ZOLL Medical Corporation Sales Training

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ZOLL Medical CorporationSales Training
M Series Monitor, Defibrillate, Pace
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M Series Agenda

• Monitor
• Defibrillator
• Clinically superior biphasic technology
• External Pacing
• Clinically superior pacing technology
• Solutions for Customer Goals

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M Series Overview

• The Fuel Behind the Fire
• Compare ZOLLs growth to the launch of the M
  Series..
• Smaller
• Lighter
• Brighter
• Better
• Superior biphasic waveform
• Superior pacing waveform
• Easy
• Intuitive
• Uniform Operating System
• Dynamic Error Correction
• Configurable
• Upgradeable

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ZOLL M Series Monitor
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M Series Monitor KNOWLEDGE

• Basic ECG Monitoring
• Attach electrodes
• Select MONITOR
• Press LEAD button to get desired lead
• Press SIZE button to get desired size

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M Series Monitor KNOWLEDGE

• 5-Lead Monitoring
• Disconnect 3-lead cable
• Connect 5-lead cable
• Attach electrodes
• Select MONITOR
• Press LEAD button to get desired lead
• Press SIZE button to get desired size
• Printing 3 leads - Set configuration
• PRINT 3 LEADS WHEN LEADS ARE SEL YES

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M Series Monitor KNOWLEDGE

• Recorder
• Start Press RECORDER
• Stop Press RECORDER
• Note there is always a 6 second delay
• Strips include
• Date Time ECG Lead
• Size Heart Rate

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M Series Monitor KNOWLEDGE

• Vital Signs Trending
• HR, SpO2, EtCO2, Respiration Rate, Systolic BP,
  Diastolic BP, Mean BP
• Trending ENABLED in Configuration
• Data sampled 1/minute for max 24 hrs, plus with
  any alarm, and with any NIBP measurement

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M Series Monitor KNOWLEDGE

• Viewing Vital Signs Trends
• Press SUMMARY
• Press TREND
• Press SELECT to highlight SET TRACE 2 or SET
  TRACE 3
• Press ZOOM to change the interval period
• All, 60 min, 30 min, 15 min, 10 min, 5 min
• To print report, press PRINT on trend screen

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M Series Monitor KNOWLEDGE
Vital Signs Trend Report
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M Series Monitor KNOWLEDGE

• Clearing Vital Signs Trends
• Press hold SUMMARY
• Erase Summary, Erase Trend, Erase All is
  displayed
• Press ERASE TREND

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M Series Monitor UNDERSTANDING

• Practice Monitor In-Service

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M Series Monitor UNDERSTANDING

• Key Differentiators/Key Selling Points
• Uniform operating system
• Benefit Increases operator confidence and
  reduces training costs by utilizing same user
  interface in all generations of product and in
  every model of the M Series platform
• Question Have you ever had a situation where
  youve arrived at an arrest and the equipment is
  unfamiliar?
• Question How often are you trained on
  equipment?
• Question Would it be beneficial to have your
  crash cart devices work the same as your
  transport devices?
• Error correcting messages
• Benefit Audibly and visually suggests
  corrective action (ie. Attach ECG Lead vs ECG
  Lead Off)
• Question How does your equipment currently
  notify you of problems?

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M Series Monitor UNDERSTANDING

• Key Differentiators/Key Selling Points
• Intuitive design
• Benefit Put an M Series in front of a
  clinician, and theyll be able to use it with
  very little training
• Question Have you ever been confused about how
  to operate a piece of equipment?
• Question How often have equipment challenges
  prevented you from treating a patient in a timely
  manner?
• Large, bright LED display
• Benefit Ability to see screen from every angle
• Question What do you currently do to see your
  screen when youre standing to the side / at an
  angle?

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M Series Monitor APPLICATION

• Practice Monitor Demo

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M Series Monitor APPLICATION

• Customer Goals

• ZOLL Solutions

Uniform Operating System Error Correcting
Messages Intuitive design Large, Bright LED
Display
Fast Response Times Confident Responders JCAHO
Compliance Effective Patient Care
?
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ZOLL M Series Defibrillator
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M Series Defibrillate

• Catherine Prophet
• April 2005

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M Series Defibrillation KNOWLEDGE

• Manual Defibrillation
• Attach MFE Electrodes to patient
• Recommend ZOLL electrodes customized for
  optimal performance with ZOLL M
  Series
• Select DEFIB
• Unit automatically defaults to first shock
  setting determined in Configuration (typically
  120J, 150J, 200J)
• To change energy setting, use UP/DOWN ARROWS.
  Selected energy is displayed as DEFIB XXXJ SEL
• Press CHARGE
• Make sure everyone is clear
• When SHOCK button lights, press SHOCK
• If so configured, the M Series automatically
  increments the energy setting after the first
  shock according to configuration. Manually
  changing the energy setting disables this
  function.
• Note Changing the energy level or switching to
  MONITOR after CHARGE is pressed results in
  defibrillator being disarmed

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M Series Defibrillation KNOWLEDGE

• Manual Defibrillation with Paddles
• Select DEFIB
• Unit automatically defaults to first shock
  setting determined in Configuration
  (typically 120J, 150J, 200J)
• To change energy setting, use UP/DOWN ARROWS
• Press CHARGE on the panel or on the apex handle
• Apply electrolyte gel to the paddles and apply
  paddles to chest
• Make sure everyone is clear
• When SHOCK button lights, place paddles on chest
  with 25 lb pressure and simultaneously press
  SHOCK on both paddles
• Note Changing the energy level or switching to
  MONITOR after CHARGE is pressed results in
  defibrillator being disarmed

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M Series Defibrillation KNOWLEDGE

• Advisory Defibrillation
• Attach MFE Electrodes to patient
• Select DEFIB
• Press ANALYZE. ANALYZING ECG will be
  displayed for about 9 seconds.
• If unit displays SHOCK ADVISED, defibrillator
  automatically charges to first shock setting
  determined in Configuration (typically 120J,
  150J, 200J)
• If automatic charge is disabled, SHOCK ADVISED
  and PRESS CHARGE will be alternately displayed.
• To change energy setting, use UP/DOWN ARROWS.
  Selected energy is displayed as DEFIB XXXJ SEL
• Make sure everyone is clear
• When SHOCK button lights, press SHOCK
• If so configured, the M Series automatically
  increments the energy setting after the first
  shock according to configuration. Manually
  changing the energy setting disables this
  function.
• Note Changing the energy level or switching to
  MONITOR after CHARGE is pressed results in
  defibrillator being disarmed

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M Series Defibrillation KNOWLEDGE

• Automatic Defibrillation (AED)
• Attach MFE Electrodes to patient
• Turn unit ON
• Unit automatically defaults to first shock
  setting determined in Configuration
  (typically 120J, 150J, 200J)
• To change energy setting, use UP/DOWN ARROWS.
  Selected energy is displayed as DEFIB XXXJ SEL
• Press CHARGE
• Make sure everyone is clear
• When SHOCK button lights, press SHOCK
• If so configured, the M Series automatically
  increments the energy setting after the first
  shock according to configuration. Manually
  changing the energy setting disables this
  function.
• Note Changing the energy level or switching to
  MONITOR after CHARGE is pressed results in
  defibrillator being disarmed

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M Series Defibrillation KNOWLEDGE

• Synchronized Cardioversion
• Press LEAD to select desired ECG lead
• Select DEFIB
• Select desired energy level
• Press SYNC softkey. Verify presence of SYNC
  marker ?
• Press CHARGE
• Verify everyone is clear of patient
• Press SHOCK
• Note Use of ZOLL electrodes is strongly
  recommended. Clinical results for AF
  cardioversion are based on 3 part system ZOLL
  Biphasic Waveform, ZOLL electrodes pad
  placement

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M Series Defibrillation KNOWLEDGE

• Code Markers
• Pressing CODE MARKER softkey during
  defibrillation displays the following options
• CPR B-block Fentanyl
• Intubate Atrovent Digoxin
• EPI Mag Sulf Vasopr
• LIDO Procain
• Narcan Adenosin
• Pressing the softkey for a specific code marker
  will cause that action to be recorded along with
  a date and time stamp in the Summary Report Memory

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M Series Defibrillation KNOWLEDGE

• Printing Reports
• Summary Report triggered by six events
• VF Alarm HR Alarm
• Defibrillator Shock Turn Recorder ON
• Selecting PACER Pressing ANALYZE
• Memory stores up to 65 defibrillation or 140
  recorder activated ECG events
• Press SUMMARY to print report, then select
  softkey
• Print Config Configuration settings
• Print Chart Select from All or Range of Events
• Print Log Incident log
• To add patient name and ID, press ID softkey and
  enter information

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M Series Defibrillation KNOWLEDGE

• Biphasic Waveform
• Fixed Flat design
• Fixed duration, constant current
• Current defibrillates ZOLL has the most
• Only biphasic waveform cleared by the FDA
  to be labeled superior to monophasic for
  cardioversion of AF defibrillation of high
  impedance VF
• Controls for variations in patient impedance
  through series of digital equipment resistors so
  that the low impedance patient is not overdosed
  and the high impedance patient gets the most
  current of any defibrillator
• Defibrillation protocol 120J 150J 200J
• Cardioversion protocol 75J 120J 150J 200J

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M Series Defibrillation KNOWLEDGE

• ZOLL Multifunction Electrodes
• Always mention electrodes during defib product
  overviews and in-services
• Validated as part of the system high quality
  performance guaranteed
• Question Do you want to use electrodes not
  validated and proven on your defib system? Not
  all have equivalent performance.
• Critical success factor for biphasic in clinical
  studies biphasic electrode and proper pad
  placement
• Optimized product line for resuscitation and
  therapy
• statpadz speed pack, center energy feed
• Question Do you want to lose precious response
  time by using pads without a preconnect feature
  on your defibrillator?
• propadz liquid gel and specialized electrodes
• Question Would you like to reduce the risk of
  dermal damage? Do you have needs for radiolucent
  or sterile electrodes in your OR and Cath/EP
  labs?
• pedipadz liquid gel reduces dermal damage
• Question Would you like to offer your pedi
  patients the best care for their delicate skin?
• CPR-Dpadz one piece, CPR feedback
• ZOLL only defib company to own electrode
  manufacturing control over quality, innovation,
  service and inventory
• Question Third party branded electrodes my save
  pennies, but why risk integrity of life saving
  therapy?
• Best reputation in the industry
• No need for adaptors or special connectors

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M Series Defibrillation UNDERSTANDING

• Practice Defibrillation In-Service

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M Series Defibrillation UNDERSTANDING

• Key Differentiators/Key Selling Points
• Clinical superiority with rectilinear biphasic
  technology
• Benefit Better patient outcomes and reduced
  costs through increased efficacy of rectilinear
  biphasic waveform
• Question What have your experiences been with
  defibrillation during a code/cardioversion? How
  many times do you typically have to shock a
  patient?
• Low Energy Defibrillation
• Benefit Provides the ability to use lowest
  effective dose of therapy for defibrillation and
  cardioversion
• Question Are you aware of the AHAs statements
  on biphasic defibrillation?
• Question Are you aware of the Mittal AF or VF
  studies on the rectilinear biphasic waveform?
• AED, Advisory or Manual on the same platform
• Benefit One machine can be used for various
  clinical applications throughout the hospital
• Question Are you familiar with AHA Guidelines
  regarding code response time?
• Question Describe what happens when you have a
  code called on a Med/Surg floor?
• Configurable Auto-escalation
• Benefit Eliminates one step in an already
  hectic environment and reduces the necessity to
  remember new energy protocols
• Question What is your current procedure for
  energy escalation?
• Uniform Operating System
• Error correcting messages
• Large, bright LED display

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M Series Defibrillation APPLICATION

• Practice Defibrillation Demo

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M Series Defibrillation APPLICATION

• Customer Goals

• ZOLL Solutions

Uniform Operating System Error Correcting
Messages Large, Bright LED Display Superior
clinical technology AED, Advisory or Manual
Fast Response Times Confident Responders JCAHO
Compliance Effective Patient Care Keep up with
therapeutic advances Cost effective
standardization
?
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ZOLL M SeriesExternal Pacing
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M Series Pace

• Catherine Prophet
• April 2005

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M Series Pacing KNOWLEDGE

• Value of External Pacing
• 60 of codes do not require defibrillation
• Survival rates for non-VT/VF rhythms is less than
  10

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M Series Pacing KNOWLEDGE

• External Pacing
• Apply electrodes and ZOLL MFE pads
• Select PACER
• Turn PACER RATE knob clockwise to set rate 10-20
  ppm higher than intrinsic rate or 100 ppm
• Turn PACER OUTPUT knob clockwise to increase mA
  until capture
• Press and hold 41 button to deliver pacing
  impulse for 1 out of 4 beat to determine
  underlying rhythm

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M Series Pacing KNOWLEDGE

• Pacing Pad Placement
• Apply EKG electrodes
• Identify your Heart Rate
• Pad Placement Back Pad First between scapula
  spine
• Front Pad V2-V5
• Take pulse on the right side
• Apply Back Pad First
• Dont shave patient

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M Series Pacing UNDERSTANDING

• Practice Pacing In-Service

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M Series Pacing UNDERSTANDING
Pacing Historical Background 1952
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M Series Pacing UNDERSTANDING

• NTP 1000 1983
• Marketed in 1983
• Pacemaker/Monitor
• Price 7200
• Always sold at list
• Never did evaluations
• Pacing Electrodes only

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M Series Pacing UNDERSTANDING

• ACLS Guidelines 2000
• Transcutaneous pacing is a Class I intervention
  for all symptomatic bradycardias.
• If clinicians are concerned about the use of
  atropine in higher level blocks, they should
  remember TP is always appropriate..If the
  bradycardia is severe and the clinical condition
  is unstable, implement TP immediately p.I-155

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M Series Pacing UNDERSTANDING

• LARGER SURFACE AREA ELECTRODES
• CONSTANT CURRENT-RECTILINEAR WAVEFORM
• HIGH IMPEDENCE GEL
• LONG PULSE DURATION-UP TO 40 MS

Pacing Evolution
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M Series Pacing UNDERSTANDING

• Different Pacing Waveforms
• ZOLL- Rectilinear
• Physio- Truncated Exponential
• Philips- Truncated Exponential

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M Series Pacing UNDERSTANDING
Pacing Waveform Comparisons
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M Series Pacing UNDERSTANDING
Clinical Research on External Pacing ZOLL Pacing
(40 msec pulse duration) Capture Rate Mean
Threshold 1PM ZOLL (Circulation
5/85) 96 56mA 2Madsen (American Heart Journal
7/88) 94 55mA 3Dunn (Heart and Lung
1/89) 91 43mA 4Heller (Prehospital Disaster
7/89) 80 67mA 5Worley (Acute Coronary Care
1987) 96 67mA 6Falk (New England Journal
11/83) 94 56mA Competitive Pacing (20 msec pulse
duration) 7Heller (Prehospital Disaster
7/89) 50 105mA 8Knowlton (American Journal
Cardiology) 46 95mA 9Crockett (Experience in
Coronary Care) 25 142mA 10Crockett (Experience
in Emergency Department 50 88mA 11Falk (J.
American College of Cardiology 1993) ---- 78mA
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M Series Pacing UNDERSTANDING

• Key Differentiators/Key Selling Points
• Clinically superior pacing waveform
• Twice the rate of capture
• Benefit Potential for higher survival rates
• Question What do you do when there is not shock
  advised? What are your criteria for using
  external pacing? What has your experience been
  with external pacing?
• Question What is your understanding of the
  differences between pacing technologies?
• Question Where might your approach change if
  you could capture more patients?
• Half the current for capture
• Benefit Ability to maintain external pacing at
  a comfortable level for longer periods of time
• Question How might capturing at lower energy
  levels benefit the patient?
• High efficacy with 35 pads
• Benefit Cheaper to than floating internal wires
• Question When do you float wires to establish
  internal pacing?
• Uniform operating system
• Error correcting messages
• Large, bright LED display

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M Series Pacing APPLICATION

• Practice Pacing Demo

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M Series Pacing APPLICATION

• Customer Goals

• ZOLL Solutions

Uniform Operating System Clinically superior
pacing waveform 55 codes NO SHOCK High
efficacy with 35 pads
Fast Response Times Effective Patient
Care Cost effective options
?
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Selling PacingWho to talk toWhat to say
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ZOLL M SeriesPutting it All Together
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User Goal
With staff changes, we need to know everyone can
operate any defibrillator in any area!
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M Series Offers Solutions

• Tools for Everyone and Every Environment
• Extensive range of M Series options and
  configurations to meet every clinical need.
• Crash Cart
• ED
• EMS
• Flight Service
• Transport
• Cath Lab/EP
• OR
• Low Acuity Units

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M Series Offers Solutions
Consistency that Builds Confidence and Minimizes
Training
A 20-Year Commitment D900 PD1200 PD1400,
D1400 PD1600, D1600 PD1700 PD2000, D2000 M
Series M Series CCT
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M Series Offers Solutions
Dynamic Error Correction

• Driven by design principles of cockpit safety.
• Issues corrective prompt instead of describing
  error
• ECG LEAD OFF

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User Goal
These days we need defibrillators everywhere
from the ICU to theparking lot, from BLSto ALS
levels
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M Series Offers Solutions
Early Defibrillation
The goal of early defibrillation by first
responders is a collapse-to-shock interval, when
appropriate, of lt3 minutes in all areas of the
hospital and ambulatory care facilities (Class
I). Guidelines 2000
The ZOLL family of AEDs is designed to help
clinical professionals deliver early
defibrillation.
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User Goal
We want to measure the quality of our
resuscitation program, but we cant find the
resources.
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M Series Offers Solutions
A Better Way to Collect Performance Data

• Data transfer via PC card technology to RescueNet
  Code Review for case review and reporting.
• Unit does not have to be removed from service

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M Series Offers Solutions
Automated Compliance with Standards and
Recommendations

• JCAHO Standard TX.8
• Effective resuscitation services are
  systematically available through the hospital.
• d. Appropriate data collection related to the
  processes and outcome of resuscitation and
• Ongoing review of outcomes related to
  resuscitation in the aggregate to identify
  opportunities for improvement of resuscitation
  efforts.
• AHA Guidelines 2000
• Organized collection and review of patient data
  can identify system wide problems and allow
  assessment of each link in the Chain of Survival
  for the adult victim of sudden cardiac death.

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User Goal
Keeping all our defibrillators up-to-date and
ready for emergencies is a challenge.
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M Series Offers Solutions
Products that Adapt Over Time
Easy to add options as needed.
12-lead
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User Goal
We cant afford downtime for the equipment we
depend on.
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M Series Offers Solutions
Uptime Beyond a Quick Fix
All ZOLL repairs, modifications and upgrades are
tested to the same quality standards as new
factory defibrillators.
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User Goal
We need a long-term partner whos 100 focused
on us.
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Customer-Driven Success

• Driven by unmatched focus on customer needs
• Ranked 11th on Forbes listing of 100 Fastest
  Growing Small Companies
• Fastest growing hospital defibrillator company
• Growth driven by customers switch to ZOLL from
  other suppliers

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Top 15 Cardiac Hospitals All Use ZOLL

• Cleveland Clinic, Cleveland OH
• Mayo Clinic, Rochester MN
• Brigham Woman's Hospital, Boston MA
• Duke University Medical Center, Durham NC
• Mass General Hospital, Boston
• Johns Hopkins Hospital, Baltimore MD
• Emory University Hospital, Atlanta GA
• Texas Heart Institute-St. Luke's Episcopal
  Hospital, Houston TX
• Stanford University Hospital, Stanford CA
• Barnes-Jewish Hospital, St. Louis MO
• New York Presbyterian Hospital
• UCLA Medical Center, Los Angeles CA
• Washington Hospital Center, Washington DC
• William Beaumont Hospital, Royal Oak MI
• Methodist Hospital, Houston

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M Series Configuration

• Critical Questions?
• Review configuration options on your own

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M Series Summary

• Standardization Tools for everyone in every
  environment
• Consistency that Builds Confidence Uniform
  operating system Dynamic error correction
• Superior clinical results with patented biphasic
  and pacing waveforms
• Upgradeable to adapt to changing needs over time
• ZOLL partner focused on resuscitation