J ANET ’ S L AW Marlboro Township School Nurses

ASSEMBLY, N O STATE OF NEW JERSEY 215 TH LEGISLATURE “ ‘Janet’s Law’; requires public schools to have automated external defibrillators for youth athletic events and to establish certain plans relating to sudden cardiac events.”

A CCORDING TO J ANET ’ S LAW …. The AEDs are to be placed on school grounds. Their purpose is to be accessible in emergency situations before paramedics and ambulances can arrive. For every minute that passes, the survival chances for a sudden cardiac arrest victim falls 10% according to the Sudden Cardiac Arrest Foundation. According to Janet’s Law, “Schools shall establish and implement emergency action plans for responding to sudden cardiac events.” Each action plan shall include “a requirement of five school faculty members, who hold current certifications in CPR and the use of a defibrillator, and will also list the person(s) responsible for each designated action.”Sudden Cardiac Arrest Foundation

W HAT IS S UDDEN C ARDIAC A RREST ? Sudden Cardiac Arrest (SCA) is an electrical problem. It occurs when the heart’s electrical system malfunctions and the heart stops beating. The heart can no longer pump blood to the brain and vital organs. SCA occurs most often with little or no warning. SCA is NOT a heart attack. A heart attack is a plumbing problem. It occurs when one or more blood vessels become blocked thus preventing the proper flow of blood to the heart.

F ACTS A BOUT SCA: Leading cause of death in US, claims approximately 1000 people per day. Strikes persons of any age, gender, race, including those in good health. Most are un-witnessed, so survival rates are low (5%) If un-witnessed, urgent medical care can not be provided in a timely fashion. Less than 1/3 of SCA victims receive CPR.

F ACTS A BOUT SCA IN Y OUTH : 5000 and 7000 children die each year from SDA but this number may be grossly underestimated. Over 3000 youths aged succumb to cardiovascular death per year. The leading cause of death on school property. The leading cause of death in student athletes. A competitive athlete suffers SCA every 3 days. Over 64% of young athletes survived SCA if an AED program existed at the high school.

W HAT IS AN A UTOMATED E XTERNAL D EFIBRILLATOR ? An automated external defibrillator (AED) is a portable automatic device used to restore normal heart rhythm to patients in cardiac arrest. An AED is applied outside the body. It automatically analyzes the patient’s heart rhythm and advises the rescuer whether or not a shock is needed to restore a normal heart beat. If the patient’s heart resumes beating normally, the heart has been defibrillated. An AED is used to treat cardiac arrest. It is a life-saving device because cardiac arrest is a sudden condition that is fatal if not treated within a few minutes. Heart attacks and other conditions can cause ventricular fibrillation and other dysrythmias. This makes the electrical signals in the heart uncoordinated and ineffective. Very little blood is pumped from the heart to the body or the lungs. If the dysrythmias are not treated, Cardiac Arrest will result. AEDs are smart devices and will not allow you to shock a person whose heart does not need to be shocked. Prompt use of an AED increases survival chances.

A UTOMATED E XTERNAL D EFIBRILLATOR (AED) F ACTS : If defibrillated within the first minute of sudden cardiac arrest, survival chances are close to 90%. For every minute of delay in defibrillation, survival chances decrease by 10%. If an AED is delayed by more than 10 minutes, survival is less than 5%. An AED should be reachable within 90 seconds. Maximum time for first shock is within 6 minutes. It is estimated that as many as 40,000 lives could be saved annually with broad public access to defibrillators AEDs speak to you, instruct you in how to use the device and perform CPR.

THE SUDDEN CARDIAC ARREST CHAIN OF SURVIVAL Early Access to 911 Early CPR – a critical step – buys crucial time Early Defibrillation –This may be the single most important factor affecting survival Early Advanced Care – Paramedics on scene to ER

W HY IS TIME OF THE ESSENCE ? Once heart flat-lines, AED no longer works, only compressions will work Unlike in Frankenstein movie, a non-beating heart will not re-start with an electrical impulse The quicker the AED assesses the heart’s status, the better the chances of survival Just because we can’t feel a pulse, doesn’t necessarily mean that the heart has stopped – an AED can read what the heart is actually doing

S CHOOL B ASED C ARDIAC D RILLS : School Nurse as team lead “Code AED” called over intercom Security Guard to bring AED and assist in CPR Cardiac team members to report to event location Nurse or team member to contact 911 as appropriate Office staff to designate someone to meet and direct EMS to site of event Classroom coverage assigned by office as needed

W HAT DOES TEAM DO ? CHECK CALL CARE

H OW DOES TEAM HANDLE VICTIM ?? Gently roll over if on face and no sign of trauma or heavy bleeding Head-tilt, chin lift (one hand on forehead to stabilize & 2 fingers under bony part of chin to lift) Once airway open, check for breathing for no more than 10 seconds If no sign of breathing, start CPR immediate for an adult, but start with 2 rescue breathes for a child Apply AED as soon as it arrives at any time in process If normal pulse, main airway and monitor for changes If vomiting present, roll person on side and sweep mouth to remove foreign object

I F NEEDED, DON ’ T STOP CPR UNLESS … You notice obvious signs of life An AED is at hand and ready to be used Another trained responder or EMS personnel are ready to take control of event You are too exhausted to continue The scene becomes unsafe

P OST DRILL REVIEW : Team meets briefly after school on day of drill or morning following event to review event Administration included in meeting with emergency response team members Review documented plan for correctness and revise as needed Ensure Emergency Action Plan carried out in full and note where omissions occurred or where additions need to be made

R EFERENCES : _E1.PDF