medical response team, they may be utilized as long as the
requirements of the regulation are maintained.
Assure that all team members are
trained in cardiopulmonary resuscitation (CPR) and AED operation in accordance
with the regulation. The Department
uses the American Heart Association (AHA)
“Heartsaver AED” course as the standard. Other courses may also be used for this training as long as they
have been approved by the Injury Prevention and EMS Bureau (IPEMS Bureau) of
the Department of Health. This training
may be scheduled through an AHA Community Training Center (CTC).
Purchase a semi-automated AED. The AED may be purchased through several
different vendors. The requirements for
the AED are outlined in the Cardiac Arrest Targeted Response Program
Regulations.
The Physician Medical Director should develop
written medical protocols for response to victims of sudden cardiac arrest,
although these could be the standard national protocols outlined by the
AHA. However, all team members should
understand these protocols. In
addition, the medical director should approve the team members selected for
response. This ensures that he/she is
familiar with the individuals and their level of training/competence.
Complete an application for registration as an
AED Program and forward it to the IPEMS Bureau along with all supporting
documentation. Include support letters,
Physician Medical Director contract or agreement, written medical protocols,
list of all approved team members and their training documentation.
Once approval of registration is received from
the IPEMS Bureau, notify the local EMS Services and emergency dispatch agencies
of the establishment of the AED Program, along with location of defibrillators,
boundaries of the program operational response area, name of the AED Program
Director/Medical Director, and contact information. A copy of the medical protocols will also be helpful for these
agencies to understand how the AED Program Trained Targeted Responders will
handle victim encounters.
Report all operational usage of the AED to the
Physician Medical Director and IPEMS Bureau using the data collection form.
[7.27.8.15 NMAC - N, 7/1/2000]
History
of 7.27.8 NMAC Reserved