Travis County Commssioners Court
March 2, 2004
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Item 7
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This may be a good time to call up number 7. 7. Discuss amendment to chapter 31, risk management division, with the addition of subchapter e, public access defibrillator program in Travis County facilities, and take appropriate action.
>> good morning, judge, Commissioners.
>> hey, doc.
>> we are here today to present a policy that we are recommending that the court adopt dealing with public access defibrillators. The policy would allow Travis County to deploy the automatic external defibrillators throughout county facilities at strategic locations within those facilities. It's a piece of equipment that's an important aspect of loss prevention within the county. The aeds are used to treat someone who goes into cardiac arrest. With us is dr. Rock who agreed to serve as our physician advisor. I would like him to speak about the aed's.
>> thanks, judge, Commissioners. That actually is a wonderful analogy, the first time that i've heard of aed's as loss prevention. You are exactly right. The concept is that we would have defibrillators to prevent the loss of life as the court knows they are very easy devices to use. This is a move nationally to move the devices from the medical arena to the public arena. We have been very fortunate in this community that we have had several successful saves from cardiac arrest as a result of the public access defibrillators. I think this does a couple of things for our community. One is it improves our ability to get defibrillation to patient's sides quickly in county buildings in designated areas where we know there is a high volume of traffic. Two is some of these places are actually difficult to access easily. So when -- when the fire engine or the ambulance stops in front there is still an access issue to get into the patient's side. Third, I think probably one of the most important side effects, it sends a message to the rest of our community that the county is committed to putting defibrillators inside of buildings for the public to use. Our hopes would be other non-governmental private entities would look at that and say this is a good move, we ought to increase defibation. The plan is present -- as presented in your backup is the template that we have used across esd's, across cities and school districts in terms of a deployment model so there is consistency. I think we are fortunate that the cost of these devices continues to develop pretty substantially.
>> the policy would be under risk management of h.r. Department and would be administer understand coordination with city of Austin fire department, Austin Travis County e.m.s., And of course dr. Rock as medical director of the e.m.s. The coordination of training and maintenance and supplies would be an important part of the -- the program and being under one department, one division, would enhance the efficiency of both maintenance and supply. There's -- there are a number of different revenue sources that -- and funding source thalsd go toward the purchase and maintenance -- that would go toward the purchase and maintain and supply of these pieces of equipment. One is the car count, the other is allocated reserve, the other of course is risk fund. The backup that you have shows a cost of $55,000. However as dr. Rock alluded to, the cost of the aed's have come down substantially and revised -- the revised figure would be $40,000. That would be to purchase 22 additional units plus the supplies and maintenance for the aed's. There are -- there is a number of aed's already deployed in the Travis County sheriff's department patrol vehicles. The emergency service district vehicles, and these would also fall under the pad policy for purposes of maintenance and supply. Again that's an efficiency point. The training would be done by lee mccormick, certified cpr and aed trainer, also chuck watt. We would be working with the individual departments where the deployment of aed's would take place on their certificate training as well as developing specific department policies about response and maintenance. It's an expansive program, it's going take some time to develop and evolve because the training aspect, the additional aed's that we would be purchasing, there's 22 additional units, there are 10 or 11 that -- that have already been purchased by the emergency service district that would be available for deployment. The other 22 would allow us to -- to deploy in all the Travis County facilities and again at strategic locations. For instance, in the criminal justice center, it would be located on every other floor, every odd numbered floor I should say that would allow the time period to -- that dr. Rock mentioned that someone would need to -- to have the -- to have the treatment before e.m.s. Was able to arrive. So that's the type of strategic location we are looking to -- to achieve here. Is there something else? The funding we are recommending be in the risk fund for management purposes. Where the original funds come from, of course, are the -- are up to the court and we -- we listed three possible areas. But -- but those funds should be placed in the risk fund as part of the loss prevention program.
>> we are talking about 40,000?
>> yes.
>> yes.
>> well I'm --
>> on the training, one question is how too use the machine I guess.
>> uh-huh.
>> the other question is when to use it, right? Is it obvious when this should be used.
>> very good, very common questions. It is usually obvious when to use it. What the training does is it allows people to recognize more clearly that someone is in need of a defibrillator. The second piece is anyone that dials 911 in our community would be walk thrud that first question. Walked through that first question. Is the patient breathing, I'm going to tell you exactly what to use. The second question is how to use the device. It's really a two-part answer. The absolute best way to to get the appropriate training which is what we are advocating. A 3 to 4 hour training program is very comprehensive in terms what was those patients need. Additionally there is data out there if someone has absolutely positively no training, because these devices are simple to use, a voice prompt actually walks the user through exactly what to do. So there is the opportunity that the 911 dispatcher could say ned granger, third floor, a defibrillator behind the desk, I'm going to tell you what to do. They could be walked through with the voice prompt and the dispatcher. The ideal is training. The fall back is if someone is there that doesn't have training, these devices are very simple to use and should be used have been shown to be capable even in -- in non-trained hands. I got confused on attachment b, less than precise wording on what the names of some of our buildings are. When we talk about precincts 1, 2, 3, 4 annexes are we talking about the buildings that the j.p.'s and constables are located in.
>> east, north, northwest, south, west, I figured out those of all of our rural community centers. What is the next one called rumor community center. We have five of them, I don't know what that next one is. Rural community center.
>> there may be a duplication.
>> because it's manor, Pflugerville, Jonestown, del valle and oak hill. Granted oak hill is going to change, but obviously the defibrillator would go with it. I don't know what that refers to. Airport road the new facility that we have got there. I didn't know what sat 1 and sat 4 offices the last two were specifically referring to.
>> satellite 1 on johnny morris and --
>> okay. That's t.n.r. Sat 1. T.n.r. Seats.
>> t.n.r. Sat 46789 pen what we -- sat 46789 then what we need to -- sat 4. Then what we need to contact date is t.n.r. 3, the big western at mansfield dam. It may be that the rural community center really ought to be sat 2 I guess is what we call it. Also do we have defibrillators at east and west command or the sheriff's office?
>> I would have to check with tcso to con federal that. I know their patrol cars do, I don't know within their facilities if they have them.
>> there are great numbers of folks and the public is invited to go out to those facilities as well to be filing paperwork, visiting with investigators. In addition to a large number of our own employees, I would highly suggest east and west command, if they do not already have them, have at least one. On west command it is a multi-story building. So the question would have to be whether one is sufficient, which it may very well be or whether you need two simply because it's a two story.
>> we'll verify that.
>> very good.
>> is there a source of funding issue? The question of the best place from which to take the money?
>> right. We have two self insurance resolutions. They don't state that loss prevention and wellness programs in the same issue that we brought with that can be paid from the self insurance fund. But the two fwundz that we have talk about insurable claims and the administrative overhead directly related to insurable claims be paid from these funds. We have been trying to -- to be very strict about that because it's very easy to start bleeding other things into those funds. We believe this is a good program to be funded. It's just a question of the source. Our recommendation would be that you -- that we don't believe that it can come from the risk management fund. But that if you have other sources of funding that you would put it in the risk management division of hr in the general fund and pay for it out of there as opposed to the risk management fund itself. Those really are kind of in lieu -- when those were set up the two funds they were kind of in lieu of insurance. So this wouldn't be something that you would buy insurance for. So that's -- that's a real quick and dirty difference. You did the resolution. And you set up the fund, you surely can change them. But it -- it really I think they are set up correctly the way they are. In that these kinds of programs are certainly good and wonderful, but they just need to be in the general fund in the risk management division of hrmd the prevention kind of programs.
>> you will be glad to, no, judge that yesterday late afternoon I talked to dr. Rock, said how much training do you need to have on these things? If dan comes down and says that you have fallen down in there, you are not breathing, we think that you have a heart problem, I can come down there and do this. Probably a little nervously. I guess the concern, it's not a concern because it's obviously a great opportunity for the county to be part of this, doc rocks give us a stat about -- if these things were available, versus something like this not being available if somebody were to have a heart attack, is this thing almost a for sure deal if you can somehow use this -- this defibrillator on a person versus if there wasn't one, that this could really be the life saver part?
>> absolutely. I think the best statistic is for every minute we don't defib late someone who is in cardiac arrest, their mortality increases by 10%. As an example if I were to have a cardiac arrest here right now, and we had a wonderful response from the engine company and the ambulance and it took four minutes, which in any circle is considered very good response interval, my mortality has worsened by 40% simply because there wasn't a device very close to me. If someone could pull that off the wall shock me immediately and the chances are that my survival would be dramatically different. Indeed our open data in Austin Travis County suggested -- our own data suggests that same thing. When defibrillators are close by patients, getting their close in vehicles or for example in schools our survival has been tremendous. So it is -- it's a very time dependent process.
>> then I would suggest that the most important thing to have these things is to make sure that everybody in a building knows exactly -- if that were to happen, I bet you that everybody in this room would be who knows when where that thing is, I mean, before you know it we might have some situations that the ambulance can get to you before we would be able to react right here. So I think that it's going to be really important, maybe that's a wellness thing that we do because we had lots of great involvement with that, so that people really -- that we really make sure that everybody knows when this thing is and this you -- that you are assured -- I think some people would be frightened to take something like this. When I had the ballpark I was always very fearful of giving people cpr. My staff, because I was afraid that loig a lot of times if you are trying to move somebody's next to get them in a spot to perform cpr, they might have had a next problem. Before you know it did you have done something that was worse than if you have just waited for the ambulance to get there. I think that it's going to be critical, we are going to do these in these things, have them, let's come up with some sort of a way to make sure -- I want to know exactly where the thing is.
>> one of the advantages of having it under one entity is that that entity can make sure things like that happen. For example, making sure that if we were to place it in a building, we placed it near an elevator somewhere that everybody who comes into a building looks at that, says gosh what is that. It sticks in their mind so in time of crisis they know exactly where to go to retrieve it. That's one of the things that would really help.
>> that's great.
>> the extensive training is part of location, again these are public access they are going to be readily available to the public as well. Part of the training is for our staff, our employees to be able to follow up once an aed is used. A question that comes up about location, I will ask chuck to address the location aspect.
>> chuck watt. Occupational health safety engineer. The locations are select sod that they will readily visible. They are going to mounted in a wall mounted box that has nome men encapsulateture that identifies -- nomenclature that identifies it as an aed. An alarm that will notify occupants that someone is accessing the aed. Part of the trach for the people in that building that we are training will include all of the locations in that facility. So we will do everything possible to make sure that we know where those are and that they are accessible.
>> we will spell out aed, though, right.
>> yes.
>> policy itself does contain some extensive training and instructions that need to be fold in addition to initial training and follow-up training.
>> there's no reason that we can't put signage consistently at the same floor that says like if we are doing elevators and stairwells in the cjc for example, if they are all in odd numbers, it doesn't mean that we can't put up a sign on the even floors saying nearest aed floor, tell them precisely, so that every floor is covered even if it doesn't have that physical piece of equipment. So that people know where the piece of equipment is. The other suggestion that I would throw out there is that we also have a ton of people where we are invited the park, the public out to, in terms of northeast metro, southeast metro and within the next six to nine months east metro parks. We have concession stands there. Where in terms of that equipment could be put in because basically when the concession stands are open, we have folks that are out there. So in terms of it being in a secure place when the park is completely closed down. I would also suggest mansfield dam, pace bend, hippie, winddy point and hamilton pool because those all have fee booths where this can be put in. The cool thing about all of those parks that I have mentioned is that we have park rangers. In materials of that person, in terms of a trained person already being there, those folks are already medically trained. Somebody is already there. We are just putting the piece of equipment closer. Those are all remote enough facilities that while there is e.m.s. In the area, we are not going to hit docks four to six -- doc's four to six minute mark at northeast metro, for example, even though the ambulance is up there on Pflugerville loop. They are not going to get to the park in four minutes.
>> in a specific facility, the locations are going to be similar on every floor. So that they will be in a general location on each floor for that facility. So you won't have to search which end of the hallway it would be. Also, the -- the list that we have here on attachment b is not an inclusive list. It's a starting point. The requirements of the procedure in policy are that we have a needs assessment by each department and office to identify locations that we will also need aed's and other circumstances. So when we go to t.n.r. And ask them where else do we need them, we have to look at these other areas that they have. And also any special -- not just location but any special times where we have a larger number of people that are gathering in an area. We can make sure that we have the equipment available.
>> I believe -- again I will confirm this. I believe some of our park rangers do have aed's in their vehicles as well.
>> right.
>> are these battery powered?
>> yes.
>> and what's the -- is it average life span?
>> the average life span in most of the devices now not used basically on the shelf waiting to be used is anywhere from four to six years. So the battery life is pretty extensive. Obviously if they are used in between, it dramatically decreases that battery life. But they are designed to be as maintenance free as they can be to hang on a wall and not be draining on resources to check them.
>> we will have a defibrillator checker at the county?
>> yes.
>> can did you say chucker or check erwin center. Might be a chuck.
>> move approval with the allocated reserve as a source of funding.
>> second.
>> any more discussion? All in favor? That passes by unanimous vote. Thank you all very much.
>> thank you.
>> thanks. Quick question, when are you going to bring back a more all inclusive list? Because like I said we have noted some things here about east and west command, we are miss an t.n.r. Satellite office, which is huge. And the potential of some of these parks.
>> we will have develop the list. Now that we have the policy in place we will be contacting each department to help us with that.
>> that works great. Thanks.
>> okay.
>> thank you.
Last Modified: Wednesday, March 3, 2004 1:22 PM