1. Community Designation
Packet
HEARTSafe Community
A Community Service of
Butler County Health Department &
Butler County EMS

2. Table of Contents
Information on HEARTSafe Community 3
Frequently Asked Questions 5
Application Information 6
Designation Process 7
HEARTSafe Requirements 8
HEARTSafe Worksheets 10
HEARTSafe Application 17

3. Information on HEARTSafe
DO YOU LIVE IN A HEARTSAFE COMMUNITY?
If someone in your community suffers sudden cardiac arrest tomorrow,
how likely is he or she to survive due to rapid access to life-saving
treatment?
How many residents and public safety officials in your community can
recognize the symptoms of cardiac arrest and know how to get help “on
the way, right away”?
Who knows CPR in your community and is prepared to administer it
when necessary?
Where are automated external defibrillators (AEDs) located, and who has
been trained to use them appropriately?
The answers to these questions could determine whether or not your
community qualifies as a HEARTSafe Community.
Butler County Emergencies Medical Services and Butler Health
Department aim to help cities and towns improve the chances that
anyone suffering a sudden cardiac arrest will have the best possible
chance for survival.

4. Through the HEARTSafe Community program, communities can
strengthen what the American Heart Association has called the
“Chain of Survival,” which has five critical steps:
1. EARLY ACCESS TO EMERGENCY CARE
• Bystanders recognize the symptoms of cardiac arrest and call 9-1-1 immediately.
• EMS dispatchers are equipped with instructions for the caller and can get an Advanced Life Support
response vehicle to the scene quickly.
2. EARLY CPR
• CPR buys precious minutes until a defibrillator is available.
• Public knowledge and awareness must be increased so that those trained in CPR will use it when it is
needed.
3. EARLY DEFIBRILLATION
• Defibrillation is the delivery of electric shock to restore the heart’s normal rhythm.
• Early defibrillation is considered to be the most critical link in the chain of survival.
• New AEDs are light-weight, sturdy, and easy to use by anyone.
• AEDs should be accessible and organizations should have defibrillation training programs that have
medical oversight and are coordinated with EMS.
4. EARLY ADVANCED CARE
• Advanced care is delivered by an Advanced Life Support response vehicles staffed by paramedics.
• Recognition of cause of cardiac arrest and transport to appropriate destination reduces disability and
death in cardiac arrest patients.
5. POST-CARDIAC ARREST CARE
• Post-Cardiac Arrest patients should be transported to hospitals that provide a comprehensive, structured,
integrated, multidisciplinary system of post-cardiac arrest care.
• Treatment should include cardiopulmonary and neurologic support including therapeutic hypothermia and
percutaneous coronary interventions.

5. Frequently Asked Questions
Who can apply to be a designated Who decides if a community has met the
HEARTSafe Community? criteria to be designated as
HEARTSafe?
Currently, any city within Butler County,
KS can apply for designation. Butler County EMS and Butler County
Health Department will review
Is there an application fee? applications. The Butler County Health
There is no application fee, although there Department will make the designation.
are costs associated with meeting the Will an AED always resuscitate someone
criteria to becoming a HEARTSafe in Cardiac Arrest?
Community.
The AED will analyze the electrical
What are the costs? activity of the heart. If the electrical
The cost will vary depending on the activity is “chaotic” and needs a “restart”
communities size and needs (i.e. CPR the unit will charge and be ready to shock.
training and AED placement). Sometimes the AED does not indicate a
shock is needed.
Why should my community be a
designated HEARTSafe Community? Is an AED safe to use?
To make the community a safer place to Absolutely! An AED is safe to use by
live, work and play by being prepared to anyone. If you can turn it on, you can use
reduce the number of deaths and it. They are designed with multiple
disabilities associated with Sudden safeguards and warnings.
Cardiac Arrest. Is there any protection for public by-
How long is the HEARTSafe standers that administer CPR/AED?
designation valid? Kansas Statute(KSA 65-6149a) provides
The designation is valid for two years. At immunity from liability for the general
that time an update application can be public during the use of an AED.
filled out to remain a HEARTSafe
Community.

6. Application Information
Overview
Butler County EMS and the Butler County Health Department seek to encourage and promote community
awareness of the potential for saving the lives of sudden cardiac arrest victims through the use of CPR
(cardiopulmonary resuscitation) and increased public access to defibrillation. The HEARTSafe Communities
project is a replicable model that seeks to strengthen the links in the Chain of Survival, which has been
documented to increase survival for cardiac arrest victims.
Communities achieve the HEARTSafe Community designation by developing and implementing a community
action plan that includes: providing CPR with Automated External Defibrillator(AED) training, helping
community members recognize the warning signs and symptoms of heart attack, activating community
members to call 911, use CPR/AED, and helping schools develop Medical Emergency Response Plans.
Designated HEARTSafe Communities will place AEDs in strategic public locations where they are readily
available to use in a cardiac emergency, and develop a community emergency response plan that furthers the
goal of saving lives from cardiac arrest.
How to Apply for the HEARTSafe Community Designation
Any municipality located within Butler County, KS is eligible to apply for the HEARTSafe designation.
The outlined steps are suggestions for successfully completing the application process:
1) Review application materials to become a HEARTSafe Community.
2) Identify a HEARTSafe Community Champion - a contact for the community,
3) Identify a HEARTSafe Community Team and Partners.
4) Define your communities needs to achieve the requirements for HEARTSafe designation.
5) Develop an action plan to achieve HEARTSafe designation.
6) Complete and submit the HEARTSafe Community application and worksheets.
7) Gain and celebrate recognition as a HEARTSafe Community.
For questions or to request technical assistance contact: Daniel Green, Public Education Coordinator for Butler
County EMS at dgreen@bucoks.com.
Acknowledgements
This document was prepared by Butler County HEARTSafe Community. We would like to acknowledge the
following contributors and extend to them our sincere thanks: Mr. David Hiltz, Physio-Control’s “Heart Safe
Communities Goals & Checklist”, the American Heart Association, and Allina Hospitals & Clinics Heart Safe
Communities Program.
Public Domain Notice
All material appearing in this publication except that taken directly from copyrighted sources is in the public
domain and may be reproduced or copied without permission. Do not reproduce or distribute this publication
for a fee.

7. Designation Process
Step 1
Review Documents and Materials for becoming a HEARTSafe Community.
•Heartbeat Criteria
•HEARTSafe Community Application
•HEARTSafe Community Worksheets
Step 2
Make a declaration of intent for your community to obtain HEARTSafe
designation and fill out the HEARTSafe Community worksheets and identify
community needs. You will have 2 years from declaration to meet criteria.
Step 3
Develop an Action Plan for meeting remaining needs and achieving
HEARTSafe Community designation.
Step 4
Engage your HEARTSafe community partners in helping meet you
communities needs.
Step 5
Using your completed worksheets, complete the Formal Application and
submit it to:
Butler County HEARTSafe Community
Butler County EMS
701 N. Haverhill
El Dorado, KS 67042
E-Mail - BCPRnetwork@gmail.com

8. HEARTSafe Requirements
Communities up to 2,500 - Douglass, Towanda, Benton, Leon, Potwin, et al.
If your community population is 2,500 or less, 200 Heartbeats are required to become a
designated Heart Safe Community. A minimum of 60 Heartbeats is required for CPR or
CPR/AED training and placement of AEDs in the community. These requirements
include a minimum of 4 training programs* and at least 2 AED sites in public locations.
In addition, a minimum of 40 Heartbeats from the required criteria of designated first
responders with AED equipped vehicles, advanced life support personnel availability
and an ongoing process to evaluate and improve the ‘Chain of Survival’ is required.
Communities of 2,500 to 10,000 - Augusta, Rose Hill
If your community population is between 2,500 and 10,000, 400 Heartbeats are required
to become a designated Heart Safe Community. A minimum of 120 Heartbeats is
required for CPR or CPR/AED training and placement of AEDs in the community.
These requirements include a minimum of six training programs and six AED sites in
public locations. In addition, a minimum of 60 Heartbeats from the required criteria of
designated first responders with AED equipped vehicles, advanced life support personnel
availability and an ongoing process to evaluate and improve the ‘Chain of Survival’ is
required.
Communities of 10,000 to 30,000 - El Dorado, Andover
If your community population is between 10,000 and 30,000, 500 Heartbeats are
required to become a designated Heart Safe Community. A minimum of 260 Heartbeats
is required for CPR or CPR/AED training and placement of AEDs in the community.
These requirements include a minimum of 10 training programs and 10 AED sites in
public locations. In addition, a minimum of 60 Heartbeats from the required criteria of
designated first responders with AED equipped vehicles, advanced life support personnel
availability and an ongoing process to evaluate and improve the ‘Chain of Survival’ is
required.

9. HEARTSafe Requirements
Below is an outline of criteria and their value
EARLY ACCESS TO EMERGENCY CARE
• Public Education on heart health, prevention, signs and symptoms of Heart Attack, Stroke, & Cardiac
Arrest, and 911 access - 10 Heartbeats for event with less then 20 participants, 15 Heartbeats for 20+
• All schools with written Medical Emergency Response Plan (MERP) - 10 Heartbeats *Required
EARLY CPR
• Free Public Education on CPR (Hands-only or traditional) & AED use - 10 Heartbeats per event with at
least 10 participants
• Education in CPR/AED that requires a fee - 5 Heartbeats per event
• CPR/AED Education for High-school students - 10 Heartbeats *Required
• CPR (Hands-only minimum) instructions providing by dispatch personnel - 10 Heartbeats
EARLY DEFIBRILLATION
• Public Access Defibrillator/AED - 10 Heartbeats per PAD in community
• AED/Defibrillator carried by First Responders - 10 Heartbeats per FR AED
EARLY ADVANCED CARE
• ALS response to all medical emergencies - 10 Heartbeats
POST-CARDIAC ARREST CARE
• Policy of transport of post-cardiac arrest patients to facilities with minimum PCI & Therapeutic
Hypothermia capabilities - 10 Heartbeats
SUSTAINABILITY PLAN
• Written sustainability plan - 10 Heartbeats *Required
• Cardiac Arrest Registry - 10 Heartbeats *Required
• Supported & Structured Debriefing Program for all responding personnel - 10 Heartbeats *Required

10. HEARTSafe Worksheets
Calculate Your Community’s Heartbeats
Attach additional documentation if needed
EARLY ACCESS TO EMERGENCY CARE
DATE OF # OF
EVENT TOPIC HEARTBEATS
EVENT PARTICIPANTS
MEDICAL EMERGENCY RESPONSE PLAN AT ALL SCHOOLS
Total Heartbeats = _________

11. HEARTSafe Worksheets
Calculate Your Community’s Heartbeats
Attach additional documentation if needed
EARLY CPR
DATE OF # OF
EDUCATION TYPE HEARTBEATS
EVENT PARTICIPANTS
HIGH SCHOOL STUDENT
CPR/AED EDUCATION
HIGH SCHOOL STUDENT
CPR/AED EDUCATION
Total Heartbeats = _________

12. DATE OF # OF
EDUCATION TYPE HEARTBEATS
EVENT PARTICIPANTS
Total Heartbeats = _________

13. HEARTSafe Worksheets
Calculate Your Community’s Heartbeats
Attach additional documentation if needed
EARLY DEFIBRILLATION
CRITERIA HEARTBEATS
NUMBER OF PUBLIC AED ___ X10 =____
NUMBER OF FIRST RESPONDER AED ___ X10 =____
Total Heartbeats = _________
AEDs must be clearly identified with signage and
at minimum the entrance of the building should
indicate the presence of a Public AED.

14. AED # Address of building w/ AED Location in Building Contact Person Contact Phone or E-Mail

15. Signage Above AED AED 2010
AED # AED Manufacturer AED Pads in Date Front Door Signage
AED Registered Guidelines
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO
YES / NO YES / NO YES / NO YES / NO YES / NO

16. HEARTSafe Worksheets
Calculate Your Community’s Heartbeats
Attach additional documentation if needed
Early Advanced Care & Post-cardiac Arrest Care
EMS Agency
Butler County EMS
701 N. Haverhill
El Dorado, KS 67042
EMS Contacts
Daniel Green - dgreen@bucoks.com
Collin Engraf - cengraf@bucoks.com
BCPRnetwork@gmail.com
CRITERIA HEARTBEATS
ALS RESPONSE TO ALL MEDICAL EMERGENCIES
POST-CARDIAC ARREST TRANSPORT POLICY
Total Heartbeats = _________

17. HEARTSafe Worksheets
Calculate Your Community’s Heartbeats
Attach additional documentation if needed
Sustainability Plan
CRITERIA HEARTBEATS
WRITTEN SUSTAINABILITY PLAN
CARDIAC ARREST REGISTRY
SUPPORTED & STRUCTURED DEBRIEFING POLICY
Total Heartbeats = _________

18. HEARTSafe Worksheets
Calculate Your Community’s Heartbeats
Attach additional documentation if needed
Calculate totals
CRITERIA HEARTBEATS
EARLY ACCESS
EARLY CPR
EARLY DEFIBRILLATION
EARLY ADVANCED CARE &
POST-CARDIAC ARREST CARE
SUSTAINABILITY PLAN
Total Heartbeats = _________
Please mail this application and worksheets to the address listed below. Be sure and call
if you have any questions or would like assistance with the application.
Butler County HEARTSafe Community
701 N. Haverhill Rd
El Dorado, KS 67042
Contact: Daniel Green, Public Education Coordinator, BCEMS - dgreen@bucoks.com

19. Butler County HEARTSafe Community
Formal Application
Name/Address of municipality seeking designation:
Community: _____________________________________________________________________________
Address: ___________________________________________________ State_____ Zip Code: _________
Municipal Chief Elected Official (or designee):
Name: ______________________________________________ Title: ______________________________
Address: ___________________________________________________ State_____ Zip Code: _________
Phone: __________________________________ E-Mail Address: _________________________________
Community Population: ____________________ Total Number of Heartbeats Earned: ___________
I attest that all information contained in this application is correct. Supporting documentation and worksheets
are attached and on file for review.
Signature : __________________________________ Name (Print): ________________________________
----------------------------------------------------------------------------------------------------------------------------------------------
For Reviewer Use Only
Recommend Designation Designation Not Recommend (explanation attached)!
!
Reviewer Signature : ________________________________________________________ Date:_________
Name/Title (Print): ________________________________________________________________________

20. Butler County
HEARTSafe Communities
CALL HARD & FAST AED
bcprnetwork @BCPRnetwork www.butlerems.org
A Community Service of
Butler County Health Department &
Butler County EMS