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Cardiac Emergency Response Plan (CERP) PROTOCOL

Ritenour School District

Sudden cardiac arrest events can vary greatly. All staff and Cardiac Emergency Response Team (CERT) members must be prepared to perform the duties outlined below. Immediate action is crucial to successfully respond to a cardiac emergency. Consideration should be given to obtaining on-site ambulance coverage for high-risk athletic events. One should also identify the closest appropriate medical facility that is equipped with advanced cardiac care.  

Follow these steps in responding to a suspected cardiac emergency: 

  1. Recognize the following signs of sudden cardiaac arrest and act quickly in the event of one or more of the following:
    1. The person is not moving, unresponsive, or unconscious.
    2. The person is not breathing normally (has irregular breaths, gasping or gurgling, or is not breathing at all).
    3. The person may appear to be having a seizure or is experiencing convulsion-like activity. Cardiac arrest victims commonly appear to be having convulsions. If the person is having a seizure without a sudden cardiac arrest an AED will not deliver a shock.
    4. If the person received a blunt blow to the chest, this can cause cardiac arrest, a condition called commotio cordis. The person may have the signs of cardiac arrest described above and is treated the same.
       
  2. Facilitate immediate access to professional medical help:
    1. Call 9-1-1 as soon as you suspect a sudden cardiac arrest. Provide the facility address, cross streets, and patient’s condition. Remain on the phone with 9-1-1. (Bring your mobile phone to the patient’s side and put on speaker, if possible.) Give the exact location and provide the recommended route for ambulances to enter and exit and escort emergency responders to the victim.
    2. Immediately contact the members of the Cardiac Emergency Response Team (CERT) using your facility’s designated communication system (i.e. walkie talkies, overhead page).
    3. If you are a CERT member, proceed immediately to the scene of the cardiac emergency.
       
  3. Start CPR as soon as possible. The first person who can start CPR should begin immediately and, if additional bystanders are available, other tasks can be delegated. 
    1. Begin continuous chest compressions and have someone retrieve the AED if not at the scene.  Referred to the Act Now. Save a Life. (Simplified Adult Basic Life Support) graphic below. 
    2. Press hard and fast in the center of the chest, at 100-120 compressions per minute. (Faster than once per second, but slower than twice per second.) Use 2 hands: The heel of one hand and the other hand on top (or one hand for children under 8 years old), pushing to a depth of at least 2 inches (or 1/3rd the depth of the chest for children under 8 years old). Follow the 9-1-1 telecommunicator’s instructions, if provided. 
    3. If you are able and comfortable giving rescue breaths, please use a barrier and provide 2 rescue breaths after 30 compressions. 
       
  4. AED Access. The person who can retrieve the AED the fastest (ideally in route to the scene) should get it to the site and leave the AED cabinet door open as a signal that the AED was retrieved. 
     
  5. Additional communication measures 
    1. Give the exact location of the emergency. (“Mr. /Ms. ___ Classroom, Office or Room # ___, gym, football field, cafeteria, etc.”). Be sure to let EMS know which door to enter. 
    2. Assign someone to go to that door to wait for and flag down EMS responders and escort them to the exact location of the patient. 
       
  6. Use the nearest AED. 
    1. When the AED is brought to the patient’s side, press the power-on button, and attach the pads to the patient as shown in the diagram on the pads. Then follow the AED’s audio and visual instructions.  If the person needs to be shocked to restore a normal heart rhythm, the AED will deliver one or more shocks. Be familiar with your school’s AED and be aware if you will need to press the shock button or if it will deliver automatically. 
      1. Note: The AED will only deliver shocks if needed; if no shock is needed, no shock will be delivered. 
    2. Minimize interruptions of compressions when placing AED pads to patient’s bare chest. 
    3. Continue CPR until the patient is responsive or a professional responder arrives and takes over. Make sure to rotate people doing compression to avoid fatigue. 
    4. Do not remove AED pads even if the patient regains consciousness - the pads should be left in place until handoff to EMS occurs. This precaution is necessary in case the patient has a relapse. 
    5. If the AED is used be sure to have a plan to download the data, store the data, and deliver to the patient’s cardiology care team. 
       
  7. Transition care to EMS. 
    1. Once EMS arrives, there should be a clear transition of care from the CERT to EMS. 
    2. Team focus should now be on assisting EMS safely out of the building/parking lot. 
    3. Provide EMS a copy of the patient’s emergency information sheet. 
       
  8. Action to be taken by Office / Administrative Staff. 
    1. Confirm the exact location and the condition of the patient. 
    2. Activate the Cardiac Emergency Response Team and give the exact location. 
    3. Confirm that the Cardiac Emergency Response Team has responded. 
    4. Confirm that 9-1-1 was called. If not, call 9-1-1 immediately. 
    5. Assign a staff member to direct EMS to the scene. 
    6. Perform “Crowd Control” – directing others away from the scene. 
    7. Notify other staff: school nurse, athletic trainer, athletic director, safety director, safety manager, leadership, sports facilities manager, etc. 
    8. Plan for ongoing coverage following an emergency response in case a subsequent event occurs. 
    9. Consider having the people (e.g., staff, students) stay in place (e.g., delaying class changes or hallway traffic, services provided, dismissal, recess, or other changes) to facilitate CPR and EMS functions. Designate people to cover the duties of the CPR responders. 
    10. Copy the patient’s emergency information for EMS. 
    11. Notify the patient’s emergency contact (parent/guardian, spouse, etc.). 
    12. Notify faculty and students, staff, employees, and sports attendees when to return to the normal schedule or services. 
    13. Contact organization leadership (e.g., school district administration), human resources and/or other facility management (e.g., sports facility management). 
       
  9. Debrief 
    1. Discuss the outcome of the cardiac emergency. This shall include but not be limited to a summary of the presumed medical condition of the person who experienced the cardiac emergency to the extent that the information is publicly available. Personal identifiers should not be collected unless the information is publicly available. 
    2. An evaluation of whether the CERP was sufficient to enable an appropriate response to the specific cardiac emergency. The review shall include recommendations for improvements to the Plan and in its implementation if the plan was not optimally suited for the specific incident. The post-event review may include discussions with medical personnel (ideally through the organization’s medical counsel) to help in the debriefing process and to address any concerns regarding on-site medical management and coordination. 
    3. An evaluation of the debriefing process for responders and post-event support. This shall include the identification of aftercare services including crisis counselors.