1. Pediatric Defibrillation Medical Directive Change March 30, 2009

2. When? Amendments to the ALS Patient Care Standards, June 2007, Version 2.1, Appendix 1 Symptom Relief and Cardiac Arrest Medical Directive for PCP’s and ACP’s is now effective March 30, 2009

3. Who? Pediatric Patients ≥1 and <8 years old Affects all PCPs who perform SAED

4. Where? Provincial change endorsed by MAC Provincial i.e. Ontario

5. Why? Recent studies indicate that the change is necessary for the most appropriate treatment of pediatric patients in a shockable rhythm. AHA Guidelines were unclear about this in 2005.

6. What? OLD General traumatic arrest protocol Manual defibrillation applies to all ages NEW Applies to all protocols Manual defibrillation applies to patients > 30 days

7. What changes? OLD AED without pediatric attenuator cables, applies to patients ≥ 8 years old. NEW AED, applies to patients ≥1 years old.

8. What changes? OLD AED with automated rhythm analysis and pediatric attenuator cables, applies to patients ≥1 and < 8 years old. NEW In patients ≥1 and <8 years old reduced energy level options are:

9. What? AED with automated pediatric rhythm analysis and energy attenuation through attenuation cables or other, manual energy selection Manufacturer dependent Service operator needs to look at equipment/training implications

10. What? Manual defibrillation with an approved education program Service operator needs to decide if this part of the Directive fits with current service delivery strategy

11. What? Where one of these methods is available, it must be used. If reduced energy is not available, a paramedic may use adult pads and adult energy settings

12. What? Transport of the Cardiac Arrest Patient: PCP/ACP In unusual circumstances such as pediatric patients < 16 years old, paramedics may consider early transport after the first no shock message or first non-VT/VF manual rhythm analysis

13. What? Transport of the Cardiac Arrest Patient: PCP Part a. adds: “or four manual interpretation/rhythm checks have been completed” **This is for PCP’s whom are certified in manual defibrillation**

14. Pad Placement Paramedics that are not certified in manual defibrillation and their defibrillator does not have pediatric attenuator cables or another means of attenuating the energy need to use adult pads with adult joule settings for pediatric patients.

15. Pad Placement Do we use the same pad placement on a pediatric patient using adult pads?

16. Pad Placement When using adult pads for defibrillation of pediatric patients anterior/posterior placement is recommended  Stat-Padz application should be Anterior/Posterior

17. How? The Base Hospital will be working with your Service Operator to allow the best solution in a given area

18. Questions? Please contact the Base Hospital office