Representatives of the American Heart Association's Cardiac Emergency Response Plan Task Force, chaired by Comilla Sasson, MD, PhD, FACEP  presented "Preparing Your School for a Cardiac Arrest Emergency," in December during the Citizen CPR Foundation's Emergency Cardiovascular Care Update in San Diego. Faculty included Michele Snyder and Martha Lopez-Anderson, Parent Heart Watch; Jeff Ranous, PhD, ATC, NREMT, American Heart Association; school nurse, Kathleen Murphy, DNP, RN, FNP-BC; and Mary Newman, MS, Sudden Cardiac Arrest Foundation. The session addressed the development of a comprehensive approach to effectively respond to cardiac emergencies in schools. Topics included an overview of the legislative landscape, overcoming obstacles, case studies, and emergency planning.
Newman presented the Cardiac Emergency Response Plan for Schools on behalf of the Task Force. A summary of her presentation follows.
Cardiac Emergency Response Plan for Schools
A Cardiac Emergency Response Plan is a written document that establishes the following steps to take during a cardiac emergency in a school setting:
- Establish an effective communications system
- Train anticipated responders in CPR and AED use
- Deploy AEDs
- Coordinate with the local EMS system
- Practice and review the plan.
Cardiac Emergency Response Plans are important, Newman said, because:
- SCA affects 326,200 people each year outside hospitals, including 6,328 youth <18. 
- At any point in time, 20 percent of the U.S. population is in a school setting.
- Prompt action by bystanders in the first few minutes of a cardiac emergency can double or triple a victim's chance of survival.
The Cardiac Emergency Response Plan should address the following action step categories:
- AED placement, maintenance and readiness
- Integration with the local EMS system
- Establishing a CPR/AED training plan
- Communication of the plan throughout the school
- Protocols for potential responders
- Activation of the team
- Annual review and updating the plan, if appropriate.
Cardiac Emergency Response Team
The first step in developing a plan is to identify the Cardiac Emergency Response Team. The team should include staff members with CPR/AED training, the school nurse, school administrators, health and physical education teachers, the athletic director and athletic trainers, coaches, and after school event advisors. The role of the team is to become familiar with the plan, meet monthly to evaluate the plan, and communicate with the school administration on an annual basis to update the plan, as needed.
The number of AEDs placed at a school should be sufficient to enable the response team to retrieve an AED and deliver it to the victim’s side within two minutes of notification, both inside the school and at any location on school grounds. One or more AEDs should be available to replace any AED that is out of service and should also be available for use by teams and other school groups traveling to off-site locations.
AEDs should have clear signage. They should never be locked in an office or stored in location that is not easily accessible at all times. Instead, they should be readily accessible throughout the school day and during after-school activities.
AED Maintenance and Readiness
Schools should regularly check and maintain AEDs in accordance with the manufacturers' operating manual, and should maintain a log of maintenance activities. Schools should designate a specific person who will be responsible for verifying AED readiness. In addition, resuscitation kits—including include latex-free gloves, a razor, a pair of scissors, antiseptic wipes, and a CPR barrier mask—should accompany the devices.
Cardiac Emergency Response Team Protocol
The recommended Cardiac Emergency Response Team Protocol follows:
- Recognize the signs of sudden cardiac arrest and take action. Signs include not moving, being unresponsive, appearing to be unconscious, and sometimes, appearing to be having a seizure or convulsions.
- Facilitate immediate access to professional help. This means calling 911, contacting members of the school response team, assigning someone to meet EMS, retrieving the AED, leaving the door open, and proceeding to the location of the emergency.
- Start CPR. Response team members should provide 100-120 chest compressions a minute at a depth of 2-2.4”, and should follow dispatcher instructions.
- Use AED. Response team members should use an AED as soon as it becomes available. Steps include turning on the power, attaching the pads, and following the visual and voice prompts.
- Transition care to EMS.
The protocol should be posted in classrooms, the cafeteria, restrooms, the health room, the faculty break room, and school offices. It should also be posted adjacent to each AED and each school telephone, and in the gym, swimming pool, and other athletic locations. In addition, the protocol should be distributed to all staff and administrators, the school nurse, athletic directors, coaches, and any organization using school.
The Cardiac Emergency Response Plan calls for sufficient numbers of staff—including the school nurse—to be trained in CPR and AED use to ensure the plan can be carried out. The Task Force recommends that at least 10 percent of staff, 50 percent of coaches, and 50 percent of the physical education staff should be trained—and further, that training should include both cognitive learning and hands-on practice.
Sample Letter to Parents
The Cardiac Emergency Response Plan includes a sample letter for parents that announces that the school is among first in nation to adopt the plan and seeks support from parents to learn CPR and how to use an AED. The letter also suggests parents may be called upon to participate in fundraising, training, and other tasks.
The Task Force suggests the following timeline for schools implementing a Cardiac Arrest Emergency Response Plan:
- July: Identify team members and determine minimum number of AEDs needed.
- Beginning in July: Check and maintain each AED.
- August: Post the response plan throughout the school, and distribute the protocol to administration, faculty, athletic director, coaches, advisors, and coordinate with local EMS.
- Beginning in August: Provide CPR/AED training for school staff, including the school nurse, teachers, athletic directors, coaches, and physical education staff.
- October and March: Conduct a cardiac emergency response drill.
- As needed: Activate the school response team.
- June: Submit an annual plan evaluation and adapt as necessary.
Implementation Tool Kit
The Cardiac Emergency Response Plan for schools provides a free tool kit that includes multiple documents and templates. These are available at the Sudden Cardiac Arrest Foundation website here and at the American Heart Association website here.
Why Cardiac Emergency Response Plans for Schools Matter: Living Proof
Newman illustrated the importance of Cardiac Emergency Response Plans for schools by highlighting the following stories about people who survived sudden cardiac arrest in school settings, thanks to careful planning and decisive action by teachers, school nurses, coaches, athletic trainers, fellow students, and community members.
For an overview, see the attached PowerPoint Presentation.
SOURCE: Sudden Cardiac Arrest Foundation
 Members of the AHA CERP Task Force are: American Association of School Administrators (Dr. Sarah Jerome); American Heart Association (Douglas Dunsavage, Emily Gardner, Madeleine Konig, Denise Miles, Sarah Poole, Jeffrey Ranous, Dr. Amber Rodriguez, Dr. Comilla Sasson, Colby Tiner, Laurie Whitsel); C.S. Mott Children’s Hospital, University of Michigan Health System (Dr. Monica Goble, Gwen Fosse); The Kimberly Anne Gillary Foundation (Randy Gillary); Michigan Department of Health and Human Services (Kristina Dawkins, Maria Willoughby‐Byrwa); National Athletic Trainers’ Association (Ron Courson); National Association of School Nurses (Kathleen Rose); Parent Heart Watch (Martha Lopez‐Anderson); Project ADAM (Allison Thompson); SHAPE America (Joe Halowich); Sudden Cardiac Arrest Foundation (Mary Newman); University of California, Davis/ American Academy of Pediatrics (Dr. Stuart Berger); Sarver Heart Center/ American College of Cardiology (Dr. Julia Indik).
 American Heart Association Heart Disease and Stroke Statistics, 2015.