An external defibrillator, like a fire extinguisher or certain medications, may be seen as a piece of equipment that every surgical facility is required to have on site but that, with any luck, will never need to be used. While your staff may rarely be called upon to operate the defibrillators that may save patients' lives, it's common sense that when your facility needs to replace or upgrade the devices, it should purchase those that are effective as well as easy to use.

Manual and automated
In terms of operation, defibrillating devices are classified into two main types: manual external defibrillators and automated external defibrillators.

Manual defibrillators, familiar from the standard crash cart, usually include monitoring capabilities. They range from large-screened models that track pacing, non-invasive blood pressure, pulse oximetry, end tidal CO2 and several other patient vital signs to smaller units that may only monitor pacing and ECG. Hospital outpatient departments are more likely to be equipped with manual defibrillators and to include among their staffs clinicians who are specially trained to use them.

Automated defibrillators, on the other hand, are the portable, self-contained resuscitation units that have begun to be installed in many public places over the past six or seven years. Since they're easy to use, fundamentally fail-safe and generally lower in cost than manual models, AEDs may be more suitable for deployment in ambulatory surgery centers or office-based practices, where the staff may have less experience with, and the procedures performed may involve a lesser risk of, cardiac events. It should be noted that many manual models also include AED modes as well.

Monophasic and biphasic
Defibrillators are also classified into two other categories: those that use monophasic waveforms, or energy protocols, and those that use biphasic waveforms. The classifications primarily distinguish the direction in which electrical current flows during defibrillation. Monophasic waveforms flow in only one direction during the process, enabling multiple shocks to increase the amount of energy they deliver. In contrast, biphasic waveforms flow in one direction during the waveform's first phase and the opposite direction in the second phase, a system that doesn't always rely on escalating amounts of energy.

Clinical studies have tended to show that biphasic waveform defibrillators are more effective in rescuing cardiopulmonary function from ventricular fibrillation or ventricular tachycardia, and the American Heart Association recommended the use of biphasic over monophasic waveform devices in 2005.

There are, however, more practical considerations to favor biphasic machines. Since about 2000, most manufacturers have been developing and marketing biphasic machines almost exclusively, and many don't even carry monophasic models anymore. For that reason, the purchase of biphasic waveform defibrillators is recommended, if not unavoidable.

Waveform considerations
This is not to say that monophasic defibrillators are now unusable. If your facility owns monophasic models that have been regularly maintained and still work properly, they'll continue to serve the purpose. But you should draw up a plan to upgrade your equipment to biphasic models and phase out the monophasic ones, perhaps over the course of a few years so as not to tax your budget by making a large capital purchase all at once.

When you're considering the biphasic models on the market, you'll find that many machines feature specific waveforms that, while they're all biphasic, differ in shape and other characteristics. Additionally, manufacturers may promote their own proprietary biphasic waveforms as more effective or more beneficial than those of other manufacturers' machines.

It's important to note, however, that at this point in time there's no need to worry about which biphasic waveform is better or to let that guide your decision, since at present no research has convincingly shown that one is superior to others.

Operational simplicity
Whether you're considering manual or automated external defibrillators, what does matter is ease of use. "Ease of use" depends, of course, on the opinions of the users, so feedback on the equipment choices from the front line - what features they need, what they're comfortable with, what they don't like about a particular model - is critical, especially given the intended purpose of defibrillators. Since AEDs have democratized the use of the equipment among surgical staff, listen to your nurses and scrub techs as well as your MDs.

In general, you'll want to look for a defibrillator with straightforward operation - it should be immediately apparent where the "on" and "shock" buttons are - and with detailed instructions that make it easy to understand, both in training and in the visual and audible prompts offered when the device is turned on.

Operational matters aside, you'll also want to give careful consideration to your defibrillators' placement in your facility. They should be readily accessible in known locations, with clinical guidelines dictating that they reach a patient within three minutes of a cardiac emergency.

Standard practices
If your facility is making a "clean sweep" to replace or upgrade all its defibrillators at once, there's no doubt you'll be buying the entire lot of new equipment from the same manufacturer. That decision offers the best chance for purchasing discounts.

If you're not replacing all your defibrillators, though, or you're simply adding a few, standardizing your purchase to one manufacturer's products also makes sense. Standardized buying ensures that all your defibrillators are uniformly easy to use, no matter who's using them or which area of your facility they're being used in. The similar user interfaces make sure that staff can quickly recognize how to use the device, plus the similar electrodes, leads and other consumable parts mean that your supply storage isn't stocked with a confusing array of parts for different manufacturers' equipment.

In working order
In addition to arranging for a training session with a manufacturer's representative, make sure you get a full understanding of the service that's required to keep your defibrillators ready to go at a moment's notice and implement a protocol to provide that service.

Manual units, which have rechargeable batteries, are required to be checked after every shift for battery power and the presence of consumable supplies such as electrodes. Your biomed staff will also have to monitor the devices through a preventative maintenance schedule.

AEDs, on the other hand, are powered by non-rechargeable batteries that are replaced when they reach a given expiration date. Battery power and device readiness are signaled by a status indicator light or other visual cue on the unit. Biomed staff will also keep maintenance schedules on these defibrillators, but since they don't have to be tested during every shift, assigning your staff members to occasionally perform a walk-by check of the indicator is a good way to keep them familiar with its location and to ensure readiness.

HeartSine Technologies, Inc.
Samaritan PAD
(215) 860-8100
www.heartsine.com
Price: $895
FYI: HeartSine Technologies' compact, lightweight and easy-to-use Samaritan PAD offers the latest in public access AED technology with its SCOPE Biphasic escalating energy waveforms, which automatically compensate for differences in patient impedance without the need for operator adjustments, says the company. The Samaritan's battery and electrode pads are integrated into the unit and it is compliant with AHA and ERC 2005 AED/CPR rescue guidelines.

Medtronic
LIFEPAK 20 Defibrillator/Monitor
(800) 442-1142, option 6
www.medtronic-ers.com
Price: $8,000 to $11,000
FYI: The LIFEPAK 20 defibrillator/monitor from Medtronic is two defibrillators in one, says the company. An automated external defibrillator function designed for the infrequent user and BLS-trained responder is combined with a manual capability that allows ALS-trained clinicians to quickly and easily deliver advanced diagnostic and therapeutic care.

Philips Medical Systems
HeartStart XL Defibrillator/Monitor
(800) 934-7372
www.medical.philips.com/heartstart
Price: $7,995 to $12,085
FYI: Philips Medical's HeartStart XL offers unsurpassed ease of use in a small, lightweight package, says the company. Its SMART Biphasic waveform arms the responder with advanced resuscitation technology and the unit is also equipped with an automated external defibrillator mode. Hands-free defibrillation, three-lead monitoring with alarms and a five-year warranty are also standard.

Zoll Medical Corporation
Zoll R Series
(800) 804-4356
www.zoll.com/rseries
Price: not disclosed
FYI: The Zoll R Series defibrillator sets a new standard for simplicity and operational readiness in resuscitation efforts, says the company. For Zoll Medical, "code ready" means a device that is simple and always prepared for use, and its R Series offers a one-step system for easy, rapid deployment, smart tools to help clinicians improve CPR performance and comprehensive, automated checks designed to maximize readiness.

Aeron Work Stool
Have the Best Seat in the Center
Even if you're always on your feet, nothing beats the comfort of a good seat. While chairs may seem like the most mundane of office equipment, there have been some recent improvements to the humble work stool that could make your workday easier, especially if you or a fellow staffer are constantly sliding from one workstation to another.

Herman Miller, Inc., has an environmentally friendly solution to this problem. The new Aeron work stool is designed to be comfortable as well as easily adjustable so it can suit whatever your needs are. It is designed to include the latest ergonomic advances to accommodate your back, but what really sets it apart is the adjustable footring that lets you control its height. The stool itself is available in two versions, one that adjusts from 24.5 to 29 inches for 36-inch workspaces, and another more suitable for 42-inch-high places that adjusts from 27.5 to 34 inches.

Those who "think green" when it comes to buying furniture for their facilities will be impressed with what the Aeron is made of - specifically 68 percent recycled content, with each chair's frame and back being made from approximately 50 recycled two-liter plastic bottles. The chair itself is 94 percent recyclable and is Greenguard-certified.

Prices for the Aeron work stool start at $1,300. For more information, go to www.hermanmiller.com, call (616) 654-3000 or circle number 167 on your Reader Service Card.

Source Medical's SurgiSource 4.4
Upgrade Billing, Scheduling, Reporting and Inventory Management with One Program
Practice administrators who made a New Year's resolution to improve their information management systems may want to consider Source Medical's SurgiSource Release 4.4 as one of their options. This software is designed to help ASCs streamline their financial processes to make everything from billing to reporting easier.

With this new version, users can capture and report primary payer numbers and electronically submit secondary claims. They can also use the new adjustment screen to input more information at the line-item level and, if they use Emdeon as their claims clearinghouse and electronically bill Medicare secondary claims with the appropriate adjustment codes. The inventory module now accommodates up to 10 characters of vendor numbers to give more support to multi-vendor supply ordering, while a new outbound export function eliminates dual entry of demographic and scheduling data for those using SourcePlus EHR technology. There are many more enhancements designed to make the whole process move more efficiently and productively for anyone, says the company.

The company declined to disclose a price for this software. For more information, go to www.sourcemed.net, call (800) 719-1904, e-mail [email protected] or circle number 168 on your Reader Service Card.