Mississippi Public/Charter School AED Application

Please Provide All Information Requested

 Attach staff training verification for AED and/or CPR. Copies of cards or in-service rosters. Attach the vendor's quotes for the proposed AEDs. If you have any questions, please call the Office of Emergency Medical Services and Acute Care Systems at 601-933-7642 or 601-576-7380. 

 NOTE:   Applications Must Be Received by 5:00 pm on December 11, 2024, or money will be reassigned to another public or charter school.            

Number of AEDs requested:

Number of AEDs awarded:   

Applicant Information

School Name:

Address:           

City:                      

State:       Zip Code:

Phone:    School Type:   

Authorized Agent/Contact Person: (Principal, Headmaster, or School Superintendent) Information

Name:     

Address: 

City:             

State:            Zip Code:

Phone:         

Title:         

Email:       

You should attach a program narrative in this section below.  The program narrative may be no longer than five (5) pages double space typed with no less than a 12 point font.

The program narrative should be labeled by the numbers below and include:

1. Needs Statement - Briefly describe your organization, its purpose and why AED placement proposed by your organization makes sense for your school. Cite specific emergency examples or data that demonstrates the need for AED placement.

          a.  Describe your CPR and AED training for first responders and how often this training will be accomplished

          b. Describe your retraining program for CPR and AED training

          c. Describe how EMS is activated

          d. Describe your procedures for ensuring AED readiness

          e. Describe your method for scheduling and conducting AED maintenance checks

          f. Describe your method for capturing data

          g. Describe your method for patient care transfer to local EMS agency

          h. Describe your method for cardiac event review

          i. Describe your method for quality improvement

          j. Describe your method for rescuer debriefing

Attach program narrative here: 

The Budget Narrative applies to proceeds from the Mississippi Public/Charter School AED grant.

For the purposes of providing AED units to public/charter schools, and in consideration for the mutual covenants contained herein, it is hereby agreed by and between the (hereinafter referred to as the applicant) and the Office of Emergency Medical Services and Acute Care Systems' (OEMSACS) Public/Charter School AED Program of the Mississippi State Department of Health (hereinafter referred to as the Department) as follows:

The Applicant agrees that:
1. Funds received from the Department will be used for purchasing new or additional automatic external defibrillators and supplies to assist patients within the applicant's school district in accordance with the specification set forth in the application and hereby incorporated into and made a part of this agreement.

2. No funds received from the Department shall be used for the payment of any attorney's fees, shipping, or taxes.

3. Financial and progress reports will be submitted by the applicant to the Department by July 31st of each year, and/or as requested by the Department.

4. Emergency medical services will be delivered in compliance with the licensing requirements and regulations of the Department.

5. The applicant understands that under the Mississippi Public/Charter School AED Program, following a notice of award, AEDs must be purchased wihtin 30 - 45 days after recipt of funding. The distribution of funds can only be accomplished under a contract between the applicant and the Department. 

6. The applicant agrees to permit reasonable program review and evaluation by the Department; to provide access to its records; and to cooperate in any other reasonable request for program information.

7. Within 30 days of receipt of AED units purchased under the conditions of this contract, the applicant must register each unit along with inventory number with the Mississippi State Department of Health, Office of Emergency Medical Services and Acute Care Systems.

8. Progress and usage reports will be submitted to OEMSACS by July 31 of each year, or as requested by the OEMSACS.

9. The applicant will provide information to support the Office of Rural Health Policy AED Placement Model as well as the following Performance Indicators:
----Increase the number of persons trained in the life saving skills of Cardio-Pulmonary Resuscitation (CPR) and use of an Automated External Defibrillator (AED) by 20% over the next 12 months.

10. Agree to permit reasonable review and evaluation by the OEMSACS, to provide access to its records, and to cooperate with any other reasonable request for program information.

11. Must adhere to manufacturer's instructions on unit maintenance and unit calibration.

12. Must participate in the AED Public Relations campaign of the OEMSACS as requested.

13.Must notify local 911 and/or Dispatch Center of AED location(s).

14. Must demonstrate within 30 days of receipt of AED units, by submitting quote, purchase order and copy of canceled check to the OEMSACS.

15. School Recipients:

• The applicant will maintain, at minimum, 50% of its first response staff trained in CPR and AED.
• Must create and submit, with application a policy/procedure manual that includes the following information:
  • CPR and AED training plans and credentialing for first responders who will respond with each unit.
  • Recertification of first responders who will respond with each unit.
  • Scheduling and conducting of periodic maintenance checks.
  • Activation of local EMS.
  • Method for data capture.

The Department agrees that:

1. Funds appropriated to the Department for Mississippi Rural AED Program shall be distributed to applicants for the support of emergency medical services.
2. After execution of proper contract, the applicant shall receive funds equal to applicant's allocated share of the Mississippi Rural AED Program funds based on review of the Mississippi Rural AED Consortium.