Project ADAM Tennessee Information Packet

Project
ADAM
Tennessee
saves lives
Form No. 30943 (05/16)
EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM/PROJECTADAM

Project ADAM Tennessee Information Packet

1. Contents

2. General Information
Project ADAM Tennessee
Project ADAM Manual
3. PAD (Public Access to Defibrillation) Program Checklists
A Comprehensive School Program for Prevention of Sudden Cardiac Death
Implementation Checklist
Sample: CPR/AED Emergency Response Plan for Schools
4. Protocols and Awareness
PAD Program Policy and Procedure Template
Sample: Notification letter to all parents and students
Sample: Notification letter to local Emergency Medical Service
Sample: Notification letter to community groups
Sample: Program News Release
Staff Awareness for SCA and AED Notes for Presentation
Awareness for Athletic Directors and Coaches
Awareness for Administrators
Awareness Form for students
Prevent Sudden Cardiac Death
5. Skill Drills
AED/CPR Skill Drill
Skill Drill scenarios
Article: AED Drills
Drill Recording
6. Tennessee Laws
TCA:Tennessee AED Law & Good Samaritan Law
7. Additional Information and Forms
AED Placement and Vandalism
AED Overview/Comparison Sheet
AED Readiness Inventory
PA Event Summary Form
Organizational Links
Budget Worksheet
Periodic Maintenance Checklist
CPR/AED Training Log

Introduction
In 2011, Project ADAM Tennessee was launched by East Tennessee Children’s Hospital as an affiliate of
Project ADAM, a national public access defibrillation (PAD) program for schools. Through Project ADAM
Tennessee, schools are provided with individual consultation on the prevention of sudden cardiac death
(SCD) in the school setting. Project ADAM Tennessee works with schools in the following ways:
• Identifying a project coordinator and emergency response team at your
school to recognize and respond efficiently to sudden cardiac arrest (SCA)
• Implementing a PAD program, including CPR and AED training for selected
faculty, staff and volunteer first-responders
• Assistance in obtaining a new AED and/or managing an existing one
• Consultation regarding maintenance of equipment, training updates and
practice drills
• Providing information to staff, students and parents about risk factors and symptoms of
sudden cardiac arrest
• Connecting participating schools so they may share best practices
• Working with local emergency responders to coordinate efforts and offer
the best chance of success
• Providing materials with step-by-step instructions in the development of a PAD
• A comprehensive planning manual is provided to each participating school, complete
with templates. All consultation is provided free of charge to schools in Tennessee thanks
to the generous support of East Tennessee Children’s Hospital.
Project ADAM Heart Safe Schools
Tennessee schools who complete the Project ADAM Tennessee checklist indicating their
implementation of a quality AED program will receive a framed certificate of recognition as a Heart Safe
School. Door stickers and directional signs to identify location of AEDs and warning signs for school clinics
and physical education/sports areas will be provided.
Project ADAM Tennessee’s mission is to serve children and adolescents through education and the
deployment of life saving programs that help prevent sudden cardiac arrest and sudden cardiac death in
schools. Adults at work or visiting in schools will also benefit from the program. Our goal is to engage the
participation of all schools in Tennessee.
For more information on how your school can become Heart Safe, please contact:
Karen Dean Smith, APRN-BC East Tennessee Children’s Hospital
Project ADAM Tennessee Coordinator 2018 Clinch Avenue, Koppel Plaza
kdsmith2@etch.com Knoxville, TN 37916
865-384-1676 or 865-541-8137
Project
ADAM
Tennessee
saves lives

Implementation Checklist
Name of School and District:___________________________________ o ES o MS o HS o Pvt.
AED Coordinator:_______________________________Contact phone number:_______________________________
Email:______________________________ Medical Director:____________________________________________
How long have you had an AED program?_______________ What AED(s) do you use?__________________________
Number of staff trained as CPR /AED rescuers?_______ Training: o Am. Heart o Red Cross o Other___________
We have______________ or have not ______________ had to use our AED.
Location(s) of AEDs _______________________________________________________________________________
Please complete this checklist for the current program in your school (one form per school):
Program Quality
Not In In Need Comments
Place Place Help
A program coordinator is identified,
who oversees the overall program.
School has _______ (#) AEDs. We have buildings,
mobile units, students, staff.
The placement of the AED(s) makes it accessible from any part
of the building or campus within 2-3 minutes (either by fast
round-trip walk or by staff transporting to victim).
There is a designated emergency response team and
CPR/AED training is updated: annually
every 2 years , or (list)
There is a system in place to track CPR/AED training,
and identify those who require retraining or practice
(including budget or plan for retraining).
All faculty and staff know where the AEDs are located
and how to access them.
All faculty and staff have had awareness training
on sudden cardiac death (warning signs, recognition,
communication procedures, other staff roles, etc.)
We have a communication code (overhead page or other)
to notify responders and others in the area that
an incident is occurring. Teachers outside with students
carry a communication device.
The device is checked monthly ________, or
per manufacturer’s directions
This maintenance check is documented each time in writing and
reported to:___________________________________.
We keep a CPR barrier device, scissors, gloves, razor,
and towel in a case or pack near or attached to the AED.
A Comprehensive School Program for
Prevention of Sudden Cardiac Death

Program Quality
Not In In Need Comments
Place Place Help
We hold at least an annual AED practice drill to test our
emergency plan,communication and emergency responders.
We have a written policy, procedure or guideline for
AED use in the school.
Local EMS has been notified about the specifics of our program,
has a copy of our plan, and is familiar with school entrances and
building layout.
Student athletes must have completed the TSSAA
pre-participation physical form. (If another form is used,
please include a copy. Not required for ES or MS)
If our device has been used, an incident debrief and
AED maintenance occurred within 24 hours.
If a device is used for sports events, there is a written
emergency action plan for when and how it is to be used
(i.e. for offsite events or if more than one event is occurring
at a time).
We have a physician medical director (Check one:
local____________ or with AED company________________)
This school has a certified CPR instructor on staff
(this is not necessary, but helps maintain the
program more inexpensively.)
Students in our school (MS/HS) are taught CPR in the
______________ grade or class.
Other community groups that use the school building
regularly have been made aware of our AED program,
location of devices, etc.
Other comments about your program:
Please send or fax this checklist to:
Karen Dean Smith, APRN, PNP, Project ADAM Tennessee Coordinator,
East Tennessee Children’s Hospital, Community Benefits Dept., 2018 Clinch Ave., Knoxville, TN 37916
Cell: 865-384-1676, Office: 865-541-8137, kdsmith2@etch.com.
Please call or email any questions regarding your PAD program or these requirements to become a Project ADAM
Tennessee Heart-Safe School. When your program has been evaluated as complete, we will arrange for the
presentation of a certificate and add your school to the community of Project ADAM Tennessee Heart-Safe Schools.
Thank you for your participation in this important initiative.

Sample: CPR/AED Emergency Response Plan for Schools
Location ofAED Unit(s),__________________________________________________________________________
Method to Announce Alert: “Code AED (or Code Blue or Code ADAM) in Mr./Ms. __________Room. AED Team
report to Mr/Ms._____________________ room immediately. All staff should contain their students in current
classroom until further notice.”
Upon transport by EMS, front office should announce. “Code AED now clear. Staff may resume normal schedules.”
CPR/AED Team Member Extension CPR Expiration Date
1.
2.
3.
4.
5.
6.
7.
Because possible scenarios requiring CPR/AED use may vary greatly, any of the CPR/AED team members may be
called upon to assist in any steps of the response plan. In the event classroom teachers are team members, they will
need backup to cover their classrooms. All staff and particularly office staff should have a basic understanding of the
response plan to presumed Sudden Cardiac Arrest.
It is assumed that teachers will have means to communicate, either by intercom, cell phone, or walkie talkie no
matter where on school grounds they may be.
RESPONSE PLAN
1. Teacher/Staff closest to victim alerts front office of “Code ADAM or Code AED” in Room_____,
If student is unresponsive, instruct front office or appropriate designee to bring AED, call EMS, & begin CPR
simultaneously. Front office or 1st
responder should notify EMS.
2. All AED team members will report immediately to victim. The AED team member closest to the AED will grab
the AED, leaving the AED box door open so the alarm will signal other team members that the AED has been
taken.
3. If CPR has not been initiated, then the closest CPR certified person begins CPR. When the rest of team
arrives, 2 person CPR may begin.
4. One responder brings walkie-talkie to communicate with office and document events. It should be noted the
time event occurred, when CPR started, when EMS called, when EMS arrives. (See attached Page 2).
5. One responder should wait for EMS and direct them to scene.
6. Front office staff should contact parents/family; copy victim’s emergency card and send with EMS. AED should
be sent with EMS to emergency room physicians.
7. Crowd control is maintained.

Public Access Defibrillation Program (school)
POLICY AND PROCEDURE TEMPLATE
This template provided is a guide for developing Automated External Defibrillator (AED) guidelines for a school setting. It
is recommended that AED guidelines be developed through consultation with the program medical director and local EMS
and must include and complement the school’s emergency medical response plan. If a specific plan does not already exist,
one must be developed and may be added as an attachment to this policy or created as a separate policy. Specific AED use
protocols should be attached, as well as a floor plan indicating exact location of the AEDs. This template is not to be interpreted
as medically or legally binding. Your medical director and school administration will approve your final policy and procedure.
Policy:
1. An Automatic External Defibrillator (AED) will be maintained on the premises of (school name, address and AED location).
2. The AED shall be used in emergency situations warranting its use by individuals specifically trained in the use of the device.
This should include an emergency response plan and specific protocols for the use of the AED. If trained individuals are not
on school grounds during an emergency, a member of the general public who is present at an emergency situation on school
grounds may use the AED.
3. Program coordinator (Include contact information):
4. Program coordinator responsibilities (Planning, CPR/AED training coordination, maintenance, etc.):
5. Medical directorship information (Name, credentials, professional affiliations, etc.):
•_ The medical director is responsible for medical oversight of the PAD program. This includes writing a prescription for the AED
device, approval of school PAD program guidelines, analysis of post-sudden cardiac arrest event forms and data.
6. Local EMS information (Contact person, address, etc.):
7._Supporting documents (e.g., state AED laws and guidelines, infection control procedures, medical emergency response plan,
etc.):
8. Attach list of trained responders.
9._Trained responder responsibilities (includes activating emergency response system, performing CPR/AED duties as assigned,
compliance with CPR certification):
Procedure:
Location, maintenance and testing of AED(s)
1. The AED shall be located __________________ (include floor plan and location of AED) .
The type of device, intended use area, plan for maintenance and testing and location of the device on the premises shall be
confirmed in writing to:
__________________ (local Emergency Medical Service provider name, address, telephone).
__________________ (program medical director name, address, telephone, pager).
2. Maintenance and testing are conducted as recommended by the manufacturer.
o Documentation of the maintenance and testing is maintained <list location> for a period of _________ years.3
o Documentation shall record the date and type of maintenance/testing and the signature of the person performing
the maintenance/testing.
1
If there is more than one AED, then each location should be listed.
2
Check the requirements of your state. Project ADAM authors highly recommend that
each school identify a medical director.
3
Legal advisors for the schools should be consulted regarding types of program documentation required and maintenance of
the documentation.

Readiness status will be assured consistently (i.e. weekly).
o Records of readiness verification shall be kept <<list location>>
3. Equipment (include AED manufacturer, sales contact information, AED model, etc.)
4. Ancillary equipment:
5. Trained responders: CPR/AED renewal certification information.
6. Post-event assessment (include procedure for handling of data card):
7. Use of the AED:
a) Determine unresponsiveness of victim and activate emergency response plan.
b) If victim is unresponsive, call 9-1-1 and retrieve AED from ____________________.
c) Assess the victim: airway, breathing, circulation
d) Initiate CPR (if required) while AED is being retrieved.
e) Public address system: used to activate responders and indicate location of emergency.
f) Designate an individual to wait at facility entrance to direct EMS to victim location.
8. Upon arrival, place AED near head of victim and close to AED operator.
9. Prepare to use the AED:
a) Turn power ON.
b) Bare and prepare the chest for AED use.
c) Attach AED pads to victim.
d) Stop CPR while the AED detects heart rhythm.
e) Follow AED device prompts for further action; if shock is indicated, be sure all rescuers are “clear” before shock is
administered.
10. Upon arrival, EMS shall take charge of emergency situation.
a) Provide victim information to EMS: name, age, known medical problems, time of incident.
b) Provide information as to current condition/number of shocks administered.
11. Data card: following AED use, the data card shall be delivered to: _____________________ for downloading and analysis.
12. Following AED retrieval and/or use:
a) A critical incident debriefing session will be held within <<time frame>> for all responders.
b) The medical director shall be notified of AED use.
o Complete follow-up report if deemed necessary by medical director.
o Arrange for quality improvement review.
13. The AED will be checked and placed back in readiness state:
a) Remove data card from unit; label with victim data; deliver to appropriate personnel according to program protocol.
b) Replace data card.
c) Restock AED per inventory list.
d) Clean AED if needed according to manufacturer recommendations.
e) Document AED readiness.
14. Place AED back in service after use:
a) Readiness status will be assured following any AED use.
b) Records of readiness verification shall be kept <<list location>>.
Medical director
Name___________________________ Signature______________________________ Date__________________________
Program coordinator
Building principal
© 2005 Children’s Hospital and Health System. All rights reserved.

Notification letter to all parents and students
SAMPLE
Dear <<parents, guardians and/or students>>,
(Name of your school) is pleased to inform you we have joined a community effort to place automated external
defibrillators (AEDs) in our school building. This decision is the result of our wish to make our schools safe for our
students, visitors and employees.
The latest national statistics indicate that more than 350,000 children and adults in the U.S. die from sudden cardiac
arrest every year, most of them outside of the hospital. We also are being made aware of the documented numbers
of young athletes who suffer sudden cardiac arrest while participating in sports. Through our cooperative efforts with
Project ADAM Tennessee and East Tennessee Children’s Hospital we have joined hundreds of schools throughout
the state of Tennessee and beyond in preparing our school for a life-threatening emergency. This program enables us
to offer any person who may experience a sudden cardiac arrest the best chance for survival.
We have placed AEDs in the following locations: <<locations>>. The AEDs are in alarmed cabinets. When the
cabinet doors are opened a loud alarm will sound. This alerts everyone that there is a potential emergency. Our
school has a maintenance plan in place for the unit(s); the AEDs are designed to work effectively unless they
are tampered with. Additionally, the unit will not shock a person unless it detects a shockable rhythm (ventricular
fibrillation). As with any emergency device, please be reminded that tampering with such a unit may result in
disciplinary action for the person involved.
Staff has been trained to assist with an emergency during regular school hours. After school hours this is a public
access defibrillation (PAD) program. If you suspect someone is experiencing a sudden cardiac arrest please feel free
to use the equipment at our school. Good Samaritan laws protect the layperson in a life-saving attempt, although
we recommend becoming trained in CPR/AED use as an investment in your health and the health of others. Our
local EMS is aware of our policies and procedures for the program; we have been provided medical oversight by
<<physician name/healthcare facility>>.
To call 911 during school hours (describe the process). To call 911 after school hours (describe the process). If the
AED is used please contact (name/phone number) so that we may follow-up on and replace materials used in the
resuscitation effort.
Sincerely,
<<School PAD coordinator>>

Notification letter to local Emergency Medical Service (EMS)
SAMPLE
Dear Chief (EMS contact person),
As part of our commitment to the health and well-being of our students, families and visitors, (name of school) has
acquired Automatic External Defibrillators (AEDs).
The intended usage areas of the defibrillators have been defined with consideration of accessibility to our staff and
lay rescuers. We have attached a map indicating these locations.
We have implemented the following protocols in affiliation with (training organization-if applicable) and Project
ADAM (Automated Defibrillators in Adam’s Memory).
• A (name the brand of AED, i.e.: Lifepak 500) has been purchased through
(vendor’s name).
• The AEDs were placed with the assistance of (list those sources here i.e.: training organization, Project
ADAM, defibrillator vendor or EMS).
• All employees in our facility know the location of the AEDs.
• Personnel have been identified to conduct appropriate maintenance and testing of the AEDs according to the
manufacturer’s directions and company policy.
• Our lay rescuers have been trained by: (list the training organization here).
• A plan for refresher courses and on-going maintenance of the equipment has been implemented.
• We will/will not be implementing the pediatric component of the program.
• Our program was implemented in compliance with <<statewide laws/guidelines>>.
• (Name of physician) has agreed to provide medical direction and control. He/she will be utilized as needed at
the discretion of our staff and in the debriefing of any life rescue event.
Please be advised that (school name) is proud to be a participant in our city’s “Chain of Survival”.
Please feel free to contact me if you have any questions or concerns.
Sincerely,
Program coordinator
School name

Community Groups Letter
SAMPLE
This letter to community groups may be provided on an as-needed basis. Please check with your school legal
counsel to ensure it may be used. It may also serve as an addendum to your school liability waiver already in place.
Feel free to copy any or all of the following key points.
<Name of company or civic group>
<Date of building/room use>
<Name of your facility> is committed to provide our students, visitors and employees with a safe environment. We
have joined a community effort to implement a Public Access Defibrillation (PAD) program in our facility. Automated
External Defibrillators (AEDs) have been placed in the following locations:
*Describe these locations. You may want to indicate whether wall-mounted cabinets are used and if so, inform the
user that they are unlocked and alarmed; the alarm will stop when the cabinet door is closed.
We have trained staff available during regular school hours should a sudden cardiac arrest or other emergency
occur. However, please be advised that trained staff MAY NOT be readily available to assist you in the event of an
emergency outside of regular school hours. If you are CPR/AED certified and feel you can effectively use the AED
please feel free to use it. We encourage everyone to participate in our community “Chain of Survival” (early 911,
early CPR, early defibrillation, early medical care).
If a life rescue event occurs please be advised that to activate 911 you must: (describe the procedure for doing
this at your facility). If you use the AED, please contact the appropriate school officials immediately. <Include
where list of names and numbers can be found>.
We would encourage everyone to learn CPR and how to use an AED; it could be the difference between life and
death. For information on CPR/AED training classes scheduled for our area please call <school representative or
any accredited training organization in your area >.

Sample Program News Release
Date:
FOR IMMEDIATE RELEASE:
(School name) announces life-saving defibrillation program.
(City and date) Starting (your school’s implementation date) the students, visitors and employees of (school name)
will have a better chance of surviving a cardiac arrest because of newly installed Automated External Defibrillators
(AEDs). The AEDs are part of our school’s new public access defibrillation program that trains staff and students
to recognize a cardiac emergency, perform CPR and use the device to administer a shock to the heart. “We
want to be sure we can effectively respond to any medical emergency that occurs on our property”, says (school
spokesperson).
Every year almost 350,000 people suffer cardiac arrest and only about 5 percent of them survive. Since 1999,
in southeastern Wisconsin alone, 25 adolescents under the age of 18 have also suffered sudden cardiac arrest.
Only 8 of those students survived. While our program will allow us to respond to any person who collapses we
certainly want to offer our young people every chance to survive, since cardiac arrest in this age group is so
unexpected. Cardiac arrest is a condition in which abnormal heart rhythms cause the heart’s electrical impulses to
suddenly become chaotic. When this happens, the heart stops abruptly, and the victim collapses and quickly loses
consciousness. Death usually follows unless a normal heart rhythm is restored within a few minutes. Defibrillation,
which delivers an electric shock to the heart, is the only known treatment to stop this chaotic electrical activity. This
allows the heart to restart itself. For every minute defibrillation is delayed, the victim’s chances of survival go down
by 7 to 10 percent.
When Adam Lemel collapsed and died while playing basketball in January of 1999 it spurred the efforts to establish
a program to help schools across Wisconsin to place AEDs in all locations. The program, Project ADAM, was a joint
effort of friends of Adam and Children’s Hospital of Wisconsin and has been a resource for many schools not only
in Wisconsin but also across the nation. Senator Russ Feingold introduced the Adam Act, a bill that will establish
a national clearinghouse, modeled after Project ADAM, for AED programs in schools across the country. In July of
2003 President Bush signed this bill into law. In 2016, Tennessee requires all schools to provide annual SCA, CPR
and AED awareness training and perform at least one AED/CPR practice drill.
According to a school spokesperson, concern about being able to ensure quick defibrillation caused them to set up
the AED program. “We have a large campus and sometimes EMS response times are delayed due to weather, traffic
problems and location
of the victim, so we worked with local EMS and the Project ADAM staff to set up our program...<<or insert other
quote>>.”
AEDs now on the market are safe and easy to use, making it possible for non-medical personnel to be trained
to provide rapid defibrillation for victims of all ages. More and more schools are taking this step since legislation
supporting the Good Samaritan law was passed in this state. This allows non-medical lay rescuers to use the AED.
The American Heart Association, Project ADAM and OSHA recommend that any facility in
which large groups of people congregate consider establishing a defibrillation program. It
is estimated that establishing these programs could save as many as 50,000 lives per year.
For more information regarding our program you may contact (contact person). For information about Project ADAM
and public access defibrillation programs in your school please call (414) 266-3889.

Staff Awareness Training for Sudden Cardiac Arrest and AED
This is just a template and may be modified. This presentation lasts approximately 20 minutes. You will
need a DVD player, projector, and speakers. You will need to have internet access and be ready to play 2
chapters of the Project ADAM training videos, located at http://www.chw.org/childrens-and-the-community/
resources-for-schools/cardiac-arrest-project-adam/video-overview/. After this presentation, the staff should
return to their normal locations for the drill. Following the drill, you may reconvene to discuss the drill with
entire staff.
INTRODUCTION
Say: This material is from Project ADAM Tennessee, an outreach program of East Tennessee Children’s Hospi-
tal which helps schools obtain AEDs, create a response plan, and implement CPR and AED training for staff.
Our school is properly equipped with an AED(s), or Automated External Defibrillators. We have a protocol for
making sure they are maintained properly. State law now requires that all school personnel undergo Sud-
den Cardiac Arrest (SCA) awareness training and perform an annual AED drill with students present. Doing
these two things will ensure any victim of SCA on our campus will have the best chance of survival.
The practice drill is not a test, but rather an exercise that helps us to measure our preparedness and tweak
any possible weaknesses. We will do the drill in just a minute. First, we’re going to watch a short video from
Project ADAM that will help us understand Sudden Cardiac Arrest.
PLAY CHAPTER 2 of Project ADAM video - http://www.chw.org/childrens-and-the-community/resourc-
es-for-schools/cardiac-arrest-project-adam/video-overview/.
Say: There’s usually not much warning with Sudden Cardiac Arrest. These often are the people who are the
picture of health, out for their daily run or in the middle of a ball game and suddenly drop.
In SCA, the heart is no longer pushing blood to the brain and other vital organs. Unless immediate action is
taken, there will be damage to these organs and the victim will likely die.
There is a general plan that every school should follow and that is the American Heart Assocation’s Chain of
Survival. It is very simple and easy to remember:
1. Early recognition of SCA (unresponsive & not breathing normally; may have seizure-like activity)
2. Early call to 9-1-1
3. Early CPR
4. Early AED
5. Early Advanced Care
Let’s talk about our schools AED or Automated External Defibrillator.
Our AED here at(this school) is a (Zoll? Cardiac Science? Phillips?–check to be sure) model and is
located ______________. It is state law that these devices are stored in an unlocked case that is easily
accessed and close to where the most activity occurs during the day. Most AED cases have an alarm. The
alarm is not connected to EMS, but is for your notification. If the AED is retrieved in an emergency, we
recommend letting the alarm sound until the team has secured the situation. The AED is very simple to
use. (Demonstrate briefly how to turn it on, where the pads for adult and peds are located, explain that we

leave adult pads attached since they are most likely going to be ones using it, but ped pads are available for
anyone under 55 lbs. or 8 years old. If in doubt about victim’s size or age, go with adult. Explain how this
AED delivers shock – either automatic or will flash and direct responder to deliver a shock).
Most AEDs have a CPR instruction feature such as voice directions and/or a metronome. (Demonstrate if
theirs has this feature). The AED will not hurt anyone. It will analyze the victim’s heart and will only shock a
shockable rhythm. The AED is not to be feared. It may make a hero out of you!
We are going to watch one more video that will help us understand why we need a Public Access to
Defibrillation Program and give us an idea of what this looks like.
PLAY Chapter 3 of Project ADAM Video - http://www.chw.org/childrens-and-the-community/resources-for-
schools/cardiac-arrest-project-adam/video-overview/.
SAY: At (our school), we have established a Medical Emergency Response Team and a plan.
(Ask response team to stand). These people have agreed to serve as our response team. They have been
trained in CPR and AED use (or they will be shortly) and will come to your aid when needed.
Whether or not you are on the“team,”you are responsible in some way:
If you find the victim or are the first adult on the scene:
You will call for the response team if you find a child or adult who is:
1. Unresponsive, and
2. Not breathing normally (not breathing at all, gurgling, shallow ineffective gasps are NOT NORMAL)
These are the only 2 criteria you are looking for. You do not need to check for a pulse.
You will assess the scene to make sure it is safe for you to approach the victim. You will tap on the victim and
shout to see if there is a response. If the victim is unresponsive and not breathing normally, you will call the
office by intercom, ask them to send the AED team to your location. If you do not get a response from the
office, it is OK to yell for help or send a student next door to get another teacher. It is crucial to contact the
office in the calmest way possible so that the response plan will be immediately initiated.
You will stay with the victim until team members arrive. If you know CPR, begin compressions at a rate of
100/minute, 2 inches deep, in the center of the chest on the lower half of the sternum (think“Stayin’Alive”).
If you do not know CPR, and you know there’s a staff member close by who does, get them! If you know CPR
but are not on the team, it is OK to start CPR until team members take over.
The team’s response:
The front office will call (on your school’s most efficient mass-communication device, usually the intercom,
in some cases walkie-talkie or phone): “There is a medical emergency in (Ms. _____’s room/ Room #____,
_____hallway – identify location clearly). AED/CPR team should report immediately to (repeat location). All
other staff should contain their classrooms, and stay clear of hallways until further notice.”

The front office will call 9-1-1.
Someone from the front office or response team will await arrival of EMS and direct them to location of
victim.
All other team members will immediately go to the location of the victim.
If you are not a team member, you will keep your students in their classroom and stay out of the hallways.
If your classroom is near a team member, you will make sure their students are supervised so the team
member can attend to the victim. All staff should make every effort to protect the privacy and dignity of the
victim, while also protecting their students from the drama and trauma of such an incident.
When the team arrives, they will continue or begin CPR, attach the AED to the victim, and listen to the
instructions of the AED. They will continue to perform CPR and listen to the AED directions until EMS arrives.
All other personnel should clear the area and should take care to keep students away from the victim and
out of the hallways.
When EMS has left the premises, the front office should notify the staff with an overhead announcement:
“Staff may resume normal activities at this time.”
Ask someone to remain and serve as timekeeper.
Questions?
(If conducting a drill, instruct participants to return to their normal location during the school day and await
notification from the office). Once we have completed the drill, we’ll return here for a quick debriefing.
Upon completion of drill, ask front office to announce,“All Clear.” If you have time, ask staff to return to
library for review of drill performance and to address additional questions. The most common trouble spots
involve communication and accessibility issues and it is helpful to consider alternatives.

SuddenCardiacArrest(SCA)InformationforAthleticDirectorsandCoaches
Catastrophic injuries can occur and you can respond:
• During any physical activity, at any age - not just with athletes
• At any level of participation
• During team and individual practices, as well as at games
• Unpredictably and without warning
• They are Low Incidence, but High Risk
• SCA is the leading cause of death in young athletes: 1,000 - 7,000 children, adolescents and
young adults each year
• Early recognition is critical. Sudden unresponsiveness means sudden cardiac arrest until proven
otherwise with AED
• An SCA may look like a seizure in the beginning
• Anyone who is unresponsive and not breathing normally, needs CPR and the AED
• Should be handled by the best trained personnel available - and you cannot wait for EMS to arrive
• Average EMS response time is 6-12 minutes. The brain can only wail3- 5 minutes
• Training in CPR and on-site AED programs are likely the only means of achieving early defibrillation
and improving survival from sudden cardiac arrest in athletes
• Any adult (or teen) witnessed arrest, can be treated with Hands Only CPR until the AED arrives:
Send someone to call 911
Start continuous chest compressions, hard and fast, in the center of the chest, 2 inches down, and to
the beat of“Stayin Alive”(rate of 100/minute)
Rationale: the victim you observe go down was breathing just before collapsing, so does not need
breathing assistance for several minutes -just great compressions.
• The single greatest factor affecting survival is the time interval from arrest to defibrillation. So
recognition of the emergency is critical. Target goal: under 5 minutes from collapse to first shock (and
effective CPR immediately and until AED arrives).
• Survival rates decrease by 10% with each minute of delayed response
• In a recent national survey of 36 SCA events in high schools, 97% SCA events were witnessed,
94% received bystander CPR, and AED deployed a shock in 83% (12 required multiple shocks),
67% of those victims survived!
• As of June 2013, at least 39 lives have been saved in Georgia schools after a sudden cardiac arrest.
These children and adults are alive today because their schools were prepared and practiced for this
emergency, where school personnel provided CPR and used the school’s AED.

Emergency Action Plans for Sports
Goal: to provide the highest possible quality health care to athletes and others (not just for cardiac
emergencies, but more commonly for fractures, spine injuries, healinjuries, asthma and allergic reactions
• Develop in consult with local EMS, administration, school health personnel
• Should be venue-specific (i.e. how would you communicate and/or retrieve AED from any
practice field or game site?)
• Communication
access to phone and back-up communication
- 911 availability- know where the call goes (is nearest cell tower in next county?)
- clearly communicate to EMS“victim is unconscious and not breathing”
• Personnel: Identify first responders and keep training current. Consider training all coaches
in CPRIAED
• Educate all members of emergency response team in:
- recognition of emergency
- CPR,AED, First Aid
- disease prevention
- the Emergency Action Plan
• Roles: immediate care of victim (CPR if needed), emergency equipment retrieval, activation of EMS,
direction of EMS to scene
• Other roles:crowd control, attention to other students, contacting parents (are emergency numbers
with you), get medical records of athlete
• Emergency equipment should be on site, easily accessible, in good operating condition, checked
at least monthly for pad dates, battery life. Build quality into your plan by reviewing regularly and
rehearsing the plan with an AED practice drill, annually or before every season
• Communicate the plan to parents and athletes
NATA Position Statement (March 2002) see complete statement at www.nata.org)
1. All personnel involved with the organization or sponsorship of athletic activities share a professional
responsibility to provide for the emergency care of an injured person.
2. Must have a written emergency plan, accounting for athletes, game officials, fans, sideline participants.
(comprehensive, practical, flexible)
3. All personnel share a legal duty to develop, implement and evaluate emergency plans for all sponsored
athletic activities.
Tennessee Sudden Cardiac Prevention Act (see Tennessee Law, TCA Chapter 68)
These emergencies are always devastating to the school community. Awareness, planning, education and
advocacy can and will save lives.
For assistance with your planning, contact:
Karen Dean Smith, APRN-BC
Project ADAM Tennessee Coordinator
East Tennessee Children’s Hospital
2018 Clinch Ave. Knoxville, TN 37916 kdsmith2@etch.com
Office: (865) -541-8137 Cell: (865) 384-1676 Fax: (865) 541-8285

• There are about 350,000 sudden cardiac deaths (SCD) in the U.S.each year, almost 1,000/day.
These victims could be on your staff or visitors to your school.
• At least 600 - 1,000 of these occur in children and adolescents each year, so we can expect there
might be 10-25 student deaths in Tennessee each year.
• There have been at least 7 probable sudden cardiac arrest in Tennessee schools in the last 2 years:
there has been 5 lives saved by an AED1 in Knoxville1 Emanuel Negedu was a lucky victim of SCA
as was Hunter Helton.
• During Sudden Cardiac Arrest (SCA) the heart goes into ventricular fibrillation or“ineffective quivering”
and can no longer pump blood to the brain and other vital organs.
• Early CPR and early defibrillation are required to save the victim’s life.
• Time is the critical element. Three to five minutes is the optimum time for emergency response.
Don’t waste precious time trying to figure out what may have happened- some on the staff needs to
call 911, while a first responder initiates CPR and someone else brings the AED to the scene if there is
one in the school.
• Survival rates decrease by 10% with each minute of delay.
• A shock delivered by an automated external defibrillator (AED) within 3 - 5 minutes can safe a life.
We cannot wait for Emergency Medical Services.
• The AED will look for a“shockable”heart rhythm and will only deliver a shock if it is needed.
All rescuers are covered by the Good Samaritan Law.
• A student victim of sudden cardiac arrest may just complain of feeling“faint”or dizzy, usually during
or just after exercise. They will rapidly become unconscious. There may be irregular and ineffective
breathing for a short time.
• A core group of staff members (at least 5) should be trained in CPR and AED use. It is advisable for all
coaches and PE teachers to have this training also.
• AED practice drills are also recommended at least annually.
• Since anyone might be the one to witness the event, it is important for all staff members to have some
general awareness of these facts: what a sudden cardiac event looks like, warning signs, importance of
a rapid response, basic AED information (such as where it is and what it is), the school communication
plan and how they can initiate and help in the emergency response.
The early warning signs of sudden cardiac arrest risk include:
• Fainting or dizziness during or right after exercise
• Excessive fatigue or shortness of breath with exercise
• Chest pain or discomfort with exercise
• Family history of a sudden, unexplained death before age 50
For more information on recognition as a Project ADAM Tennessee Heart-safe school or for consultation
for your school please contact:
Karen Dean Smith, APRN-BC, Project ADAM Tennessee Coordinator
East Tennessee Children’s Hospital,2018 Clinch Ave. Knoxville, TN 37916
kdsmith2@etch.com (o) 865-541-8137 (c) 865-384-1676 (f) 865-541-8285
Awareness for Administrators

Sudden Cardiac Arrest Awareness Form
Name of Student:___________________________________________
What is Sudden Cardiac Arrest?
• Occurs suddenly and often without warning.
• An electrical malfunction (short-circuit) causes the bottom chambers of the heart (ventricles) to beat
dangerously fast (ventricular tachycardia or fibrillation) and disrupts the pumping ability of the heart.
• The heart cannot pump blood to the brain, lungs and other organs of the body.
• The person loses consciousness (passes out) and has no pulse.
• Death occurs within minutes if not treated immediately.

What causes Sudden Cardiac Arrest?
• Conditions present at birth
G Inherited (passed on from parents/relatives) conditions of the heart muscle:
s Hypertrophic Cardiomyopathy – hypertrophy (thickening) of the left ventricle; the most
common cause of sudden cardiac arrest in athletes in the U.S.
s Arrhythmogenic Right Ventricular Cardiomyopathy– replacement of part of the right ventricle
by fat and scar; the most common cause of sudden cardiac arrest in Italy.
s Marfan Syndrome – a disorder of the structure of blood vessels that makes them
prone to rupture; often associated with very long arms and unusually flexible joints.
G Inherited conditions of the electrical system:
s Long QT Syndrome – abnormality in the ion channels (electrical system) of the heart.
s Catecholaminergic Polymorphic Ventricular Tachycardia and Brugada Syndrome
– other types of electrical abnormalities that are rare but are inherited.
G NonInherited (not passed on from the family, but still present at birth) conditions:
s Coronary Artery Abnormalities – abnormality of the blood vessels that supply blood to the
heart muscle. The second most common cause of sudden cardiac arrest in athletes in the U.S.
s Aortic valve abnormalities – failure of the aortic valve (the valve between the heart
and the aorta) to develop properly; usually causes a loud heart murmur.
s Non‐compaction Cardiomyopathy – a condition where the heart muscle does not
develop normally.
s Wolff‐Parkinson‐White Syndrome – an extra conducting fiber is present in the heart’s
electrical system and can increase the risk of arrhythmias.
• Conditions not present at birth but acquired later in life:
s Commotio Cordis – concussion of the heart that can occur from being hit in the chest
by a ball, puck, or fist.
s Myocarditis – infection/inflammation of the heart, usually caused by a virus.
s Recreational/Performance ‐ Enhancing drug use.
• Idiopathic: Sometimes the underlying cause of the Sudden Cardiac Arrest is unknown, even after
autopsy.

What are the symptoms/warning signs of Sudden Cardiac Arrest?
• Fainting/blackouts (especially during exercise)
• Dizziness
• Unusual fatigue/weakness
• Chest pain
• Shortness of breath
• Nausea/vomiting
• Palpitations (heart is beating unusually fast or skipping beats)
• Family history of sudden cardiac arrest at age < 50
ANY of these symptoms/warning signs that occur while exercising may necessitate further
evaluation from your physician before returning to practice or a game.

What is the treatment for Sudden Cardiac Arrest?
• Time is critical and an immediate response is vital.
• CALL 911
• Begin CPR
• Use an Automated External Defibrillator (AED)
What are ways to screen for Sudden Cardiac Arrest?
• The American Heart Association recommends a pre-participation history and physical including
12 important cardiac elements.
• The UIL Pre‐Participation Physical Evaluation – Medical History form includes ALL 12 of
these important cardiac elements and is mandatory annually.
• Additional screening using an electrocardiogram and/or an echo cardiogram is readily available to
all athletes, but is not mandatory.
Where can one find information on additional screening?
• Check the Health & Safety page of the UIL website (http://www.uiltexas.org/health) or do an
internet search for “Sudden Cardiac Arrest”.
_________________________________________ ____________________________________________
Parent/Guardian Signature Date
____________________________________________
Parent/Guardian Name (Print)
_________________________________________ ____________________________________________
Student Signature Date
____________________________________________
Student Name (Print)

3 Simple Steps to Protect Your Family
1: Learn the Early Warning Signs
If you or your child has had one or more of these signs, see your primary care physician:
• Fainting suddenly and without warning, especially during exercise or in response to loud sounds like
doorbells, alarm clocks or ringing phones
• Unusual chest pain or shortness of breath during exercise
• Family members who had sudden, unexplained and unexpected death before age 50
• Family members who have been diagnosed with a condition that can cause sudden cardiac death, such _
as hypertrophic cardiomyopathy (HCM) or Long QT syndrome.
• A seizure suddenly and without warning, especially during exercise or in response to loud sounds like
doorbells, alarm clocks or ringing phones
2: Learn to Recognize Sudden Cardiac Arrest
If you see someone collapse, assume he has experienced sudden cardiac arrest and respond quickly. This
victim will be unresponsive, gasping or not breathing normally, and may have some jerking. Send for help and
start CPR. You cannot hurt him.
3: Learn Hands-Only CPR
Effective CPR saves lives by circulating blood to the brain and other vital organs until rescue teams arrive. It
is one of the most important life skills you can learn--and it’s easier than ever.
• Call 911 (or ask bystanders to call 911 and get an AED)
• Push hard and fast in the center of the chest. Kneel at the victim’s side, place your hands on the lower
half of the breastbone, one on top of the other, elbows straight and locked. Push down 2 inches, then up
2 inches, at a rate of 100 times/minute, to the beat of the song “Stayin’ Alive.”
• If an Automated External Defibrillator (AED) is available, open it and follow the voice prompts. It will lead
you step-by-step through the process, and will never shock a victim that does not need a shock.
Project ADAM Tennessee works to ensure that schools in East Tennessee are trained and prepared to handle
a sudden cardiac arrest. Make sure that wherever your child plays, practices, or goes to school is heart-safe.
Learn more at etch.com or email kdsmith2@etch.com.
Learn more about hands-only CPR at www.heart.org/handsonlyCPR.
Prevent Sudden Cardiac Death

AED / CPR Skill Drill
Preparation
1. Instruct team members to go to http://www.projectadam.com.html. On the home page, there is an icon for
Project ADAM video on lower right side. Click on this arrow. Go to Chapter 3 and watch. This will take less
than 4 minutes and is excellent preparation.
2. Inform all staff that a drill will be run in the next two weeks at a time when few, if any, students are present. It will
be announced as, “This is a DRILL.” Code Blue in the ______. Emergency Response Team report immediately
to the ______.” Repeat.
3. Select a time and place for the drill. If front office staff are not part of Team, inform them of their role and of drill
time. Inform teachers who are team members to assign backup to cover their classrooms.
4. Inform team members that though they may be assigned a specific task , they will need to be aware of all
responses.
5. Assign members to: Initiate response and alert team to victim’s location; Call 9-1-1; Assess victim & situation;
Bring AED; Begin CPR; Provide crowd control; Assist with CPR; Gather information on emergency card and
contact parents.
6. Select Drill from examples in Project ADAM notebook or make up your own.
7. Assign two people to document.
The Drill
1. Place manikin on floor near one of your team members. This team member will: Assess and determine that
victim is unresponsive, call for help, alert office to emergency location and to contact 9-1-1, and bring AED.
This member will assure that victim is on firm surface, scene is safe, check for pulse for at least 5 seconds and
no more than 10 seconds, and begin CPR.
2. Designated team members will: Bring AED to site, leaving AED case open so alarm will sound and others
will know it has been retrieved; Front office will call 9-1-1 and announce “This is a DRILL. Code Blue on the
playground. Emergency Response Team members please report to your assigned locations.” (Repeat). One
member will await arrival of EMS, one will remain in office to maintain communication, find emergency card,
alert guardians. Others will go to scene. Person bringing AED may assist with CPR. One person will maintain
crowd control.
3. When AED arrives, substitute AED Trainer for your real AED. Apply appropriate pads and follow prompts.
Continue CPR while attaching pads.
4. When EMS arrives, direct them to scene. Send AED and emergency card with EMS.
5. Review and correct any problems.

The following scenarios may be utilized to make practice of CPR and AED skills more realistic for the
responders within a school public access defibrillation program. They are useful for both initial training and
periodic“skill drills.”
What are“skill drills?”
This is a system of role-play that provides periodic practice of skills rarely preformed but which are, at
the same time, essential. Periodic skill practice is necessary to the overall quality of a program. Without
opportunity to practice, responders may not be able to perform at an optimal level when an emergency
happens. In addition, planned drills allow for review to assure that the essential elements of optimal
response are operational such as prompt notification of the EMS, knowledge of AED location and time
required to deploy AED to the scene both proper sequence and timely implementation of efforts to
maintain airway, breathing and circulation.
Many schools have systems for periodic practice of evacuation procedures already in place. Skill drills for
public access defibrillation programs may follow a similar process as longs as they provide for hands-on
practice by responders. For example, a drill for staff responders may be planned on a scheduled in-service
day with CPR mannequins as victims.
As an alternative to planned drills, specific times for review sessions may be designated that allow for
practice. It is highly recommended that all trained responders have hands-on practice at an interval of
not less than every six months. This requires merely the amount of time required for a responder to work
through a practice scenario. In groups of four, trained responders may work through each role of a scenario
quickly.
Skill Drill Scenarios

Public Access Defibrillation in a School Setting
Purpose:
In this scenario, the learners practice the following AED scenario: victim collapse witnessed in the
gymnasium. Persistent ventricular fibrillation (VF), as determined by the AED, will require three shocks, one
minute of CPR, a fourth shock and the rhythm will convert to a non-shockable rhythm.
After VF is converted, breathing and pulse will be present.
Critical thinking: Seizure type activity due to hypoxia may precede sudden cardiac death.
Materials Required:
• AED trainer device (or training card to safely use AED for training).
• Mannequin for CPR (and appropriate barrier device/ decontamination supplies).
• Telephone (unconnected phone set or play phone).
• Stop watch.
Rhythm sequence for AED training unit:
Start with shockable rhythm ’ 3 shocks delivered ’ CPR for 1 minute ’ shockable rhythm continues ’
fourth shock ’ convert to non-shockable rhythm; pulse returns; breathing returns.
Scenario role assignments:
Rescuer 1 – AED rescuer Rescuer 2 – 9-1-1 caller
Rescuer 3 – CPR rescuer Rescuer 4 – observer/time keeper (this person should record
amount of time taken for entire drill to be completed as well
as should serve as an observer to provide feedback to the group.)
Scenario:
It is a big game. John leaves the house early to head to school for practice. As he goes out the door, he tells
his mom that he has never felt this good in all his life. While practicing, John feels a little short of breath and
thinks,“I’m probably just a little nervous”but does not mention it to the coach. Near the end of the game,
John’s team is up by 10 points. Suddenly, John has another episode of shortness of breath. He collapses and
begins to have some seizure activity. You (Rescuer 1) are attending the ball game. You and a coach (Rescuer
2) are the first people to reach the fallen player. Begin to assess and manage this victim now.
Instructor actions and victim information:
• The victim has what appears to be a seizure. The seizure has stopped. There is no breathing.
• There is no pulse. (Note: seizures have often been noted in actual events and are related to
hypoxia. This is an important point to make with the learners).
• Rescuer 2 returns with AED. Before attaching AED, remind students that a teen who has been
playing basketball may be sweaty (wet chest). Chest may need to be dried before pads are
attached.
Skill Drill Scenarios 1

Expected Learner Actions
Rescuer 1 – AED Rescuer
• Assess victim: check responsiveness, open airway, assess breathing. Simultaneously ask
Rescuer 2 – 9-1-1 caller to notify the EMS and obtain the AED.
Rescuer 2 – 9-1-1 Caller
• Notifies the local EMS of the emergency; obtains AED.
• Initiate CPR until AED arrives.
• When AED arrives, attach leads and begin use.
• Clear and analyze.
• Initial rhythm in VF.
• Rhythm remains VF for 3 shocks.
After 3 shocks, the victim has no pulse.
The victim is not breathing.
• Rescuer 3 now is available.
• After 3 shocks, victim has no pulse.
• Victim is not breathing.
• After 1 minute CPR, the rhythm is VF.
• After fourth shock, rhythm converts to
“no shock advised”non-shockable rhythm.
• Victim now is breathing.
• Victim now has a pulse.
Taking time immediately after implementing the scenario to
review actions taken will provide a richer learning experience.
1. What did we do well?
2. What could we do better? If needed, discuss with students how the time from delivery
of the AED to delivery of the first shock might be made shorter.
3. What was easy to remember to do?
4. What was hard to remember to do?
RECAP:
Rescuer 1 – AED rescuer
• Clear and shock one time. Follow with
two more shocks
Rescuer 3 – CPR rescuer
• Check pulse.
• Perform CPR for one minute.
Rescuer 1 – AED rescuer
• After one minute of CPR; clear & analyze
• Clear and give fourth shock.
• Clear and analyze.‘No shock advised.’
Rescuer 3 – CPR rescuer
• Check pulse; check breathing.
• Monitor victim.

Purpose
In this scenario, the learners practice the following AED scenario: victim collapse witnessed in the gymnasium. VF
will require two shocks and then the rhythm will be converted to a non-shockable rhythm. After VF is converted,
breathing and pulse will be present briefly and then the rhythm will revert to VF. One additional shock will be re-
quired.
Critical thinking: maintaining the AED in operation since ventricular fibrillation (VF) may reoccur.
Materials required:
• Stop Watch.
Rhythm sequence for AED training unit
Start with shockable rhythm ’ 2 shocks delivered ’ convert to non-shockable rhythm; pulse returns; breathing ab-
sent ’ continue monitoring with AED ’ reverts to shockable rhythm ’ 1 shock delivered ’ convert to non-shock-
able rhythm with pulse and breathing present.
Scenario role assignments
Rescuer 3 – CPR rescuer Rescuer 4 – observer/time keeper
Scenario
Robert’s soccer game is tonight. Robert’s parents and grandparents are all attending. Arriving at the field, the family
finds a vantage point that will give them a great view of the game. During the first half of the game, Robert’s grand-
father suddenly sits down and states,“I don’t feel very well.”He collapses almost immediately. You (Rescuer 1) are a
part of the coaching staff for the soccer team and hear someone call for assistance. You look around and see Rob-
ert’s mother (Rescuer 3) beginning CPR. There is a cellular phone and AED on the sidelines at the game. Begin to
assess and manage the victim now.
• CPR is in progress by Rescuer 3

Expected Learner Actions
• Ask Rescuer 2 – 9-1-1 caller to use the cellular phone to notify the EMS.
(NOTE: Cellular phone should be at least 10 feet away from the victim).
• Take the AED with you as you go to the victim.
Rescuer 3 – CPR Rescuer
• Continue CPR in progress.
Rescuer 2 –9-1-1 Caller
• Uses the cellular phone to notify the local EMS
of the emergency. Responds to assist at the scene.
Instructor actions and victim information
• Initial rhythm is VF
• Rhythm remains VF for 2 shocks.
Rhythm converts to non-shockable rhythm
with pulse present, breathing absent.
• Victim lapses back into VF rhythm.
• After third shock, rhythm converts to
‘no shock advised’non-shockable rhythm.
• Victim again is breathing and has a pulse.
immediately after implementing the scenario to review actions taken
will provide a richer learning experience.
1. What did we do well?
2. What could we do better? If needed, discuss with students how the time for delivery
of the AED to delivery of the first shock might be made shorter.
RECAP:
Rescuer 1 –AED Rescuer
• Set up AED. Attach leads.
• Clear and shock one time.
Follow with one more shock.
Clear and analyze.‘No shock advised.’
• Check pulse
• Check breathing
• Continue to have AED monitor heart rhythm.
• Clear and give third shock.
• Clear and analyze.‘No shock advised.’
• Check pulse; check breathing.
• Monitor victim.

Purpose
In this scenario, the learners practice the following AED scenario: victim collapse witness in the area of swimming
pool. Persistent VF will require two shocks and then the rhythm will convert to non-shockable rhythm. After VF is
converted, breathing and a pulse will be present.
Critical thinking: using the device safely due to water being present in environment.
Materials required:
• Stop watch.
Rhythm sequence for AED Trainer:
Start with shockable rhythm ’ 2 shocks delivered ’ convert to non-shockable rhythm;
pulse returns; breathing returns.
Scenario role assignments:
Scenario:
The swim team is competing today. Sue has not been feeling well during the week but is ready to compete. Sue
prepares for her race with a few laps and then gets out of the pool. She suddenly sits down and appears to have a
hard time breathing. As you (Rescuer 1) go to assist her, she slumps over. Rescuer 2 and Rescuer 3 are present. Begin
to assess and manage the victim now.
• Upon arriving at victim’s side, there is no breathing or pulse present.
• Initial rhythm is VF.
• Rhythm remains VF for two shocks. Rhythm converts to non-shockable rhythm with pulse and breathing
present.
Expected learner actions
• Assess victim for pulse and breathing.
• Initiate CPR.
Rescuer 1 –AED Rescuer
• Ask Rescuer 2- 9-1-1 Caller to notify the EMS.
• Obtain AED.
Rescuer 2 – 9-1-1 Caller
• Appropriately notifies local EMS of the emergency.
Rescuer 1- AED Rescuer
• Assure victim is in dry location.
• Use towel to dry victim’s chest.
Clear and shock 1 time. Follow with 1 more shock. Clear and analyze.“No shock advised.”
Taking time immediately after implementing
the scenario to review actions taken will
provide a richer learning experience.
1. What did we do right?
2. What could we do better? If needed, discuss
with students how the time for delivery of the
AED to delivery of the first shock might be
made shorter.

Taking time immediately after
implementing the scenario to review
actions taken will provide a richer
learning experience.
1. What did we do right?
2. What could we do better? If needed,
discuss with students how the time for
delivery of the AED to delivery of the
first shock might be made shorter.
Purpose
In this scenario, the learners practice the following AED scenario: victim collapse witnessed in the gymnasium. VF
will require two shocks.
Critical thinking: before the electrodes are applied, tell the rescuer the victim is wearing a medication patch.
Materials required
• Stop watch.
Scenario role assignments
Scenario:
The school day is almost over and the custodian is fixing the gym doors while the basketball team practices. You
(Rescuer 1) hear a sound as if someone has fallen. As you look over, you see the custodian lying on the floor. An AED
is located in the gymnasium. Begin to assess and manage the victim now.
• Upon arriving at the victim’s side, there is no breathing or pulse present.
• Victim has medication patch on chest.
• Rhythm remains VF for two shocks. Rhythm converts to non-shockable rhythm with
pulse and breathing present.’
Rescuer 3 -- CPR Rescuer
• Initiate CPR.
Rescuer 1 -- AED Rescuer
• Ask Rescuer 2 – 9-1-1 Caller to notify the EMS.
• Obtain AED.
Rescuer 2 -- 9-1-1 Caller
• Remove medication patch. Use towel to dry victim’s chest.
Clear and shock one time. Follow with one more shock.
Clear and analyze.“No shock advised.”

SKILL DRILL 5 – One person rescue
Purpose
In this scenario, the learners practice the following AED scenario: victim collapse discovered on the playground. VF
will require one shock.
Critical thinking: One-person rescue requires clear thinking and forethought.
Remember the chain of survival.
Materials required
• Stop watch.
Scenario role assignment
Rescuer 1 – 9-1-1 caller/CPR Rescuer/AED Rescuer
Observer/timekeeper
Scenario:
You are the last person to leave an after-school event. The door still is unlocked, although you have not seen the
custodian in some time. As you exit the school, you see a teenager lying on the ground. An AED is located in the
gymnasium. You are carrying a cellular phone. Begin to assess and manage the victim now.
• Upon arriving at the victim’s side, there is no breathing or pulse present.
• Victim seems to be having a seizure.
• Rhythm remains VF for one shock. Rhythm converts to non-shockable rhythm with
pulse and breathing present.
• Initiate CPR (one minute).
Rescuer 1 – 9-1-1 caller
• Call 9-1-1 to notify the EMS.
• Set up AED and pads.
• Clear and shock one time. Clear and analyze.“No shock advised.”
Taking time immediately after
implementing the scenario to review
actions taken will provide a richer
learning experience.
1. What did I do right?
2. What could I do better? If needed,
discuss with students how the time for
delivery of the AED to delivery of the
first shock might be made shorter.

346 NASN School Nurse | November 2011
Healthy Lifestyles
Automated External
Defibrillator Drills
Martha Anderson, RN, Texas
Brenda Clarke, RN, MSN, NCSN, Texas
Chrissy R. Hester, Texas
Jeff Mann, MS, ATC, LAT, Texas
Keywords: automated external
defibrillator; AED; AED team; skill drill
T
he automated external defibrillator
(AED) is commonplace in
community settings such as airports,
malls, and churches. Public access defi-
brillation came to the forefront in the
United States in 1994 by the American
Heart Association Task Force on Early
Defibrillation. Placement of AEDs in
locations easily accessible by trained lay-
persons may improve the survival of sud-
den cardiac arrest by quick identification
of arrhythmia and defibrillation. In 2004,
the American Academy of Pediatrics and
the American Heart Association issued
guidelines on medical emergency plans
for schools. An emergency response plan
includes placement of AEDs (Gregory,
2007). Many state legislatures have
enacted laws requiring AED placement
in all school facilities.
The Real Deal
September 15, 2006, was the night
that started legislation that would
affect all Texas public schools. A&M
Consolidated High School (AMCHS) was
hosting Austin Westlake High School
in a varsity football game. There were
4,500 fans in attendance watching the
two state-ranked top 10 teams. The
temperature was in the high 80s, and it
was just before 8:00 p.m. The game was
two minutes into the second quarter,
and Westlake had just driven the field to
tie the game 7 to 7.
A 6-foot, 6-inches, 300-pound offensive
tackle for Westlake had just left the field
to sit on the bench. He was discussing
the successful scoring drive with his
teammates when he fell backward onto
the track. His body began to go into
what looked like a seizure. The football
players yelled for help, and the athletic
trainer for Westlake responded. He
determined the player was still breathing,
so he monitored him during the seizure.
DOI: 10.1177/1942602X11409418
For reprints and permission queries visit SAGE’s Web site, http://www.sagepub.com/journalsPermissions.nav.
 2011 The Author(s)
Figure 1. Current and Pending AED Legislation in the United States (as of
September 3, 2009)
Source: Map provided by Zoll Medical Corporation (2009). Reprinted with permission.
at East Tennessee State University on January 20, 2015nas.sagepub.comDownloaded from

347November 2011 | NASN School Nurse
Figure 2. School-Based AED Program

After the seizure ended, the student did
not regain consciousness.
Doctors from the sideline and from
the stands (including the player’s
parents, both physicians) came to his
aid. As CPR was being performed by the
player’s parents, the referees yelled for
the athletic trainers and team doctors
from AMCHS to assist. Meanwhile, the
Westlake AED was retrieved from the
splint bag and applied to the player’s
chest. Within a matter of seconds, the
AED delivered a life-saving shock. The
student’s eyes opened up, and he began
to speak and ask how he did in the
previous drive. He was loaded into the
ambulance and taken to the hospital.
Today, this athlete has an internal
defibrillator, and with the exception of
refraining from contact sports, he has
been able to resume an active lifestyle
(Robbins & Cantu, 2006).
At the time, AMCHS had two AEDs:
one for athletics and one for the band.
College Station Independent School
District (CSISD) experienced firsthand
the importance of having an AED on site,
and the decision was made to purchase
AEDs for all of the athletic venues at the
high school and the middle schools. An
AED was purchased for each of the two
middle schools, and two more AEDs
were purchased for the high school
athletic department.
AEDs in the School Setting
CSISD was well ahead of the game
with the decision to require AEDs in the
school setting. By the spring of 2007,
all schools in the district had at least
one AED. Texas State Representative
Rob Eissler sponsored Senate Bill 7,
dedicating it to “all parents who have
lost children because AEDs weren’t
available” (Elliott, 2007, p. 1). After
approval by the Texas House, every
school was required to have an AED by
September 1, 2007 (Elliott, 2007).
The head athletic trainer at AMCHS,
was given the responsibility of
developing the policy and procedure for
our district—College Station Independent
School District. In addition, a team of
first responders (an AED team) was
established on each campus. The
AED teams continue to this day and
are composed of coaches, teachers,
administrators, resource officers,
and school nurses. The rationale for
establishing the AED team is to have a
designated group of CPR/AED-trained
individuals to respond on campus when
an AED is needed during school hours.
By having a varied representation of all
personnel, it is CSISD’s goal that at least
one of the AED team members will be
present prior to or after school should an
AED emergency occur.
What Now?
With policies and procedures for AED
use and response put into place and
campus teams of AED first responders
certified by the American Heart
Association in the standards for CPR/
AED training, specific implementation
Figure 3. AED Drill Roles
Rescuer 1 (finds victim)
Identifies the victim in need
Calls the front office
Begins CPR
AED arrives—continues CPR
Continues CPR until AED monitors the victim
Continues CPR after first shock
Repeats with shock and CPR until emergency medical services (EMS) arrives
If shock is successful, places victim in recovery position
Rescuer 2 (AED arrival)
Opens AED
Places electrodes on victim
AED monitors victim
Shock delivered
Assists with CPR as needed
Repeats with shock and CPR until EMS arrives
If shock is successful, places victim in recovery position
Rescuer 3 (remaining AED team members)
Calls 911 if needed/directed
Assists with CPR if needed
Opens doors and gates as needed
Crowd control
Meets the ambulance
Calls the front office to confirm communication with principal and administrative staff

349November 2011 | NASN School Nurse
Figure 4. AED Skill Drill Checklist

readiness details followed. How would
the AED team and campus nurse
create an effective plan? First, the idea
of having a practice AED drill was
proposed. A task force was subsequently
established with the head athletic trainer,
the two middle school nurses, and
the director of student services, who
also serves as the nurse administrative
liaison. The goal was to develop an
AED drill to help team members practice
regularly and reinforce more realistic
CPR and AED use. After about 6 months
of planning, the drills began to take
shape. The basic format for the drill
was adapted from information found
online (CPR/AED Pamphlet, 2008).
It was decided by the task force that
both middle schools would pilot the
drills and then meet to finalize the AED
drill format before presenting the drill
recommendations to the entire CSISD
school nurse group.
Piloting the AED Drill
Piloting the AED drill involved two
major components. First, the nurse at
A&M Consolidated Middle School created
a video utilizing student interviews that
focused on students’ knowledge of an
AED and informed students of the AED
drill procedure and upcoming drill. The
video was shown schoolwide during
announcement time.
The nurse at College Station Middle
School (CSMS) enlisted the help of
science teachers to prepare students for
the drill. The student preparation was
a three-day process. Science teachers
first showed a PowerPoint presentation
that focused on compressions-only
CPR and how an AED works. Next,
students viewed a video showing
CSMS AED team members performing
CPR and using the AED on a manikin.
Students were also shown what to
expect during an AED drill. On the
third day, advisory teachers presented
an oral review. The actual drills
followed within one week and were
unannounced. Both schools held
the drill during the school day when
students were in the classroom.
The drill utilized three rescuer roles,
and the remaining 4 to 10 team members
provided support with crowd control,
communication, or anything else that
the rescuers needed. Each drill was
videotaped, and the AED skill drill
checklist was recorded by a someone
not on the team.
At each school, the school nurses
led a debriefing session with the team
immediately after the practice drill. The
ability to practice the scenario was given
high marks by both AED teams. In fact,
the team members were rather impressed
by their knowledge and skills! It was
very beneficial to have the videotape
for team members to watch their
performance and be able to recognize
where communication was not clear or
Figure 6. Members of the A&M Consolidated Middle School AED Team
During a Skill Drill
Figure 5. Members of the College Station Middle School AED Team
During a Skills Drill

duplicated and how they could improve
upon those skills.
Conclusion
Skill drills should be a part of any
school-based AED program. There are
many drills that are practiced yearly to
remind students and staff how to handle
fires, tornados (duck and cover), safe
shelter in place, and site evacuation.
Adding a yearly AED drill, with a
debriefing session, helps to keep first
responders and rescuers in the school
setting competent and familiar with CPR
and the use of the AED should these skills
ever be needed in the school setting. ■
Resources
Berg, R. A., et al. (2010). Part 5: Adult basic life
support: 2010 American Heart Association
guidelines for cardiopulmonary resuscitation
and emergency cardiovascular care. Circulation,
122(18), S685-S705.
Markenson, D., et al. (2010). Part 17: First
aid: 2010 American Heart Association and
American Red Cross Guidelines for First Aid.
Circulation, 122(19), S934-S946.
References
CPR/AED Use Drill Pamphlet. (2008). Retrieved
January 21, 2011 from http://aeddrill.com
Elliott, J. (2007). Texas House OKs bill for
defibrillation at schools. Chron. Retrieved
December 9, 2010, from http://www.chron
.com/disp/story.mpl/special/o7/
legislature/4822964.html
Gregory, A. (2007). Schools should have
emergency response plans, AEDs. American
Academy of Pediatric News, 28(3).
Robbins, K., & Cantu, R. (2006). High
school football: Saving Matt: How many
people saved a life on the sidelines. The
Statesman. Retrieved March 24, 2010, from
http://www.statesman.com/sports/content/
sports/stories/highschool/09/22/22Nader
.html
Zoll Medical Corporation. (2009). AED
legislation. Retrieved February 10, 2010,
from http://www.zoll.com/medical-products/
automated-external-defibrillation
Martha Anderson, RN
School Nurse
A&M Consolidated Middle School
College Station, TX
Martha is a school nurse for 7th and
8th grades. She is also the president
of the Region VI Texas School
Nurse Association.
Brenda Clarke, RN, MSN, NCSN
School Nurse
College Station Middle School
College Station, TX
Brenda is a school nurse for 7th
and 8th grades. She is also the
president-elect of the Region VI
Texas School Nurse Association.
Chrissy R. Hester
Director of Student Services
District
College Station, TX
Chrissy is the administrative liaison
for the 13 school nurses in the
District.
Jeff Mann, MS, ATC, LAT
Head Athletic Trainer
A&M Consolidated High School
College Station, TX
Jeff is the head athletic trainer for
the College Station Independent
School District. Jeff also serves as
the Texas State Athletic Trainers’
Association Secondary Schools
Committee Chairman as well
as a committee member on the
Southwest Athletic Trainers’
Association Secondary Schools
Athletic Training Committee.

Drill Record
School:_____________________________________________Date:_________________________________________
TIME DRILL BEGINS:_______________________TIME DRILL ENDS:________________________________________
1. Time victim is discovered and front office called _____________________________________________
2. Time “Code” called by front office staff ____________________________________________________
3. First Rescuer responds(check all that apply) __ Time arrived
__Called for help(vocal)
__ Called for help (phone)
__ Started CPR
__ Ran for help
__ Called for AED
__ Other___________________
4. Second Rescuer arrives on scene ________________________________________________________
5. Time CPR begins _____________________________________________________________________
6. CPR started by ______________________________________________________________________
7. Did rescuers switch off CPR role every 2 minutes? ___________________________________________
8. Number of responders _________________________________________________________________
9. Time AED arrives _____________________________________________________________________
10. Time AED fully attached to victim ________________________________________________________
11. Time of first shock ___________________________________________________________________
12. Staff member communicates identity of victim to front office ___________________________________
13. Front office notifies parent/guardian if necessary ___________________________________________
14. Staff member awaits EMS arrival ________________________________________________________
15. Staff members perform crowd control ____________________________________________________
What did rescuers do correctly?
What could have been done better?
What was easy to remember?
What was hard to remember?
What will you do differently next time?
Team Members:____________________________________________________________________________________
______________________________________________________________________________________


Tennessee Code Annotated
TENNESSEE AED LAW
Tennessee Code Annotated
68-140-401. Legislative intent.
lt is the intent of the general assembly that an automated external defibrillator (AEO) may be used in accordance with the
provisions of § 68-140-401 for the purpose of saving the life of another person in cardiac arrest.
68-140-402. Part definitions.
As used in this part, unless the context otherwise requires:
(1) “AED” or “defibrillator” means an automated external defibrillator:
and
(2) “Automated external defibrillator (AED)” means a medical device heart monitor and defibrillator that:
(A) Has received approval of its premarket notification, filed pursuant to 2, U.S.C. §360(R), from the
United States Food and Drug Administration;
(B) ls capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular
tachycardia, and is capable of determining, without intervention by an operator, whether
defibrillation should be performed; and
(C) Upon determining that defibrillation should be performed, automatically charges and requests delivery
of an electrical impulse to an individual’s heart.
68-140-403. Use of AED devices-Training-Maintenance- Registration encouraged.
ln order to ensure public health and safety:
(1) A person or entity who acquires an automated external defibrillator (AED) shall ensure that:
(A) Expected defibrillator users receive American Heart Association CPR and AED or an equivalent
nationally recognized course in defibrillator use and cardiopulmonary resuscitation,
(B) The defibrillator is maintained and tested according to the manufacturer’s operational guidelines; and
(C) 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.
(2) Any person or entity who acquires an AED shall, within reasonable time after the placement of an AED,
register the existence and location of the defibrillator with the emergency communications district or the
ambulance dispatch center of the primary provider of the emergency medica¡ services where the AED
is to be located.
68-140-404. Program for use of AEDs.
ln order for an entity to use or allow the use of an automated external defibrillator, the entity shall:
(1) Establish a program for the use of an AED that includes a written plan that complies with subdivisions
(2)-(6) and the rules adopted by the department of health. The plan must specify:
(A) Where the AED will be placed;
(B) The individual who are authorized to operate the AED:

(C) How the AED will be coordinated with an emergency medical service providing services in the area
where the AED is located;
(D) The maintenance and testing that will be performed on the AED;
(E) Records that will be kept by the program;
(F) Reports that will be made of AED use;
(G) Other matters as specified by the department; and
(H) A plan of action for proper usage of the AED;
(2) Adhere to the written plan required by subdivision (l );
(3) Ensure that before using the AED, expected users receive appropriate training approved by the
department in cardiopulmonary resuscitation and the proper use of an AED;
(4) Maintain, test, and operate the AED according to the manufacturer’s guidelines and maintain written
records of all maintenance and testing performed on the AED;
(5) Each time an AED is used for an individual in cardiac arrest, require that an emergency medical
service is summoned to provide assistance as soon as possible and that the AED use is reported
to the supervising physician or the person designated by the physician and to the department as
required by the written plan; and
(6) Before allowing any use of an AED, provide to the emergency communications district or the primary
provider of emergency medical services where the defibrillator is located:
(A) A copy of the plan prepared pursuant to this section: and
(B) Written notice, in a format prescribed by department rules, stating:
(I) That an AED program is established by the entity;
(II) Where the AED is located; and
(III) How the use of the AED is to be coordinated with the local emergency medical service system.
68-140-405. Rules relating to AEDs - Adoption - Scope and contents.
The department of health shall adopt rules specifying the following:
(1) The contents of the written notice required by § 68-140-704;
(2) Reporting requirements for each use of an AED;
(3) The contents of a plan prepared in accordance with § 68-140-704 and requirements applicable
to the subject matter of the plan;
(4) Training requirements in cardiopulmonary resuscitation and AED use that are consistent with the
scientific guidelines of the American Heart Association for any individual authorized by an AED
program plan to use an AED:
(5) Requirements for medical supervision of an AED program,
(6) Performance requirements for an AED in order for the AED to be used in an AED program; and
(7) A list of the AED training programs approved by the department.
68-140-406. Limitation on liability of entity responsible program.
The entity responsible for the AED program shall not be liable for any civil liability for any personal injury that results from
an act or omission that does not amount to willful or wanton misconduct or gross negligence if the applicable provisions
and program established under § 68-140-704 and the rules adopted by the department pursuant to $ 68- T 40-705 have
been met by the entity and have been followed by the individuals using the AED
68-140-407. Limitation on liability of trainers.
An individual providing training to others in an approved program on the use of an AED shall be held harmless by the
employer of the trainer for damages caused by training that was negligent.
Tennessee Codes 2

68-140-408. Training and demonstration competence use of in CPR and of AED.
For purposes of § § 68-140-704-68-140-710, expected AED users shall complete training and demonstrate
competence in CPR and the use of an AED through a course of instruction approved by the Tennessee
emergency medical services board.
68-140-409. Applicability of § § 68-140-401, 68-140-404- 68-140-409.
The provisions of § § 68-140-704 - 68-,140-710, shall only apply to situations involving emergency use of an AED
and in no case shall it apply where there is a duty to provide care. Nor shall it apply where a doctor has prescribed
use of an AED for a patient’s use in the patient’s private home.
68-140-410. [Transferred]
HB0032 000436
TCA 49-2-122.
HOUSE BILL 32 by Todd
AN ACT to amend Tennessee Code Annotated, Title 68, relative to sudden cardiac arrest prevention.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 68, is amended by adding the following language as a new chapter 54:
68-54-101.
This act shall be known and may be cited as the “Sudden Cardiac Arrest Prevention Act.”
68-54-102.
As used in this chapter, unless the context otherwise requires:
(1) “Community-based youth athletic activity” or “youth athletic activity” means an athletic activity organized by
a city, county, business, or nonprofit organization when the majority of the participants are under eighteen
(18) years of age, and are engaging in an organized athletic game or competition against another team,
club, or entity or in practice or preparation for an organized game or competition against another team, club,
or entity. “Community-based youth athletic activity” does not include college or university activities or an
activity which is entered into for instructional purposes only, an athletic activity that is incidental to a nonathletic
program, or a lesson;
(2) “Department” means the department of health;
(3) “Health care provider” means a Tennessee licensed medical doctor (M.D.) or an osteopathic physician (D.O.);
(4) “Person” means any individual or governmental entity, corporation, association, organization, nonprofit
institution, or other entity or such entities’ representatives; and
(5) “School youth athletic activity” means a school or a local education agency organized athletic activity when
the majority of the participants are under eighteen (18) years of age, and are engaging in an organized
athletic game or competition against another team, club, or entity or in practice or preparation for an organized
game or competition against another team, club, or entity. “School youth athletic activity” does not include
college or university activities, an activity which is entered into for instructional purposes only, or an athletic
activity that is incidental to a nonathletic program, or a lesson.
68-54-103.
(a) This section applies to school youth athletic activity.
(b)
(1) The governing authority of each public and non-public elementary school, middle school, junior high school,
and high school, working through guidance approved by the department of health and communicated through
the department of education, shall at a minimum:
(A) Adopt guidelines and other pertinent information and forms as approved by the department of health to
inform and educate coaches, school administrators, youth athletes, and their parents or guardians of the
nature, risk, and symptoms of sudden cardiac arrest, including the risks associated with continuing to play or
practice after experiencing any of the following symptoms:
(i) Fainting or seizures during exercise;
(ii) Unexplained shortness of breath;
(iii) Chest pains;
(iv) Racing heart rate; or
Tennessee Codes 3

(v) Extreme fatigue;
(B) Require annual completion by all coaches, whether the coach is employed or a volunteer, and by school
athletic directors of a sudden cardiac arrest education program approved by the department. In developing
the program, the department may use, at no cost to the state, materials and resources created by
organizations, such as Simon’s Fund, for the purpose of educating coaches about sudden cardiac arrest. The
department shall make the sudden cardiac arrest education course program available on its web site for any
school to access free of charge;
(C) Require that, on a yearly basis, a sudden cardiac arrest information sheet be signed and returned by each
coach and athletic director and, if appointed, a licensed health care professional, to the lead administrator
of a non-public school or, for a public school, the local education agency’s director of schools prior to initiating
practice or competition for the year;
(D) Require that, on a yearly basis, a sudden cardiac arrest information sheet be reviewed by each youth athlete
and the athlete’s parent or guardian. The information sheet shall be signed and returned by the youth athlete,
if the youth athlete is eighteen (18) years of age or older, otherwise by the athlete’s parent or guardian, prior to
the youth athlete’s initiating practice or competition, to confirm that both the parent or guardian and the youth
athlete have reviewed the information and understand its contents;
(E) Maintain all documentation of the completion of a sudden cardiac arrest education course program and signed
sudden cardiac arrest information sheets for a period of three (3) years;
(F) Establish as policy the immediate removal of any youth athlete who passes out or faints while participating in
an athletic activity, or who exhibits any of the following symptoms:
(i) Unexplained shortness of breath;
(ii) Chest pains;
(iii) Racing heart rate; or
(iv) Extreme fatigue; and
(G) Establish as policy that a youth athlete who has been removed from play shall not return to the practice or
competition during which the youth athlete experienced symptoms consistent with sudden cardiac arrest and
not return to play or participate in any supervised team activities involving physical exertion, including games,
competitions, or practices, until the youth athlete is evaluated by a health care provider and receives written
clearance from the health care provider for a full or graduated return to play.
(2) After a youth athlete who has experienced symptoms consistent with sudden cardiac arrest has been
evaluated and received clearance for a graduated return to play from a health care provider, then a school may
allow a licensed health care professional, if available, with specific knowledge of the youth athlete’s condition to
manage the youth athlete’s graduated return to play based upon the health care provider’s recommendations.
The licensed health care professional, if not the youth athlete’s health care provider, shall provide
updates to the health care provider on the progress of the youth athlete, if requested.
(3) No licensed health care professional or other person acting in good faith within the authority prescribed under
this act shall be liable on account of any act or omission in good faith while so engaged; provided, that “good
faith,” as used in this act, shall not include willful misconduct, gross negligence, or reckless disregard.
(c) The local education agency, in consultation with the head of the school youth athletic activity, may establish the
following minimum penalties for a coach found in violation of ignoring a youth athlete’s sudden cardiac arrest
symptoms or allowing the youth to return to the practice or competition during which the youth athlete
experienced the symptoms without written clearance from the health care provider for a full or graduated return
to play:
(1) For a first violation, suspension from coaching any school youth athletic activity for the remainder of the
season;
(2) For a second violation, suspension from coaching any school youth athletic activity for the remainder of the
season and the next season; and
(3) For a third violation, permanent suspension from coaching any school youth athletic activity.
68-54-104.
(a) This section applies to community-based youth athletic activity.
(b)
(1) Any city, county, business, or nonprofit organization that organizes a community-based youth athletic activity
for which an activity fee is charged, working through guidance from the department of health, shall at a
minimum:
(A) Adopt guidelines and other pertinent information and forms as developed by the department of health to
inform and educate the director of the youth athletic activity, coaches, youth athletes, and their parents or
guardians of the nature, risk, and symptoms of sudden cardiac arrest, including the risks associated with
continuing to play or practice after experiencing any of the following symptoms:
Tennessee Codes 4

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