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SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved

150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 1 of 21

I. CONTENT:

This document describes the Saudi Heart Association (SHA) and Saudi Aramco requirements for
training in Basic Life Support (BLS) Heartsaver Automated External Defibrillator (AED), Standard
First Aid (SFA), Instructor Training Program (ITP), and acquisition of First Aid Kits/AED machines.

1. Definitions:

1.1 SFA/BLS Heartsaver AED Training: is provided by Instructors of the Health


Promotion Unit (HPU), Preventive Medicine Services Division (PMSD), Saudi
Aramco Medical Services Organization (SAMSO).
1.2 SFA/BLS Heartsaver AED Instructor Training Program (ITP): is provided
by certified SFA/BLS/AED Instructors from the Health Promotion Unit, in order
to train trainers designated by a requesting organization to conduct SFA/BLS
Heartsaver AED classes on job site only for employees who fall under its
department/division.
1.3 SFA/BLS/AED Instructor Trainer: is a Health Promotion Instructor who is certified
to train others to become SFA/BLS/AED Instructors.
1.4 Non-SAMSO Instructor: is an Instructor trained in SFA/BLS Hearsaver AED by a
certified SFA/BLS/AED Instructor Trainer from the Health Promotion Unit. He/she will
send monthly statistics of completed classes to the SFA/BLS/AED Group Leader,
Health Promotion Unit.
1.5 First Aid Kits: are supplies required to administer First Aid to the sick or
injured; available through B2B Purchasing System.
1.6 Health Promotion Standards and Guidelines: are based on the Saudi Heart
Association (SHA), American Heart Association (AHA) and American Red
Cross (ARC) requirements.
1.7 Overall AED Program Coordinator: is a qualified individual in the Health
Promotion Unit, Preventive Medicine Services Division, who will be responsible
for implementing and administering the AED program in Saudi Aramco.
1.8 AED Site Coordinator: is a qualified individual at the authorized facility who
will supervise the implementation of the AED program in that facility.
1.9 SAMSO AED Committee: Chaired by the Overall AED Program Coordinator
and includes members from Occupational Medicine Services (OMS), Emergency
Medical Services (EMS), Medical Designated Facilities Department (MDFD),
SAMSO and the Cardio-pulmonary Resuscitation (CPR) Center. The committee
is responsible for ensuring that the AED installation and operation requirements
have been met. These requirements fall under three categories:
(i) Pre-installation Requirements: a) Evaluate the site assessment form.
(ii) Post-installation Requirements: b) provide assistance in the installation,
if requested.

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 2 of 21

1.10 AED Facility Sponsoring Committee: includes the AED Site Coordinator and other
personnel in the facility where the AED machine is to be installed. The committee
coordinates with the SAMSO AED Committee with regards to the AED installation and
operation requirements.

II. PURPOSE:

1. To ensure that a standardized high quality training in SFA/BLS/AED is practiced


consistently throughout the company in accordance with the Health Promotion Unit’s
standards and guidelines.
2. To ensure that at least one employee per shift at each site is qualified to administer
SFA/BLS Heartsaver AED to the sick or injured victim.
3. To ensure that adequate AED machines are available at all company work sites.
4. To ensure that end-users are aware of the AED installation and operation requirements.

III. GENERAL POLICES:

1. AED machine shall be placed in strategic locations at all company work sites
based on completion of the AED Site Assessment Form (Attachment) by Facility
Sponsoring Committee. A work location is considered a strategic location if:
o The location is more than 3km far from the nearest Emergency Medical
Service (EMS).
o The estimated response time from the location to the nearest Emergency
Medical Service (EMS) is more than 5 minutes.
o The approximate average age of workforce at the location is over 45.

2. First Aid Kit shall be available at all work sites, in accordance with Saudi Arab
Government Decision No.404, dated 17 Jamada 11, 1394 (7 July 1974).

3. All employees are eligible to be certified to administer SFA/BLS Heartsaver


AED procedure through a recognized training program.

4. Health Promotion Unit shall provide direction and support to BLS Heartsaver
AED Instructors to include a training module on AED use with pediatric
electrodes for children from 1 to 8 years of age in BLS Heartsaver AED courses
at the community.

5. SFA/BLS Heartsaver AED training and certification are the responsibility of the
Health Promotion Unit for non SAMSO employees and dependants throughout
the company.

6. If the requesting department/division has more than 200 employees to be trained


annually, Health Promotion Unit will train candidates from the respective area to

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 3 of 21

serve as Instructors, who will then provide SFA/BLS Heartsaver AED Training
to their department/division employees only.

7. Departments/Divisions are to ensure formation of a functional AED Facility


Sponsoring Committee.

IV. SFA/BLS/AED TRAINING POLICIES:

1. Class Format:

Course Title Duration Max. Class Size Validity of Certificate


Participants
Adult BLS Hearsaver 6 hours 6 candidates 2 years
AED
Standard First Aid 6 hours 8 candidates 3 years
Adult BLS Hearsaver 4 hours 6 candidates 2 Years
AED Re-certification

2. Scheduling:

2.1 Applying:

¾ Employees are booked by their training coordinators through SAP Human


Resources only.
¾ Health Promotion Unit sends an automated confirmation of the booking to the
employee, his/her Training Coordinator and Supervisor. The confirmation will
be sent directly to the requester if he/she is a dependant.

2.2 Eligibility:

¾ All Saudi Aramco employees are eligible to receive BLS Hearsaver AED and
SFA Training. The training coordinator for contract personnel is required to
enroll the contractor through Saudi Aramco Contractor Training Division.

2.3 Time Frame:

¾ Classes are taught in one day, but may be split into two consecutive mornings
for special reasons of convenience, such as Ramadan schedule.

2.4 Scheduling Candidates in Arabic vs. English Classes:

¾ Health Promotion may urge bilingual candidates to select Arabic classes.

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 4 of 21

2.5 Infant and Child CPR Course

¾ The course is available to employees and dependents upon special request.

3. Requirements to Successful Completion of SFA/BLS Heartsaver AED Training


Courses:

3.1 Attendance: Participants must attend all (6) hours for all training courses

3.2 Practical evaluation: Participants must perform all skills satisfactorily.

3.3 Written test: Participants must pass a written test.

4. Class Location:

Health Promotion Unit offers these courses on its premises in Dhahran, Ras Tanura,
Abqaiq, Al-Hasa, Udhailiyah, Jeddah and Yanbu.

5. Language Skills:

5.1 Candidates for Arabic classes must be proficient in reading and writing Arabic.
5.2 Candidates for English classes must be proficient in reading and writing English and
must have completed ITC English level 7B as minimum requirements.

Instructors must not use two languages in the same class to accommodate language difficulties
as it is distracting to all parties in the class

V. SFA/BLS Heartsaver AED Instructor Training Program (ITP)

1. Class Format:

Course Title Minimum Duration Maximum class Size Prerequisites


BLS Heartsaver AED 8 days 3 candidates No prerequisite
Instructor required
SFA Instructor 8 days 3 candidates BLS Heartsaver
AED + 3 months
Note: Health Promotion Unit reserves the right to call the Instructor for an evaluation and
recertification, if needed.

1st day Provider Class 5th day 1st Instructor Teaching

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 5 of 21

2nd day Solo One 6th day 2nd Instructor Teaching


3rd day Solo Two 7th day 3rd Instructor Teaching
4th day Solo Three 8th day Graduation

2. Scheduling:

2.1. Applying:

(i) Application must be signed by a department head or above.


(ii) The requesting organization must commit itself to adhere to SFA/BLS
Heartsaver AED standards and guidelines.

2.2. Eligibility:

In order to qualify for the ITP:


(i) The size of population to be trained by the requesting
department/division must exceed the manpower capacity of Health
Promotion Unit to carry out the training (200 or more students per
year)
(ii) The Instructor will have a workload of at least two full SFA or BLS
Heartsaver AED classes per week.
(iii) After completing the SFA/BLS Heartsaver AED Course, Instructors
must teach their department/division employees only. Instructors are
not eligible to teach employees from other departments/divisions
unless prior permission from the Health Promotion Unit is obtained.

Note: Ordinarily, if the requesting organization already has a certified Instructor, he/she must be
carrying a load of at least (4) full SFA/BLS Hearsver AED classes per week before applying for
training of an additional Instructor. A request for an additional Instructor, when the existing one teaches
fewer than four classes a week, will be evaluated on a one to one basis.

2.3. Requirements for successful completion:

(i) A satisfactory performance evaluation and a passing score on a final test are
required for successful completion of any of the aforementioned courses.

2.4. Class location:

(i) Health Promotion Unit offers these courses on its premises in Dhahran.

2.5. Language:

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 6 of 21

(i) Priority is given to candidates who will teach Arabic classes.

2.6 Reporting & Recordkeeping:

(i) Each Instructor shall:


a. Send monthly statistics of completed classes to the
SFA/BLS/AED Group Leader, Health Promotion Unit.
b. Enter all completed courses into the SAP System.
c. Issue certificates.

VI. RESPONSIBILITIES:

1. Supervisors of Requesting Organization:

1.1 Ensure that at least one employee per shift in each site has a current SFA/BLS/AED
certificate by scheduling initial training through the Health Promotion Unit.

1.2 Order the appropriate SFA/BLS/AED materials through SAP Purchase Requisition.

1.3 Ensure that the Facility Sponsoring Committee is functional.

1.4 Order training materials as recommended by the Health Promotion Unit.

1.5 Order the appropriate First Aid Kit items through SAP/B2B system,
specifying one of the following kits:

(i) 10-unit size First Aid Kit.


(ii) 36-unit size First Aid Kit.

2. Supervisor, Health Promotion Unit:

2.1 Assumes overall responsibility to respond to the industrial and community need for
SFA/BLS/AED Instructor training company-wide through adequate manpower and
materials.

2.2 Assumes responsibility to issue SFA/BLS Heartsaver AED Instructor certificates


throughout the company.

2.3 Assumes overall responsibility to keep statistics and records of certified SFA/BLS
Hearsaver AED Instructor Training Program participants throughout the company.

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 7 of 21

2.4 Assigns Instructors to teach SFA/BLS Hearsaver AED Instructors Training courses in
Dhahran or Districts, in Arabic or in English, as appropriate.

2.5 Conducts ongoing evaluation of Health Promotion Unit Instructor to ensure that
employees receive the highest possible quality of teaching.

2.6 Provides Non-SAMSO departments/divisions with Audiovisual Software.


2.7 Provides Non-SAMSO departments/divisions with information on how to order
SFA/BLS/AED materials, and how to conduct an AED site assessment.

2.8 Assumes overall responsibility of keeping the program up to date. This


includes:

(i) Ensuring that the literatures and audiovisual materials are available in both Arabic
and English languages at all time.
(ii) Updating certified Instructors with the most recent information.

3. AED Program Sponsoring Physician:

3.1 The Company’s sponsoring physician shall be an Occupational Medicine


Specialist.

3.2 The sponsoring physician shall review incidents where AED has been
operated.

3.3 The sponsoring physician shall be responsible for providing medical direction for the
deployment of the AED’s in Saudi Aramco Facilities.

3.4 Immediately notify the Company’s AED Program Coordinator of any changes in the status
of the Company Sponsoring Physician.

4. Overall AED Program Coordinator:

4.1 Shall be a qualified individual in the Health Promotion Unit,


Preventive Medicine Services Division, SAMSO.

4.2. Shall meet the following qualifications:


(i) Be certified or licensed as a BLS/AED provider.
(ii) Have successfully completed an AED training course, incorporating BLS
training.
(ii) Be responsible for administering the AED program at Saudi Aramco.
4.3 Shall provide information and orientation on the operation of the AED
machine to Company Management upon request.

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 8 of 21

4.4 Conduct AED Site Assessment Training Sessions as needed.

4.5 Shall keep a record of the location of the AED machines installed in Saudi Aramco
facilities.

4.6 Shall be responsible for providing advice on placement of AED machines in


locations which meet the requirements of SAMSO.

4.7 Shall serve as Chairman of the SAMSO AED Committee.

5. Authorized AED Program Operator

5.1 Must be 18 years old or over.

5.2 Must be initially trained as a qualified BLS/AED provider and maintain training
certifications in accordance with the Health Promotion Unit standards and guidelines.

5.3 Operators who utilize an AED in Saudi Aramco facilities must notify the AED
Program Coordinator and SAMSO’s or MDF’s EMS as applicable, as soon as
possible after using the AED.

6. AED Program Site Coordinators:

Each authorized facility is required to have an AED Program Site Coordinator, who shall:

6.1 Ensure that the location of the AED machine is shown on the building emergency
map.

6.2 Ensure that the AED daily inspection is performed by a properly trained
individual in accordance with manufacturer procedures.

6.3 Ensure that completed Inspection Log Forms are kept quarterly for internal
record.

6.4 Ensure all electronic rescue data is downloaded from the AED within 24 hours
of any incident where the AED was used on an arrest victim in company
facilities, and that all required reports are completed and forwarded to
SAMSO’s or MDF’s EMS, as applicable.

6.5 Submit data or other information concerning the company AED Program
which may be periodically requested by SAMSO.

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 9 of 21

6.6 Perform an AED drill and site assessment, as needed, in coordination with the
SAMSO AED Committee.

VII AED REPORTING & RECORD KEEPING

The Preventive Medicine Services Division will maintain the documentation of all necessary AED
machine inspections, authorized users, etc., and will be the company’s point of contact with all
company facilities kingdom-wide.
The EMS of SAMSO or the MDF will be notified immediately whenever an AED is deployed during
an emergency, and whenever an AED is utilized on an actual arrest victim during an incident. The
information contained on the Saudi Aramco Facility AED Report Form for Cardiac Arrests will be
submitted to the concerned EMS within 24 hours of the incident.

For quality control purposes, the following records shall be maintained:

1. Saudi Aramco Facility AED Report Form for Cardiac Arrests:

The AED Program Site Coordinator will complete the form in Appendix A “Saudi Aramco
Facility AED Report Form for Cardiac Arrests” upon all uses of the AED on an actual arrest
victim, and will forward it to the concerned EMS. A copy of this report will be maintained in
the concerned EMS Offices.

2. AED Daily Inspection Log Form:

Each AED Program Site Coordinator is responsible for ensuring that the AED daily inspection
is performed by a properly trained individual in accordance with manufacturer procedures.
Completed Inspection Log Forms should by kept by the AED Program Site Coordinator.

VIII AED INCIDENT REVIEW

1. The SAMSO AED Committee shall:

1.1 Review each incident in which an AED was operated or where


there was a response with an AED, to determine the
appropriateness of the operation of the AED or the AED response.
For each incident in which the AED Committee determines that
the use of the AED was inappropriate, a conference among the
individual operating the AED, the AED Program Coordinator and
the sponsoring committee shall be held.

1.2 Receive a report summarizing the conclusions of the review and


conference.

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 10 of 21

1.3 Report each incident as required by the regulations.

1.4 Provide remedial action as necessary to resolve any issues of


compliance with the regulations.

2. The AED Facility Sponsoring Committee shall maintain:

2.1 Original AED Program Certificates


2.2 AED machines and related supplies in accordance with the standards established by the
AED manufacturer as follows:

i. sets of defibrillator chest pads (1 set attached to device and 2 spare


sets);
ii. disposable pocket facemasks
iii. 1 disposable bag resuscitator
iv. pairs disposal gloves
v. safety razors (for shaving patient’s chest, if necessary to obtain proper
defibrillator pad contact;
vi. 1 absorbent towel/trauma pad
vii. 4x4 inch gauze pads
viii. 1 waste bag for contaminated wastes
ix. 1 pair scissors
x. 1 bottle waterless antibacterial hand gel/hand sanitizer
xi. Saudi Aramco Facility AED Report Forms for Cardiac Arrest

2.3. All AED storage areas, machines and supplies in a clean and sanitary condition.

2.4 Each AED in a closed, intact case with no visible signs of damage which would interfere
with its use.

2.5 Written records of the required information (see the record keeping section of this G.I. -
Section VI Reporting & Record Keeping).
Automated External Defibrillator
Quality Review Procedures

AED Operated

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 11 of 21

Review incident
With AED Program Sponsoring
Physician

The AED Operation was


Appropriate


Yes No Device Failed

↓ ↓ ↓

• Keep original • Keep original • Keep original report by AED


report by AED report by AED Program Site Coordinator
Program Site Program Site • Send Copies to the
Coordinator Coordinator concerned EMS
• Send Copies to the • Send Copies to the
concerned EMS concerned EMS

Conference With
• The AED Operator
• Overall AED Program
Coordinator
• AED Program Sponsoring
Physician

Send a Summary/Report to the
concerned EMS

REFERENCES:

Saudi/American Heart Associations / Emergency Cardiovascular Care (ECC) Guidelines 2005.

Preventive Medicine Services Division/Health Promotion Unit Guidelines.

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 12 of 21

Recommended : ____________________________________ _________________


Chief
Preventive Medicine Services Division Date

Concurred: _____________________________________ _________________


General Manager
Healthcare Development Organization Date

Approved: _____________________________________ _________________


Vice President
Medical Services Organization Date

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SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 13 of 21

APPENDIX A

SAUDI ARAMCO FACILITY AED REPORT FORM FOR


CARDIAC ARRESTS

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 14 of 21

CONFIDENTIAL

SAUDI ARAMCO FACILITY AED REPORT FORM FOR CARDIAC ARRESTS


To be completed immediately after a cardiac arrest occurs at your facility or the facility where an AED is put on a patient.
Form should be filled out by the main caregiver at the scene and the Facility AED Operator and returned to SAMSO’s or MDF’s EMS, as
applicable, within 48 hours.
Please Return Completed Form with your AED Summary Report to:

1. Facility Name: ____________________________________________________________________

2. Incident Location: _________________________________________________________________

3. Date of Incident: ______/______/_____


Mo Day Yr

4. Estimated Time of Incident: ___:____ am/pm 4.a. Estimated Time that 110 Call was placed: ___:____ am/pm
Hr Min Hr Min

5. Name of Patient: ___________________________________________________________________


First Middle Last

6. Patient Gender Male [ ] Female [ ] 7. Estimated age of Patient: __________________ yrs

8. Did the patient collapse (become unresponsive)? Yes [ ] No [ ]

8a. If Yes, what were the events immediately prior to the collapse (check all that apply):

Difficulty Breathing [ ] Chest Pain [ ] No Signs or Symptoms [ ] Drowning [ ]


Electrical Shock [ ] Injury [ ] Unknown [ ]

8b. Was someone present to see the person collapse? Yes [ ] No [ ]


If yes, was that person a trained AED Employee? Yes [ ] No [ ]

8c. After the collapse at the time of patient assessment and just prior to the Facility AED pads being applied:
Was the person breathing? Yes [ ] No [ ]
Did the person have a pulse? Yes [ ] No [ ]

9. Was BLS given prior to 110 EMS arrivals? Yes [ ] Go to #9a No [ ] Go to # 10a

9a. Estimated time BLS Started: ___:___ am/pm


Hr Min
9b. Was BLS started prior to the arrival of a trained AED employee? Yes [ ] No [ ]
9c. Who Started BLS? Bystander [ ] Trained AED Employee [ ]

10. Was Facility AED brought to the patient’s side prior to 110 EMS arrivals? Yes [ ] No [ ]

10a. If No, briefly describe why and skip to question 17: _____________________________________
10b. If Yes, estimated time (based on your watch) Facility AED at patient’s side: ___:____am/pm
Hr Min

TURN OVER AND COMPLETE BOTH SIDES

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 15 of 21

CONFIDENTIAL
11. Were the Facility AED pads put on the patient? Yes [ ] No [ ]
11a. If yes, was the person who put the AED pads on the patient:
A trained AED Facility Employee [ ] An untrained AED Facility Employee [ ] A bystander [ ]

12. Was the Facility AED turned on? Yes [ ] No [ ]


12a. If Yes, estimated time (based on your watch) Facility AED turned on? : ___:___am/pm
Hr Min

13. Did the facility AED ever shock the patient? Yes [ ] No [ ]
13a. If Yes, estimated time (based on your watch) of 1st shock by facility AED? : ___:___am/pm
Hr Min
13b. If shocks were given, how many shocks were delivered prior to the EMS ambulance arrival?

14. Name of person operating the Facility AED: ___________________________________________________________________________________


First Middle Last
14a. Is this person a trained AED employee? Yes [ ] No [ ]
14b. Highest level of medical training of person administering the Facility AED:
Public AED trained [ ] First responder AED trained [ ] EMT-B [ ] CRT EMT-P [ ]
Nurse/Physician [ ] Other healthcare provider [ ] No known training [ ]

15. Was there any mechanical difficulty or failure associated with the use of the Facility AED? Yes [ ] No [ ]
15a. If yes, briefly explain:
____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

16. Were there any unexpected events or injuries that occurred during the use of the Facility AED? Yes [ ] No [ ]
16a. If yes, briefly explain:
___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________
17. Indicate the patient’s status at the time of the EMS arrival:

17a. Pulse restored Yes [ ] No [ ] Don’t Know [ ] If Yes, time pulse restored ________________
17b. Breathing restored Yes [ ] No [ ] Don’t Know [ ] If Yes, time breathing restored_____________
17c. Responsiveness restored Yes [ ] No [ ] Don’t Know [ ] If Yes, time patient responsive ____________

18. Was the patient transported to the hospital? Yes [ ] No [ ]


18a. If Yes, how was the patient transported? EMS Ambulance [ ] Private Vehicle [ ] Other________________________________

Report Completed by: __________________________________________________________________________________________________________


Please Print Name Date
______________________________________________________________________________________________________
Signature Date
_________________________ ______________________________________________________
Title Office Phone
Make Model of the Facility AED that was used? ______________________________ _____________________________________________________
Manufacture Model
RETURN TO SAMSO’s EMS OR MDF’s EMS AS APPLICABLE WITHIN 48 HOURS FOLLOWING INCIDENT:
PLEASE FORWARD QUESTIONS TO YOUR FACILITY AED COORDINATOR
Facility Name: _________________________________

c.c: Occupational Medicine Section, PMSD

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 16 of 21

APPENDIX B

SAUDI ARAMCO AED DAILY INSPECTION LOG FORM

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 17 of 21

SAUDI ARAMCO AED DAILY AND MONTHLY SAFETY INSPECTION RECORD

______________ (Month/Year) AED Machine Serial #:________________ AED Location: ___________________

DAILY CHECK
Day MM/DD/YY Inspector’s Case Intact? Status Pads All Supplies in
Initials Indicator Expired Case?
Green
Yes No Yes No Yes No Yes No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 18 of 21

ctd… SAUDI ARAMCO AED DAILY AND MONTHLY SAFETY INSPECTION RECORD

______________ (Month/Year) AED Machine Serial #:________________ AED Location: ___________________

MONTHLY CHECK
INSTRUCTIONS YES NO
1. Open AED lid
2. Wait for the AED to indicate status:
Observe the change of the Status Indicator to Red. After approximately 5 seconds,
verify that the Status Indicator returns to Green.
3. Check the expiration date on the electrodes.
4. Listen for the voice prompts.
5. Close the lid and confirm that Status Indicator remains Green.

MONTHLY CHECK COMPLETED BY:_____________________ BADGE #: ____________ DATE: ___________

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 19 of 21

INSTRUCTIONS FOR COMPLETING AED DAILY AND MONTHLY INSPECTION RECORD

DATE: The AED machine should be inspected daily. Enter the date the AED machine
was inspected.

INSPECTORS INITIALS: Enter the inspector’s legible initials. Only trained individuals may perform the
daily inspection.

CASE INTACT? Yes or No. Check to see if the storage case (either soft, flexible or intact: wall-
mounted) is present, serviceable and undamaged. If all ok, enter “yes”, if not,
enter “no”.

To report deficiency, immediately complete the Saudi Aramco Return Form #


attached and contact the local vendor.

STATUS INDICATOR: Yes or No. Check to see if the status indicator in the handle is “green”. If the
indicator is “red”, the unit is NOT ready for a rescue and should be
immediately pulled from service. Complete Saudi Aramco Return Form
# SA 9667 (insert link when is up on e-forms) and contact the local vendor
immediately for repair.

PADS EXPIRED? Yes or No. Check to see if expiration date of the pads (electrodes) has exceeded.
Sixty (60) days prior to the expiration date. Plan ahead to order the replacement
pads from local vendor.

ALL SUPPLIES IN Yes or No. If everything is present enter “yes”, if everything is not present,
CARRYING CASE: enter “no”. Immediately order the missing supplies from the local vendor.

MONTHLY CHECKS: Follow the instructions on the Saudi Aramco AED Daily and Monthly Safety
Inspection Record.

CONTACT
Local Vendor
E-mail: customercare@mbm-est.com
Office Tel: 02 667-8811 Ext 226
Office Fax: 02 669-1188
Mobile: 0506 311 179

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 20 of 21

Saudi Aramco AED Site Assessment Form

This Form is to help Saudi Aramco Departments determine whether an on-site AED program is advisable.

Use one Form per facility

Organization Name: Facility Location:

Building: Region:

(AED Site Coordinator)

1. SITE GEOGRAPHY

1.1 How many buildings are on your site: ___________

1.2 Number of floors: ___________

1.3 List all areas that may not be easily accessible by responders including closed or locked or restricted
areas:

a)_________________________ c)_________________________

b) _________________________ d) _________________________

2. POPULATION CHARACTERISTICS

2.1 Number of Saudi Aramco employees: _________

2.2 Number of Contractor employees: _________

2.3 Approximate average age of workforce: 20-30 30-40 40-50 < 50

2.4 Approximate % of employees over 45 years: __________

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION


SAUDI ARABIAN OIL COMPANY (Saudi Aramco) GI NUMBER Approved
150.002
GENERAL INSTRUCTION MANUAL
ISSUE DATE REPLACES
ISSUING ORG. SAUDI ARAMCO SAMSO ORGANIZATION 03/09/2005
09/15/2008
Basic life Support (BLS) Heartsaver Automated External APPROVAL PAGE NO.
SUBJECT Defibrillator(AED) / Standard First Aid (SFA) and First Aid Kit MMR 21 of 21

Saudi Aramco AED Site Assessment Form (Page 1 of 2)

3. EMS CAPABILITIES

3.1 Where is the primary EMS unit located?

Within 3 KM within 5 KM within 10 KM >15 KM

3.2 What is the estimated response time from your location to the nearest EMS?

0-3 Min 3-5 Min 5-10 Min 10-15 Min 20 + Min

4. TRAINING COURSES

4.1 Is BLS/AED training conducted by one of your employees at your department/division?

Yes No

If “Yes” How often _____________________

By whom_______________________

# trained________________________

AED Site Coordinator Signature: __________________________________

Date: __________________________________________________________

* CHANGE ** ADDITION NEW INSTRUCTION COMPLETE REVISION

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