# Three deaths as ambulance defibrillators fail



## enjoynz (May 11, 2014)

I thought I'd post this as some of you might find it of interest.

Article as attached:
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11253315

What checks and how often does your station change the batteries in your Defibs?


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## DesertMedic66 (May 11, 2014)

Our AEDs have a little LCD screen inside the handle that says "OK". 

Our monitors are checked out at the start of ever shift and 1-2 extra fully charged batteries are placed in the unit.


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## rmabrey (May 11, 2014)

We dont have any AED's. Monitors our checked before shift and 2 spare batteries on the unit.


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## TransportJockey (May 11, 2014)

No AEDs. LP12s are plugged in at all times to their charging pack, and always have a spare battery on board just in case.


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## 18G (May 11, 2014)

*Video: MD PSP Trooper 5 Making River Rescue*

Edited


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## Tigger (May 11, 2014)

LP12s are user tested every day as the first part of rig checks. An incident occurred last year where one was tested but the crew did not actually read the printout, which said "user test failed." They ended up on a call needing a monitor and then discovered this. People are more careful now.

Two extra batteries on every rig, and with the Li-on batteries are not often needed. We get the service yearly by a Physio contractor as well.


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## rails (May 11, 2014)

Tigger said:


> Two extra batteries on every rig, and with the Li-on batteries are not often needed. We get the service yearly by a Physio contractor as well.



I'm really a fan of having two extra batteries on every rig. It's pretty common in my area, but not every service does it.


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## NomadicMedic (May 11, 2014)

LP15s at my service. User Test run twice a day and a 200j defib load test as well. We don't carry extra batteries, but have extras at the station. The Li-on batteries last a LONG time. (Anecdotal evidence follows: ran a code with 15+ 360j shocks, no battery issues.)


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## UnkiEMT (May 11, 2014)

DesertEMT66 said:


> Our AEDs have a little LCD screen inside the handle that says "OK".



You want to be careful with that, not saying it's true of every AED, but I was placed in charge of an AED program. Security at the site had been marking off the batteries in the AEDs as ok based on the LCD indicator, but when I actually ran the self-test on them, one of the three reported failed batteries, and from that point on showed a nogo on the LCD.



DEmedic said:


> LP15s at my service. User Test run twice a day and a 200j defib load test as well. We don't carry extra batteries, but have extras at the station. The Li-on batteries last a LONG time. (Anecdotal evidence follows: ran a code with 15+ 360j shocks, no battery issues.)



Defibs actually require very little electricity. Witness the fact that per the LP12 service manual, even the little 1.2Ah nicad fastpaks are supposed to be good for 80 360J shocks.


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## NomadicMedic (May 11, 2014)

Correct, but as you'll remember, charging that big capacitor in a LP10 (or 12... Or waaay back to the LP5) would suck the juice out of the already strained nicad batteries. I recall having to change batteries after every shock or so with a LP10. Lifepak batteries were notoriously bad and we always kept a stash of decent batteries in the truck. 

Many of the medics here can't get used to the fact that you can run calls all day with one battery.


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## rails (May 11, 2014)

UnkiEMT said:


> You want to be careful with that, not saying it's true of every AED, but I was placed in charge of an AED program. Security at the site had been marking off the batteries in the AEDs as ok based on the LCD indicator, but when I actually ran the self-test on them, one of the three reported failed batteries, and from that point on showed a nogo on the LCD. <snip>



Very interesting. Do you recall the brand of the AED? (Though I'm also thinking that more detailed checks in general could be in order!)


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## UnkiEMT (May 11, 2014)

rails said:


> Very interesting. Do you recall the brand of the AED? (Though I'm also thinking that more detailed checks in general could be in order!)



They were Phillips HeartStarts, but I don't remember the exact model.


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## NPO (May 11, 2014)

Zoll M series CCT monitor.

Checked at the beginning of every shift, charged while not in use and one extra battery carries, however they are the larger Zoll batteries.


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## mycrofft (May 11, 2014)

"Two year" battery service life? I believe that the service life is more measured on discharges and recharges. The shelf life may be to a specific date, then MINUS any discharges. A lot of rechargeables need to be serviced periodically ("recalibrated" as Zoll calls it) or they lose their charge and need "rehabbing" in a smart or special charger. 

And they died because of it…might not be easy to prove forensically that without a doubt the malfunctioning defib CAUSED the death. It may have forced them to operate out of protocol and leave community standards of care (which are damning enough), but….aaaaugh, I hate headlines as news reporting.


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## UnkiEMT (May 11, 2014)

mycrofft said:


> "Two year" battery service life? I believe that the service life is more measured on discharges and recharges. The shelf life may be to a specific date, then MINUS any discharges. A lot of rechargeables need to be serviced periodically ("recalibrated" as Zoll calls it) or they lose their charge and need "rehabbing" in a smart or special charger.



Physiocontrol publishes time based guidelines for battery life, in addition to discharge cycles, Amp hour minimum and discharge below voltage cutoffs. It's sort of a "whichever happens first" thing.

The degradation that happens to cells themselves because of age is effectively insignificant, but most of the time when someone issues an age restriction for cells, it's an attempt to place a conservative estimate on the length of time in service before failure for the accumulation of environmental insults (Temp cycles, vibration, impact, etc.).


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## Handsome Robb (May 12, 2014)

That's pretty sad. I'd agree that the events probably didn't have any effect on the outcome but the one with delayed defibrillation is the biggest issue. It sounds like they're working to correct the problem though. That's all I'll say on that. 

We use the Philips MRx, they're tested twice daily with a 150J test shock into a testing block. Once when we check them out by the VST checking out gear to us and then again after we turn them back in. The batteries are removed every night and placed on the charger. They're checked when we check the monitor out as well. We do not carry spare batteries, I've run 12 hour shifts with every call being "ALS" and using the monitor, two of which were refractory VF arrests with >20 shocks between the two of them and I still had >2/3 of my "B" battery left, A was dead. I'm not sure about maintenance but they seem like they're on it. As soon as a recall or maintenance notice comes out they issue the back-door fix to get around the issue and immediately start cycling monitors out to be fixed. For standard maintenance I'd bet a paycheck we do what Philips says if not more, knowing our logistics department.


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## UnkiEMT (May 12, 2014)

I really like the work environment that comes from working at small services, but I have to admit, the phrase "logistics department" sent a pang of envy through me.


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## Ensihoitaja (May 12, 2014)

Tigger said:


> LP12s are user tested every day as the first part of rig checks. An incident occurred last year where one was tested but the crew did not actually read the printout, which said "user test failed." They ended up on a call needing a monitor and then discovered this. People are more careful now.
> 
> Two extra batteries on every rig, and with the Li-on batteries are not often needed. We get the service yearly by a Physio contractor as well.



Our set-up is similar. We have a test load in the monitor pocket that can be used for a test shock as well. Our monitors are serviced yearly by Physio-Control and the hospital has a Biomedical Engineering department that can service/trouble shoot them as well.

We switched to the Li-On batteries a while back (2 years? I really don't remember) and I've never had to change batteries during a shift since.


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## mycrofft (May 12, 2014)

UnkiEMT said:


> Physiocontrol publishes time based guidelines for battery life, in addition to discharge cycles, Amp hour minimum and discharge below voltage cutoffs. It's sort of a "whichever happens first" thing.
> 
> The degradation that happens to cells themselves because of age is effectively insignificant, but most of the time when someone issues an age restriction for cells, it's an attempt to place a conservative estimate on the length of time in service before failure for the accumulation of environmental insults (Temp cycles, vibration, impact, etc.).



"Two years" was the _old_ rule of thumb for service life of NiCad batteries. Wonder if it stuck? I've recently run into folks still yelling about how you have to discharge rechargables entirely before recharge or it ruins them, which with lithium cells is not the case.

And what happens to the user manuals when the package gets opened?


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