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Emergency Medical Services
PO Box 355
Santa Ana, CA 92701
(714) 834-3500

Information on
Automated External Defibrillator (AEDs)
Orange County Emergency Medical Services

New Automated External Defibrillator laws for 2006

1. What is an automated external defibrillator (AED)?

An AED is a device used in cardiac arrest, or sudden cardiac death, when the heart’s electrical activity is disorganized and there is no effective pumping of blood. The AED is capable of recognizing the heart's electrical activity, and determining if an electric shock is required. If the shock is needed, a voice prompt in the AED is activated, telling the rescuer to push a button to deliver the shock.

2. What procedure is followed to use the AED?

The rescuer looks at the patient and determines there is no sign of effective heart action such as normal breathing, coughing, or movement. The rescuer should ask someone to call 911, and someone else to bring the AED to the patient. The rescuer removes the patient's clothing over the front part of the chest, attaches the AED pads to the patient’s skin, and turns on the machine. The AED has a voice chip that instructs the rescuer what to do, and which button to push on the machine, allowing human control. CPR is performed before the AED arrives at the patient’s side, and after any needed electric shocks, prompted by the AED.

3. Does AED use save lives?

The more quickly needed electric shocks are applied to a victim of sudden death, the more likely the person is to survive. Electric shocks are needed in about one-half of cardiac arrest victims. The best "save" rates have been reported when the electric shock is delivered within 3 minutes of the patient's collapse. This is almost always faster than the emergency system can respond, so AED use by the lay public should save lives. Research shows that AEDs probably have saved lives in casinos, airports, and on aircraft. Whether lives will be saved by more widespread use of AEDs by lay persons in public locations will be answered by more research.

The North American Public Access Defibrillation (PAD) study concluded in 2003. This research compared how many victims of cardiac arrest survived in locations given CPR training and an AED, to locations with CPR training only. Orange County was one of the sites, coordinated by Mission Hospital Regional Medical Center and Orange County Emergency Medical Services. Across North America over several years, there were over 500 cases of presumed cardiac arrest. Survivors were 30 with an AED compared to 15 with CPR only. The overall benefit is likely to be limited, however, since the vast majority of cardiac arrests are in residences, not in public.

4. Are AEDs safe?

These devices are safe. They are programmed to deliver shocks only when the heart rhythm is not effective and the electric shock is definitely required. The device is only applied when a person has collapsed in cardiac arrest and has no effective breathing or coughing, and no movement. An AED should not deliver an electric shock even if applied by mistake to a person who has fainted or had a seizure.

5. Am I allowed to obtain an AED?

California law allows an individual to have this device for use in the home, a work setting, or other location. Rules vary depending on whether the use is for a specific individual, or for a public setting.

6. Is there liability protection for using this device?

Yes, California state law provides liability protection from negligence in the use of the AED. This would cover any ordinary mistakes. The law does not cover gross negligence – an extreme or purposeful bad act (see #11).

7. What are the requirements to have an AED?

If a physician prescribes the AED for a specific patient, then the physician will establish any requirements such as training, etc.

For AEDs in other settings, the AED must be maintained and regularly checked for readiness at least every 30 days. There must be individuals trained in the use of the AED available for emergencies and a written emergency plan. Please see #12; this reproduces the state regulations.

Orange County Emergency Medical Services should be notified where the device is located. (See #10).

8. Are there training programs available?

The following are a few of the AED training programs available to train the lay public. In addition, these training programs have medical directors that provide prescriptions and medical oversight.

9. Are there vendors who sell the device?

Yes. Vendors in Orange County include:

10. How can I get more information?

E-mail Orange County Emergency Medical Services, Patrick Powers or call 714-834-3500.

11. Liability Protection:

California Health & Safety Code
Updated for 2007

1797.196. (a) For purposes of this section, "AED" or "defibrillator" means an automated or automatic external defibrillator.
(b) In order to ensure public safety, any person or entity that acquires an AED is not liable for any civil damages resulting from any acts or omissions in the rendering of the emergency care under subdivision (b) of Section 1714.21 of the Civil Code, if that person or entity does all of the following:
(1) Complies with all regulations governing the placement of an AED.
(2) Ensures all of the following:
(A) That the AED is maintained and regularly tested according to the operation and maintenance guidelines set forth by the manufacturer, the American Heart Association, and the American Red Cross, and according to any applicable rules and regulations set forth by the governmental authority under the federal Food and Drug Administration and any other applicable state and federal authority.
(B) That the AED is checked for readiness after each use and at least once every 30 days if the AED has not been used in the preceding 30 days. Records of these checks shall be maintained.
(C) That any person who renders emergency care or treatment on a person in cardiac arrest by using an AED activates the emergency medical services system as soon as possible, and reports any use of the AED to the licensed physician and to the local EMS agency.
(D) For every AED unit acquired up to five units, no less than one employee per AED unit shall complete a training course in cardiopulmonary resuscitation and AED use that complies with the regulations adopted by the Emergency Medical Service Authority and the standards of the American Heart Association or the American Red Cross. After the first five AED units are acquired, for each additional five AED units acquired, one employee shall be trained beginning with the first AED unit acquired. Acquirers of AED units shall have trained employees who should be available to respond to an emergency that may involve the use of an AED unit during normal operating hours.
(E) That there is a written plan that describes the procedures to be followed in the event of an emergency that may involve the use of an AED, to ensure compliance with the requirements of this section. The written plan shall include, but not be limited to, immediate notification of 911 and trained office personnel at the start of AED procedures.
(3) When an AED is placed in a building, building owners shall ensure that tenants annually receive a brochure, approved as to content and style by the American Heart Association or American Red Cross, which describes the proper use of an AED, and also ensure that similar information is posted next to any installed AED.
(4) When an AED is placed in a building, no less than once a year, building owners shall notify their tenants as to the location of AED units in the building.
(5) When an AED is placed in a public or private K-12 school, the principal shall ensure that the school administrators and staff annually receive a brochure, approved as to contents and style by the American Heart Association or the American Red Cross, that describes the proper use of an AED. The principal shall also ensure that similar information is posted next to every AED. The principal shall, at least annually, notify school employees as to the location of all AED units on the campus. The principal shall designate the trained employees who shall be available to respond to an emergency that may involve the use of an AED during normal operating hours. As used in this paragraph, "normal operating hours" means during the hours of classroom instruction and any school-sponsored activity occurring on school grounds.
(c) Any person or entity that supplies an AED shall do all of the following:
(1) Notify an agent of the local EMS agency of the existence, location, and type of AED acquired.
(2) Provide to the acquirer of the AED all information governing the use, installation, operation, training, and maintenance of the AED.
(d) A violation of this provision is not subject to penalties pursuant to Section 1798.206.
(e) The protections specified in this section do not apply in the case of personal injury or wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED.
(f) Nothing in this section or Section 1714.21 may be construed to require a building owner or a building manager to acquire and have installed an AED in any building.
(g) This section shall remain in effect only until January 1, 2013, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2013, deletes or extends that date.
[Added by SB 911 (CH 163) 1999. Amended and repealed by AB 2041 (CH 718) 2002. Amended, by SB 600 (CH 62) 2003; AB 254 (CH 111) 2005, and AB 2083 (CH 85) 2006.]
 

12. State Lay Person Regulations:

California Code of Regulations Title 22, Division 9, Chapter 1.8. Training Standards and Utilization for Use of the Automated External Defibrillator by Non-Licensed or Non-Certified Personnel, Sections 100031 – 100043.

Article 1. Definitions

§ 100031. AED Service Provider. “AED Service Provider” means any agency, business, organization or individual who purchases an AED for use in a medical emergency involving an unconscious, person who has no signs of circulation. This definition does not apply to individuals who have been prescribed an AED by a physician for use on a specifically identified individual. Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

§ 100032. Authorized Individual.“ Authorized individual” means any person, not otherwise licensed or certified to use the automated external defibrillator, who has met the training standards of this chapter, and who has been issued a prescription for use of an automated external defibrillator on a patient not specifically identified at the time the physician’s prescription is given. Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code, Section 1714.21, Civil Code.

§ 100033. Automated External Defibrillator.“ Automated external defibrillator” or “AED” means an external defibrillator that after user activation is capable of cardiac rhythm analysis and will charge and deliver a shock, either automatically or by user interaction, after electronically detecting and assessing ventricular fibrillation or rapid ventricular tachycardia. Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

§ 100034. Cardiopulmonary Resuscitation. “Cardiopulmonary resuscitation” or “CPR” means a basic emergency procedure for life support, consisting of artificial respiration, manual external cardiac massage, and maneuvers for relief of foreign body airway obstruction. Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

§ 100035. Internal Emergency Response System. “Internal Emergency Response System” means a plan of action which utilizes responders within a facility to activate the “9-1-1" emergency system, and which provides for the access, coordination, and management of immediate medical care to seriously ill or injured individuals. Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

§ 100036. Prescribing Physician.
“Prescribing physician” means a physician and surgeon, licensed in California, who issues a written order for the use of the automated external defibrillator to authorized individual(s).
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

Article 2. General Training Provisions

§ 100037. Application and Scope.
(a) Any physician and surgeon licensed in California may authorize an individual to apply and operate an AED on an unconscious person who has no signs of circulation only if that authorized individual has been successfully trained according to the standards prescribed by this chapter.
(b) The training standards prescribed by this chapter shall not apply to licensed, certified or other prehospital emergency medical care personnel as defined by Section 1797.189 of the Health and Safety Code.
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.189, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

Article 3. AED Training Program Requirements

§ 100038. Required Hours and Topics.
(a) The AED training component shall comply with the American Heart Association or American Red Cross standards. The course shall consist of not less than four hours, which shall include the following topics and skills:
(1) basic CPR skills
(2) proper use, maintenance and periodic inspection of the AED;
(3) the importance of:
(A) CPR,
(B) defibrillation,
(C) advanced life support,
(D) adequate airway care, and
(E) internal emergency response system, if applicable;
(4) overview of the local EMS system, including 9-1-1 access, and interaction with EMS personnel;
(5) assessment of an unconscious patient, to include evaluation of airway, breathing and circulation, to determine if cardiac arrest has occurred and the appropriateness of applying and activating an AED;
(6) information relating to defibrillator safety precautions to enable the individual to administer shock without jeopardizing the safety of the patient or the authorized individual or other nearby persons to include, but not be limited to;
(A) age and weight restrictions for use of the AED,
(B) presence of water or liquid on or around the victim,
(C) presence of transdermal medications, and
(D) implantable pacemakers or automatic implantable cardioverter-defibrillators;
(7) recognition that an electrical shock has been delivered to the patient and that the defibrillator is no longer charged;
(8) rapid, accurate assessment of the patient’s post-shock status to determine if further activation of the AED is necessary; and,
(9) authorized individual’s responsibility for continuation of care, such as the repeated shocks if necessary, and/or accompaniment to the hospital, if indicated, or until the arrival of more medically qualified personnel.
(b) The required hours for an AED training program can be reduced by no more than two hours for students who can show they have been certified in a basic CPR course in the past year and demonstrate to a qualified CPR instructor that they are proficient in the current techniques of CPR.
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

§ 100039. Medical Director Requirements
Any AED training course for non-licensed or non-certified personnel shall have a physician medical director who:
(a) Meets the qualifications of a prescribing physician. (b) Shall approve a process to ensure instructors are properly qualified to the AED instructor standards established by the American Heart Association or the American Red Cross and ensure that instructors are trained to the course content.
(c) Shall ensure that all courses meet the requirements of this chapter.
(d) May also serve as the “prescribing physician.”
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.
(a)

§ 100040. Testing.
In order for an individual to be authorized to use the AED, the individual shall pass a written and skills examination, which tests the ability to assess and manage the specified conditions prescribed in Section 100038.
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

§ 100041. Written Validation.
The prescribing physician shall issue to the authorized individual a written validation or other documented proof of the authorized individual’s ability to use an AED. The requirements for a “Written Validation” and “Prescription for Use” can both be satisfied by the issuance of a written certification card from an AED training program. The prescribing physician’s signature shall be on file with the AED training program authorizing the issuance of the written certification card upon successful completion of the required training.
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

Article 4. Operational AED Service Provider/Vendor Requirements

§100042. Operational Requirements.
(a) An AED Service Provider shall ensure their internal AED programs include all of the following:
(1) Development of an Internal Emergency Response System which complies with the regulations contained in this Chapter.
(2) Notification of the local EMS agency of the existence, location and type of AED at the time it is acquired.
(3) That all applicable local EMS policies and procedures are followed.
(4) That expected AED users complete a training course in CPR and AED use that complies with requirements of this chapter and the standards of the American Heart Association or the American Red Cross.
(5) That the defibrillator is maintained and regularly tested according to the operation and maintenance guidelines set forth by the manufacturer, and according to any applicable rules and regulations set forth by the governmental authority under the federal Food and Drug Administration and any other applicable state and federal authority.
(6) That the defibrillator is checked for readiness after each use and at least once every 30 days if the AED has not been used in the previous 30 days. Records of these periodic checks shall be maintained.
(7) That a mechanism exists to ensure that any person, either an employee or agent of the AED service provider, or member of the general public who renders emergency care or treatment on a person in cardiac arrest by using the service provider’s AED activates the emergency medical services system as soon as possible, and reports any use of the AED to the local EMS agency.
(8) That there is involvement of a California licensed physician and surgeon in developing an Internal Emergency Response System and to ensure compliance with these regulations and requirements for training, notification and maintenance.
(9) That a mechanism exists that will assure the continued competency of the authorized individuals in the AED Service Provider’s employ to include periodic training and skills proficiency demonstrations.
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

§100043. AED Vendor Requirements
Any AED vendor who sells an AED to an AED Service Provider shall notify the AED Service Provider, at the time of purchase, both orally and in writing of the AED Service Provider’s responsibility to comply with the regulations contained in this Chapter.
Note: Authority cited: Sections 1797.107 and 1797.190, Health and Safety Code. Reference: Sections 1797.5, 1797.190, and 1797.196, Health and Safety Code. Section 1714.21, Civil Code.

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