PAD Cover Letter

March 18, 1999

To: Persons or Organizations Wishing to Provide Public Access Defibrillation

From: Southern Tier Regional Emergency Medical Services Council

Re: Process to Become a Public Access Defibrillation Provider in Chemung, Schuyler and Steuben Counties

Recent changes in Public Health Law now allow the lay public to utilize Automated External Defibrillators (AEDS) under certain conditions. This is referred to as Public Access Defibrillation (PAD). For example, an organization may wish to have key personnel such as security guards, trained in the use of AEDS. An AED analyzes the heart's rhythm and helps treat victims of cardiac arrest.

According to this new legislation, Regional Emergency Medical Services (EMS) Councils have been designated in each region of the State to be responsible for coordinating and maintaining information and data collection and analysis as part of a Quality Assurance (QA) program.

As a matter of background information, the Southern Tier Regional Emergency Medical Services Council is the statutory body designated by the Commissioner of Health of the State of New York under Article 30 to coordinate the EMS system in the counties of Chemung, Schuyler and Steuben.

All persons or organizations within the STREMS Region wishing to provide PAD will be required to forward information and QA data to the STREMS Council.

In order for you or your organization to begin providing PAD under the new legislation, you must first do the following:

1. Obtain a physician or hospital (its Chief Executive Officer or designee) to become your Emergency Health Care Provider. The physician must be licensed and have knowledge of emergency cardiac care. The hospital must be licensed under Article 28 of the Public Health Law and provide emergency cardiac care.

2. Submit a written Collaborative Agreement between yourself (person or organization) and the Emergency Health Care Provider (physician or hospital Chief Executive Officer or designee ) to the STREMS Council. Attached you will find a SAMPLE Collaborative Agreement* that you may use. If you wish to develop your own, please refer to Section 3000-B of Article 30.

3. Submit information regarding all of your AEDs to the STREMS Council using the form provided (see attached form Notice of Intent to Provide PAD*).

4. Designate key personnel from your organization to receive training in PAD through an approved organization. You may contact the Offices of the Council to find out the names and addresses for the NYS Approved PAD curricula. Only New York State approved PAD curricula may be used for training.

Once your organization has completed the above process, you need to do the following:

1. Inform the Regional EMS Council each time an AED is used on a patient, via a written report to be completed by your Emergency Health Care Provider (physician or hospital Chief Executive Officer or designee) within five (5) days of the incident. Use the attached, one-page QA Report Post-Use of an AED By a PAD Provider in the STREMS Region.

2. Maintain your AED equipment according to manufacturer's standards.

3. Provide refresher training to your AED operators as required. PAD providers are strongly encouraged to participate in the STREMS Region Recertification Program for AED Providers.

4. Inform the Regional EMS Council in writing, within five (5) business days if your Emergency Health Care Provider changes or resigns.

In addition to the items previously listed, you will also find attached an overview of the legislation and some suggestions to maintain an effective PAD program within your organization.

If you have any questions regarding the implementation of a PAD program or questions regarding specific items enclosed in this packet, please do not hesitate to contact the STREMS office at 732-2354.

Thank you for your interest in providing early defibrillation in the STREMS region.

Community marketplace *The packet and forms referred to above are available from the STREMS Office at 315 West Water Street, Elmira NY 14901; you may call (607-732-2354 ext. 10), fax (607-732-2661) or e-mail (strems@stny.rr.com) your request. Or you may download the packet here PAD Packet. The packet is in Adobe Acrobat PDF (Portable Document File) format. If you do not have Adobe Acrobat Reader, you may download it free from Adobe. Just click on the graphic:

Excerpts of the 1998 Revision of SECTION 3000-B, ARTICLE 30 OF THE
NYS PUBLIC HEALTH LAW - AUTOMATED EXTERNAL DEFIBRILLATORS:
PUBLIC ACCESS DEFIBRILLATION
(and as adapted for the STREMS Region)

Definitions. As used in this section, unless the context clearly requires otherwise, the following terms shall have the following meanings:
A)	"Automated External Defibrillator" means a medical device, approved by the United States food and drug administration, that: I) is capable of recognizing the presence or absence, in a patient, of ventricular fibrillation and rapid ventricular tachycardia; II) is capable of determining, without intervention by an operator, whether defibrillation should be performed on the patient; III) upon determining that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to the patient's heart; and M then, upon action by an operator, delivers an appropriate electrical impulse to the patient's heart to perform defibrillation.
B)	"Emergency Health Care Provider" means: I) a physician with knowledge and experience in the delivery of emergency cardiac care; or II) a hospital licensed under article twenty-eight of this chapter that provides emergency cardiac care.
C)	"Public access defibrillation provider" means a person, firm, organization or other entity possessing or operating an automated external defibrillator pursuant to a collaborative agreement under this section.
	"Nationally-recognized organization" means a national organization approved by the department for the purpose of training people in the use of an automated external defibrillator.
2. Collaborative Agreement. A person, firm, organization or other entity may purchase, acquire, possess and operate an automated external defibrillator pursuant to a collaborative agreement with an emergency health care provider. The collaborative agreement shall include a written agreement that incorporates written practice protocols, and policies and procedures that shall assure compliance with this section. The public access defibrillation provider shall file a copy of the collaborative agreement with the department and with the appropriate regional Council prior to operating the automated external defibrillator.
3. Possession and operation of automated external defibrillator. Possession and operation of an automated external defibrillator by a public access defibrillation provider shall comply with the following:
A)	No person may operate an automated external defibrillator unless the person has successfully completed a training course in the operation of an automated external defibrillator approved by a nationally-recognized organization or the state emergency medical services Council, and the completion of the course was recent enough to still be effective under the standards of the approving organization. However, this section shall not prohibit operation of an automated external defibrillator, I) by a health care practitioner licensed or certified under title VIII of the education law or a person certified under this article acting within his or her lawful scope of practice or II) by a person acting pursuant to lawful prescription.
B)	The public access defibrillation provider shall cause the automated external defibrillator to be maintained and tested according to applicable standards of the manufacturer and any appropriate government agency.
C)	The public access defibrillation provider shall notify the STREMS Council of the existence, location and type of any automated external defibrillator it possesses.
D)	Every use of an automated external defibrillator on a patient shall be immediately reported to the appropriate local emergency medical services system, emergency communications center or emergency vehicle dispatch center as appropriate and promptly reported to the emergency health care provider.
E)	The Emergency Health care provider shall participate in the regional quality improvement program pursuant to subdivision one of section three thousand four-A of this article.
4. Application of other laws. A) Operation of an automated external defibrillator pursuant to this section shall be considered first aid or emergency treatment for the purpose of any statute relating to liability. B) Operation of an automated external defibrillator pursuant to this section shall not constitute the unlawful practice of a profession under title VIII of the education law.
5. (I) According to 1998 Revision of Section 3000-B of Article 30 of the Public Health Law, a person who, or entity, partnership, corporation, firm or society that, purchases or makes available resuscitation equipment that facilitates first aid, as required by or pursuant to law or local law, or (II) the emergency health care provider with a collaborative agreement under section three thousand-B of this article with respect to an automated external defibrillator, shall not be liable for damages arising either from the use of that equipment by a person who voluntarily and without expectation of monetary compensation renders first aid or emergency treatment at the scene of an accident or medical emergency, or from the use of defectively manufactured equipment; provided that this subdivision shall not limit the person's or entity's, partnership's, corporation's, firm's, (or) society's or the emergency health care provider's liability for his, her or its own negligence, gross negligence or intentional misconduct.
OVERVIEW OF 1998 AMENDMENT TO PUBLIC HEALTH LAW
1.	The PAD Provider (Person or organization) must have a written Collaborative Agreement with an Emergency Health Care Provider (physician or hospital). This Agreement must be filed with the STREMS Council.
2.	The PAD Provider should designate key personnel within the organization/corporation to be trained as Automated External Defibrillation (AED) operators.
3.	AED operators must receive training through a national organization approved by the New York State Department of Health or an organization approved by the New York State EMS Council.
4.	The PAD Provider must notify the STREMS Council of all AEDs in its possession.
5.	The PAD Provider must maintain the AED according to manufacturer's standards.
6.	The Emergency Health Care Provider must participate in the STREMS Council's Quality Assurance Program via a written reporting process each time the AED is used on a patient.
7.	The PAD Provider and Emergency Health Care Provider will be protected from civil liability according to the Provisions of the 1998 Revision of Article 30 provided that a Collaborative Agreement is on file with the STREMS Council and s/he is not negligent or intentionally misusing the AED.