37 TAC §91.94
The Texas Youth Commission (the commission) adopts new §91.94,
Automated External Defibrillators with changes to the proposed text as published
in the December 10, 2004, issue of the
Texas Register
(29 TexReg 11461). Changes to the proposed text were made in response
to the public comments listed below.
The justification for the new rule is to provide for the emergency medical
care of commission staff and youth.
The new rule will establish guidelines for the operation and training requirements
associated with the use of an Automated External Defibrillator to aid in an
emergency response to a sudden cardiac arrest which occurs at a commission
facility, a District office, or the Central/Annex office.
The commission received comments from the American Red Cross (ARC) regarding
the proposed new rule. The comments are summarized below, followed by the
commission's response.
Comment: Regarding subsection (f)(1), a recommendation was made to Call
9-1-1 or the local emergency number, and include notification that an AED
is available.
Response: The commission has operational procedures for the commission's
facilities regarding life-threatening emergencies. In the event of a life-threatening
emergency, the individual who discovers or is first notified of the emergency
will call for help via radio or telephone to the gatehouse/control center
staff and state "CODE BLUE/Call 911" and state the location and nature of
the 911 emergency. The gatehouse/control center staff hearing the "CODE BLUE/Call
911" will immediately call for an ambulance and include notification that
an AED is available for use. Control center staff will immediately call "CODE
BLUE" via the radio and will then call the infirmary, security and the superintendent
or administrator on duty. The protocol for Central, District and Annex offices
is to directly call 911. The commission has determined not to make the recommended
change, based on current practice.
Comment: Regarding subsection (f)(2), a recommendation was made to delete
the word "begin" and insert the word "early" to be consistent with (f)(3).
Response: The commission does not agree with the recommendation to insert
the word "early" to subsection (f)(2). If an individual is in sudden cardiac
arrest, CPR should begin immediately rather than early. The commission made
no changes to the rule in response to the recommendation.
Comment: Regarding subsection (f)(4), the comment expressed that Advanced
Cardiac Life Support is a specific course taught by the American Heart Association
(AHA). The recommendation is to name the fundamentals, which may be covered
in similar courses.
Response: The commission agrees using the Advance Cardiac Life Support
language is too specific, in that it refers to a course taught by the AHA,
which was not the intent of the Cardiac Chain of Survival procedure. The commission's
intention was to include language that reflected AHA or similar courses in
how to prepare an individual to perform advanced medical care; therefore,
the commission amends the proposed subsection (f)(4) to read
facilitate access to advanced medical care.
Comment: Regarding subsection (f)(4), the comment expressed the preferred
terminology for "has no pulse" is "shows no signs of circulation". The recommendation
is to change the sentenced to read, "The AED is to be used only if the person
is unresponsive and shows no sign of circulation".
Response: The commission does not agree with the recommendation. The lay
terminology for "shows no signs of circulation" is one that "has no pulse".
The commission made no changes to the rule in response to the recommendation.
Comment: Regarding subsection (g)(2), the comment recommended that the
commission consider equipping the AEDs with pediatric pads.
Response: The commission's youth population averages 17 years old (with
ten (10) being the youngest). The commission facilities receive a small percentage
of visitors who are under the age of eight. The commission believes these
factors do not warrant the inclusion of pediatric pads on TYC residential
facilities and administrative offices. No amendments were made to the rule
in response to the comment.
Comments: Regarding subsection (h)(1), the comment expressed a concern
that the first sentence was unclear as to its purpose and the second sentence
is redundant with the first sentence regarding TYC direct care staff training
requirements.
Response: The commission agrees with ARC comment regarding the duplication
of training requirements for all TYC direct care staff in both sentences.
The commission has made an amendment to subsection (h)(1) to read, "AED training
is incorporated into the ARC training. All TYC direct care staff are required
to be trained annually by a qualified CPR/First Aid/AED TYC trainer or a qualified
contracted trainer".
Comment: Regarding subsection (h)(2), the comment expressed that non-direct
care staff should not be expected to be users of the AEDs, and watching a
training video without a practical skill component is not considered to be
a sufficient "training" experience. The ARC recommends the alternative language
"All TYC non-direct care staff working in TYC facilities that house youth,
designated District offices, and Central office/Annex are required to watch
the AED training video at least once annually. The ARC encourages all staff
to learn about the Chain-of-Survival and the importance of early recognition
of sudden cardiac arrest and immediate notification of emergency medical services.
Response: The commission's General Counsel, with consultation from the
commission's Medical Director, has determined the video training for all non-direct
care staff is sufficient training for the usage of the AED. The risk of misusing
the AED equipment is far less than the potential harm caused by not using
the AED in a sudden cardiac arrest situation. The commission made no changes
in response to the recommendation.
Comment: Regarding subsection (i)(4)(B), a recommendation was made that
scissors should be blunt-tipped in order to prevent additional injury.
Response: The commission agrees with the recommendation. Therefore, an
amendment has been made in subsection (i)(4)(B) to read "trauma shears or
blunt-tipped (safety) scissors;"
Comment: Regarding (i)(4)(F), the comment noted that "Pocket Mask" is a
specific name brand, and the correct terminology is a CPR breathing barrier
or a resuscitation mask.
Response: The commission did not intend to limit the mask to a single brand.
To broaden the type of breathing barriers, the commission amends the proposed
subsection to read "CPR breathing barrier or resuscitation mask;"
Comment: Regarding subsection (i)(4)(G), the comment expressed concern
that some individuals may have latex allergies, therefore, the ARC recommends
having non-latex gloves available. Also, multiple pairs of gloves should be
available for the responder(s) to use.
Response: The commission does not agree that non-latex and latex gloves
should be stored together with the AED equipment. The commission has determined
that the risk of providing multiple types of gloves (non-latex and latex)
could cause confusion and potentially delay an already-crisis situation. The
commission made no changes in response to the recommendation.
Comment: In addition to the items listed under subsection (i), ARC is recommending
to have a spare battery for the AED available. The recommendation is to insert
a new subparagraph (H) to subsection (i)(4) with the following language "spare
battery for the AED".
Response: The commission has determined that a spare battery is not necessary,
in that, the AED has a rechargeable battery with a four-year life span. Therefore,
the commission made no changes in response to the recommendation.
The new rule is adopted under the Human Resources Code, §61.045,
which provides the commission with the authority to adopt rules that provide
for the welfare of the youth in its care.
The adopted rule implements the Human Resources Code, §61.034.
§91.94.Automated External Defibrillators.
(a)
Purpose. The purpose of this policy is to establish procedures
and guidelines for the operation, storage, and maintenance, and training requirements
associated with the use of Automated External Defibrillators (AEDs). It is
Texas Youth Commissions (TYC's) objective to provide immediate emergency response
to a sudden cardiac arrest that occurs at a TYC-operated facility, designated
TYC district offices, and Central Office/Annex.
(b)
Applicability.
(1)
This rule applies to employees at TYC-operated facilities,
designated district offices, and Central Office/Annex.
(2)
The use of AEDs applies to TYC youth, staff, volunteers,
visitors, and contractors.
(c)
Explanation of Terms Used.
(1)
Automated External Defibrillator (AED)--a United States
Food and Drug Administration (FDA) approved electronic device, about the size
of a laptop computer, which is programmed to analyze the heart's rhythm for
any abnormalities and, if necessary, directs the rescuer to deliver an electrical
shock (defibrillation) to assist the heart in reestablishing a normal rhythm.
(2)
Cardiac Arrest--a malfunction in the heart's electrical
system (ventricular fibrillation or rapid ventricular tachycardia) that may
cause the heart to stop suddenly.
(3)
Myocardial Infarction--death of heart muscle tissue caused
by lack of blood supply to the heart due to plaque or blood clot.
(d)
The TYC Medical Director authorizes the acquisition of
AEDs at TYC-operated facilities, designated District offices, and Central
Office/Annex.
(e)
Upon acquiring an AED, the chief local administrator or
designee shall notify the local EMS provider of the existence, location, and
type of AED.
(f)
Cardiac Chain of Survival. Cardiac chain of survival is
the current treatment for sudden cardiac arrest that includes the following
four steps:
(1)
Call 911 or facility gatehouse/control center and include
notification that an AED will be used;
(2)
begin Cardiopulmonary Resuscitation (CPR);
(3)
provide early defibrillation; and
(4)
facilitate access to advanced medical care.
(g)
Restrictions for Use.
(1)
The AED is to be used only if the person is unresponsive
and has no pulse.
(2)
The AED is to be used only on persons over the age of eight
(8) years old.
(3)
The AED will provide voice prompts giving further instructions
if it cannot read the cardiac rhythm due to improper electrode placement,
motion of the person, low battery, or electromagnetic interference, etc.
(4)
The AED voice prompt will not instruct the user to shock
the person if the person's cardiac rhythm does not warrant a shock or if the
person's cardiac rhythm suddenly changes and shock is no longer indicated.
(5)
The AED voice prompts will not advise the user to shock
the person if the person is experiencing a myocardial infarction.
(h)
AED Training.
(1)
AED training is incorporated into the American Red Cross
CPR/First Aid training required for all TYC direct care staff. All TYC direct
care staff are required to be trained annually by a qualified CPR/First Aid/AED
TYC trainer or a qualified contracted trainer.
(2)
All TYC non-direct care staff working in TYC facilities
that house youth, designated district offices, and Central Office/Annex are
required to watch the AED training video at least once annually, and the training
will be documented and maintained by the local training officer.
(3)
The AED training program is approved by the TYC Medical
Director and the Texas Department of Health in accordance with the Health &
Safety Code, Chapter 779.
(i)
General Requirements.
(1)
At no time shall a TYC youth be accessible to the AED.
(2)
Each TYC-operated facility that houses youth, designated
TYC district offices, and Central Office/Annex will have an AED on-site. Al
Price State Juvenile Correctional Facility, Ron Jackson State Juvenile Correctional
Complex, and McLennan County State Juvenile Correctional Facility will have
two AEDs on-site (one for each unit and one for the medical dorm).
(3)
The AED should be stored in a protective case at all times.
The storage area is free from water, dirt, extreme cold (less than 32 degrees
F), and extreme heat (over 100 degrees F).
(4)
The following equipment should be stored with each AED:
(A)
carrying case;
(B)
trauma shears or blunt-tipped (safety) scissors;
(C)
defibrillation pads (2 sets; each facility/district office
will keep on hand an additional set of AED replacement pads);
(D)
razor;
(E)
towel;
(F)
CPR breathing barrier or resuscitation mask; and
(G)
latex disposable gloves.
This agency hereby certifies that the adoption
has been reviewed by legal counsel and found to be a valid exercise of the
agency's legal authority.
Filed with the Office of
the Secretary of State on February 1, 2005.
TRD-200500444
Dwight Harris
Executive Director
Texas Youth Commission
Effective date: February 21, 2005
Proposal publication date: December 10, 2004
For further information, please call: (512) 424-6301