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DOC ID: 1583
CITY OF SAN BERNARDINO -REQUEST FOR COUNCIL ACTION
In Support/Opposition
From: Charles McNeely M/CC Meeting Date: 02/21/2012
Prepared by: James Graham, (909) 384-5122
Dept: City Manager Ward(s): All
Subject:
Discussion and Possible Action of the Mayor and Common Council to Authorize City Staff to
Pursue the Potential of Establishing a Public Access Defibrillator Pilot Project in City Hall.
(Discussed at the Special Ways and Means Committee Meeting of January 30, 2012 -Committee
Members Present: Kelley, Johnson, Shorett)
Financial Impact:
During Mc Christopherson's presentation he stated that it would cost the City between $14,000
to $15,000 to initially establish a program with his company. In addition, it would cost
$4,000.00 every two years to train 30 people. The City would have to periodically purchase new
batteries and other accessories to keep the devices in good working order.
Funding for a new PAD program is not included in the FY 2011-12 budget. Therefore, based on
advisories from experts in the field that CPR increases the chances of survivability prior to
defibrillation, it would be more cost effective for the San Bernardino Fire Department to develop
a CPR training program for City employees and to report back to the Council once a proposal is
ready for review.
Motion: Staff recommends that the Fire Department provide additional training for City
employees under the existing program.
Swoasis of Previous Council Action:
None
Back round:
On October 19, 2011 Council Member Chas Kelley introduced to the Ways & Means Committee
Mr. Enrique Christopherson with Cardiac Science, a manufacturer of the Powerheart Automated
External Defibrillator ("AED"), Mr. Christopherson made a presentation to the Committee
regarding his company's Public Access Defibrillator program ("PAD")
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During the presentation, Mr. Christopherson provided a demonstration of his firm's heart
defibrillator device. He stated that his company's a heart defibrillator program was comprised of
three components:
1. Program Management: in order to provide good patient care a medical director is
required to over-see program.
2. Training: City staff needs to be trained and certified in CPR.
3. Record-keeping: Maintenance records of the heart defibrillator device have to be kept to
ensure that the device will properly operate as all times
The Ways & Means Committee discussed the possibility of establishing a pilot program in City
Hall. Having a heart defibrillator device installed on each floor of City Hall was discussed.
Staff was asked by the Committee to review the material submitted by Mr. Christopherson and
return with a report.
On Monday, January 30, 2012 staff provided a written report to the Ways & Means Committee
stating that the American Heart Association (AHA) standards indicate that "hands-only" CPR
significantly enhances the potential for successful defibrillation as well as doubling the time
window of survivability prior to defibrillation. In addition, staff indicated that if Council
approved having a PAD Pilot Program in City Hall, that the selected Vendor be a distributor or
manufacture of Zoll heart defibrillator devices. Zoll is the brand manufacturer of all the Fire
Deparhnent's cardiac monitor/defibrillator devices. These devices are already carried in the Fire
Department's command vehicles. Integration with the Fire Department's Zol] cardiac
defibrillators prevent having to tear off different heart defibrillator pads upon the Fire
Department's arrival. Having to change pads would result in an unnecessary and preventable
delay in patient care.
The Committee unanimously approved forwarding the issue to the Mayor and Common Council
for further consideration.
ANALYSIS
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The major components of a Public Access Defibrillator Program ("PAD") include:
1. CPR training (which includes AED operation)
2. Appropriate selection and purchase of AEDs
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The scientific evidence on patients in cardiac arrest has been growing significantly in the past 10
years; and, is overwhelmingly in support of early compressions (CPR) by citizens and eazly
defibrillation either by lay rescuers or by EMS/Fire personnel. In essence, a successful, PAD
programs must include CPR.
The model in which eazly defibrillation has been demonstrated to result in higher survival rates is
in airports and casinos. in addition to heavy customer traffic, these locations have common
elements that contribute to successful patient outcomes:
Extensive, monitored surveillance camera systems allowing for early detection of persons
that have suffered a cardiac arrest.
2. A relatively large, well-trained security force, widely deployed and immediately available
to respond.
This model allows trained personnel to deliver the first shock within four to five minutes of the
patient going into cardiac arrest, when the heart is more receptive to a shock, and is still able to
resume beating on its own.
Numerous studies demonstrate that once the patient has been in cardiac arrest over 4-5 minutes,
compressions (CPR) are significantly more beneficial to the patient than delivering a shock.
Restoring limited circulation with CPR for a two minute period prior to shocking the patient
greatly increases the likelihood that the shock will work and that the hear[ will be able to resume
beating afterwazds.
Training options include:
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1. Adult CPR (hands-onlvl with AED. This is a two hour American Heart Association
progmm that requires bi-annual recertification and could be offered in house for 6-8
employees on a quarterly schedule. This option would give us 50-60 employees trained
to the minimal necessary level at no cost.
2. Heartsaver CPR (Adult/Child/Infantl with AED, Chokin¢, and First Aid. This is a more
extensive (6-8 hours) training program, requiring bi-annual recertification. This
American Heart Association program is offered monthly through arrangements with an
associated fire department at no cost to the city. They would be able to accommodate 2-3
additional students a month also with bi-annual recertification. This option would also
give us the 50-60 employees trained to a higher level of CPR and able to provide first aid
as well.
3. Both options follow standazd curriculum of the national standazd for CPR/AED training
program and fall within the purview of the Fire Department's Medical Director.
Currently, the Emergency Medical Services Division ("EMS") of the San Bernardino Fire
Department carries the Zoll AED brand on all of its vehicles. The Fire Department wntmcts
with a local physician who serves as the Department's Medical Director. The Fire Department
has the capability of providing CPR training to employees but has not done so due to budgetary
constraints.
The Cardiac Science Company has various contracts throughout the County of San Diego,
particularly with the City of San Diego through the City's Project Heartbeat Program. San
Diego's Project Heartbeat has had a contractual relationship with the Cardiac Science Company
for eleven years. The program is self-sustaining because it receives an on-going financial
stipend from Cardiac Science. Project Heartbeat also charges other communities to provide CPR
training; therefore, the City of San Diego provides no financial support for Project Heartbeat.
There are tour manufacturers of AEDs including: Phillips, Zoll, Physio-Control, Medictronics
and Cardiac Science. The City of San Diego's Project Heartbeat states that their EMS vehicles
use Zoll brand AEDs as well as have the Cardiac Science AED's in City buildings although an
adapter has to be utilized to ensure compatibility.
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Start-up costs for six Zoll brand AEDs (one for each floor of City Hall) would be $8,000-10,000
with used/refurbished AED's (2-3 year warranty), or $12,000-13,000 for brand new Zoll AED's
(5-7 year warranty). This includes alarmed wall cabinets for the AED's.
Continuing costs would be about $1,300 every 2-3 years for replacement batteries and pads.
This does not include any replacement costs for AEDs. Zoll brand devices only require a visual
check once a month to confirm that the batteries and pads are chazged and serviceable_ This
could be accomplished by the facility safety officer. A prescription for these AEDs as medical
devices is provided by the manufacturer or vendor and is a no-cost item included with the
purchase.
It is evident that having Public Access Defibrillators strategically placed in City Hall may
provide an enhanced level of protection to the public and employees when coupled with CPR
training of key personnel. As with any program, the devices require some level of maintenance
and inspection on a regular basis and the coordination of ongoing training for employees would
be necessary.
Because the program is costly, staff recommends providing additional training for City staff on
CPR. Training would be included in the existing employee training program and be provided by
the City's Fire Department personnel.
Sunoortina Documents:
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San
OFFICE OF THE CITY MANAGER
300 North °D" Street • San Bernardino • CA 92415.0001
909.384.5122 • Pax: 909.384.5138
wwwsbcity.org
MEMORANDUM
TO: Mayor and Members of Common Council
FROM: Chazles McNeely, City Manage
SUBJECT: Public Access Defibrillator Program
DATE: February 21, 2012
As a follow-up to the agenda item for Mayor and Common Council regazding potentially
establishing a Public Access Defibrillator Program, agenda item # 6(A), staff proposes
various options for Council's consideration.
OPTION I: ADDITIONAL CPR TRAINING ONLY
The City's Fire Department could provide additional training for employees,
approximately 30 employees on an annual basis in City Hall.
Cost: $500 - $1,000
A Medical Duector is cunently under contract with the Fire Department
OPTION H: PHASED IN APPROACH
The City's Fire Department would expand its existing CPR program to include CPR
training to initially 30 employees in City Hall, and aRer a six to eight month-period,
evaluate and identify potential funding options and, if funding is available, initiate a bid
process to select a company to establish a PAD program in City Hall.
CPR Training Only for six to eight month-period: $500 - $1,000
Potential PAD Program Cost: $14,000 to $15,000
Includes a Medical Director
Includes CPR Training
Company should be required to provide Zoll brand heart defibrillator devices
CITY OF SAN BERNARDIIYO ; / _
ADOPT® SAARED YALU&S: Integrity • Accountability • Respect for Human Dignity • Honesty 7Yr
2/zi ~iZ
OPTION III: BID AND SELECT
The City would bid to select a company to provide a PAD Program.
Immediate Cost: $14,000 to $15,000
Includes a Medical Director
Includes CPR Training
Company should be required to provide Zoli brand heart defibrillator devices
REVISED RECOMMENDATION:
Staff recommends option II.