CPR Unit With an Expired AED
Ms. Rivera teaches 9th-grade health and is scheduled to begin a six-day CPR/AED unit in the gym. She is certified in basic life support, but the school’s only AED in the gym has an indicator showing a replacement battery is needed; the main office AED is functional but locked in a cabinet, and the office is closed during her class. One student in the class has epilepsy with a seizure action plan that includes avoiding flashing lights and prolonged kneeling; another student uses a wheelchair and wants to participate. The class has 34 students and one gym period is shared with a study hall. Ms. Rivera has manikins for 12 students and one training AED. The principal says the unit must continue because CPR is in the state standards, but the nurse is on leave.
1. What safety and accommodation issues must Ms. Rivera resolve before teaching the unit?
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She must resolve several issues before students practice:
- Equipment readiness: the gym AED’s replacement-battery indicator means it may not be rescue-ready. She should confirm with administration which AED is functional and ensure it is accessible during class, not locked away while the office is closed. If the only working AED is inaccessible, she must escalate before the unit-not teach AED use as if the equipment were ready.
- Seizure action plan: review the plan, avoid flashing videos, provide a quiet break space, and let the student sit or use a mat rather than kneel for long periods.
- Wheelchair participation: plan adaptations such as performing compressions on a table-height manikin, taking the caller/recorder role, or using an adjustable surface; the standard is to perform the skill, not to perform it identically.
- Ratios and supervision: 12 manikins for 34 students means stations and rotation, not long lines. The shared study hall raises supervision and space concerns; she should coordinate with the other teacher or move to a better space.
- Infection control: ensure cleaning supplies and a plan for manikin hygiene.
2. Identify the key content points Ms. Rivera must teach accurately and explain why “hands-only” CPR should be presented as part of a sequence, not a replacement for all rescue skills.
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Key content includes recognizing cardiac arrest, calling 911 and activating the emergency response system, starting chest compressions, and using an AED as soon as it is available. For adult victims, compression rate is about 100–120 per minute, depth about 2 inches (5 cm), with full recoil and minimal interruptions; for children, depth and technique differ. She should teach that hands-only CPR is appropriate for untrained or unwilling bystanders in adult out-of-hospital cardiac arrest, but it is not a substitute for trained rescue breathing in situations such as drowning or pediatric arrest where hypoxia may be the cause. AED use includes turning it on, following prompts, exposing the chest, applying pads, and ensuring no one touches the victim during analysis or shock. She should correct the common misconception that an AED can “restart” a stopped heart by itself; it treats certain rhythms and must be paired with compressions.
3. What advocacy and documentation steps should Ms. Rivera take regarding the expired AED and the nurse’s absence?
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She should document the equipment status in writing to the principal: the gym AED battery indicator, the locked office AED, the class schedule, and the fact that the unit is required by state standards. She should request a written plan for emergency equipment access during class and ask whether the district has a maintenance schedule for AED batteries and pads. If the principal does not respond, she should escalate through the school nurse’s supervisor, the district health services coordinator, or the safety committee. She should not simply teach around the problem without notifying anyone, because that normalizes a nonfunctional emergency device. Regarding the nurse’s absence, she should ask who will handle medication and seizure emergencies and confirm that the student’s action plan is available. She should keep copies of her communications and avoid promising students that the AED is ready if it is not.