ZOLL E Series Manual

ZOLL E Series
Defibrillator
Operators Guide
Get an original copy of the ZOLL E Series Defibrillator
Operators Guide for manufacturer information about
service, available accessories and how to use and
maintain your device.

9650-1210-01 Rev. T
E Series Operator’s Guide
®

The issue date for the E Series Operator's Guide (REF 9650-1210-01 Rev. T) is June, 2014.
If more than 3 years have elapsed since this date, contact ZOLL Medical Corporation to determine if additional
product information updates are available.
Copyright © 2014 by ZOLL Medical Corporation. All rights reserved. AutoPulse, Base Power Charger,
CPR Dashboard, CPR Index, CPR-D-padz, E Series, pedi-padz, Protocol Assist Code Markers, Real CPR Help,
Rectilinear Biphasic, RescueNet, See-Thru CPR, SmartAlarms, stat-padz, SurePower and ZOLL are trademarks or
registered trademarks of ZOLL Medical Corporation in the United States and/or other countries.
All other trademarks are the property of their respective owners.
ZOLL Medical Corporation
269 Mill Road
Chelmsford, MA USA
01824-4105
ZOLL International Holding B.V.
Newtonweg 18
6662 PV ELST
The Netherlands

9650-1210-01 Rev. T E Series Operator’s Guide iii
TABLE OF CONTENTS
SECTION 1 GENERAL INFORMATION.................................................................. 1-1
Product Description.............................................................................................. 1-1
How to Use This Manual....................................................................................... 1-2
Manual Updates..................................................................................................... 1-2
Unpacking.............................................................................................................. 1-2
Accessories ........................................................................................................... 1-2
Symbols Used on the Equipment ........................................................................ 1-4
Defibrillator Function............................................................................................ 1-7
Intended Use — Manual Operation..................................................................... 1-7
Intended Use — Semiautomatic Operation (AED).............................................. 1-7
Contraindications for Semiautomatic Operation.................................................. 1-7
Defibrillator Complications .................................................................................. 1-7
Defibrillator Output Energy.................................................................................. 1-7
External Pacemaker Function (Pacer version only) .......................................... 1-8
Intended Use — Pacemaker ............................................................................... 1-8
Pacemaker Complications .................................................................................. 1-8
Pediatric Pacing .................................................................................................. 1-9
Paddle and Electrode Options ............................................................................. 1-9
MFE Pad Application/Connection........................................................................ 1-9
Monitor................................................................................................................. 1-10
Recorder Function .............................................................................................. 1-10
Batteries............................................................................................................... 1-10
Internal Battery Charging ................................................................................... 1-10
External Battery Charger.................................................................................... 1-10
Diagnostics.......................................................................................................... 1-10
Safety Considerations .........................................................................................1-11
WARNINGS - General ...................................................................................... 1-11
Operator Safety................................................................................................. 1-12
Patient Safety.................................................................................................... 1-12
CAUTIONS ........................................................................................................... 1-13
FCC Statement Regarding Bluetooth Operation............................................... 1-13
Restarting the Device ......................................................................................... 1-14
FDA Regulations ................................................................................................. 1-15
Tracking Requirements ..................................................................................... 1-15
Notification of Adverse Events .......................................................................... 1-15
Software License................................................................................................. 1-15
Service ................................................................................................................. 1-15
Returning a unit for service ............................................................................... 1-15
The ZOLL Serial Number.................................................................................... 1-16

E Series Operator’s Guide
iv www.zoll.com 9650-1210-01 Rev. T
SECTION 2 OPERATING CONTROLS AND INDICATORS................................... 2-1
Code Markers .........................................................................................................2-4
Summary Report Function....................................................................................2-4
Summary Report Formats....................................................................................2-4
Defibrillation Format.............................................................................................2-5
Pacer Format (Pacer version only) ......................................................................2-6
Heart Rate Alarm Activated Format .....................................................................2-7
VF Alarm Activated Format (Refer to Section 6)..................................................2-7
Recorder On Format ............................................................................................2-7
Analyze Format....................................................................................................2-8
Manual Mode Activated .......................................................................................2-9
Printing a Report....................................................................................................2-9
Printing a Call Report ............................................................................................2-9
Printing a Partial Summary Report ......................................................................2-9
Printing an Incident Log........................................................................................2-9
Adding a Patient Name and ID Number to a Report .........................................2-10
Modifying a Patient Name and ID Number.........................................................2-11
Erasing Summary Report Memory ..................................................................... 2-11
SECTION 3 MANUAL DEFIBRILLATION ............................................................... 3-1
Emergency Defibrillation Procedure with Paddles or MFE Pads ......................3-1
Troubleshooting.....................................................................................................3-4
SECTION 4 ADVISORY DEFIBRILLATION............................................................ 4-1
Advisory Defibrillation...........................................................................................4-1
Advisory Function Messages ...............................................................................4-4
Warning Messages ................................................................................................4-4
Troubleshooting.....................................................................................................4-5
SECTION 5 AUTOMATED EXTERNAL DEFIBRILLATOR (AED) OPERATION ... 5-1
AED Semiautomatic Operation.............................................................................5-2
Operating Messages..............................................................................................5-3
AED Manual Mode Operation................................................................................5-5
Troubleshooting.....................................................................................................5-5
SECTION 6 SYNCHRONIZED CARDIOVERSION ................................................. 6-1
Synchronized Cardioversion ................................................................................6-1
Troubleshooting.....................................................................................................6-3
SECTION 7 REAL CPR HELP................................................................................. 7-1
Prepare the Patient and Attach the CPRD-to-MFC Connector...........................7-1
Real CPR Help Field...............................................................................................7-1
CPR Compressions Indicator...............................................................................7-2
CPR Idle Time Display.........................................................................................7-2

Table of Contents
9650-1210-01 Rev. T E Series Operator’s Guide v
FULLY RELEASE Prompt....................................................................................7-2
CPR Voice Prompts .............................................................................................7-2
Compressions Bar Graph ....................................................................................7-2
Displaying the CPR Compressions Bar Graph ....................................................7-3
CPR Dashboard .....................................................................................................7-3
CPR Feedback Indicators and CPR Index...........................................................7-3
CPR Rate and Depth Display ..............................................................................7-3
CPR Idle Time Display.........................................................................................7-3
SECTION 8 SEE-THRU CPR................................................................................... 8-1
Using See-Thru CPR..............................................................................................8-1
Examples .............................................................................................................8-1
SECTION 9 NONINVASIVE TEMPORARY PACING (PACER VERSION ONLY).. 9-1
Noninvasive Temporary Pacing ...........................................................................9-1
Special Pacing Applications.................................................................................9-3
Standby Pacing....................................................................................................9-3
Asynchronous Pacing ..........................................................................................9-4
Pediatric Pacing ...................................................................................................9-4
Troubleshooting.....................................................................................................9-4
SECTION 10 ECG MONITORING ........................................................................... 10-1
Introduction..........................................................................................................10-1
Preparations.........................................................................................................10-1
Electrode Placement ...........................................................................................10-1
Monitoring Electrodes Attachment ..................................................................... 10-2
Control Setting.....................................................................................................10-2
Spikes from Implanted Pacemakers ..................................................................10-2
Alarms...................................................................................................................10-3
Setting Alarm Limits ...........................................................................................10-3
Vital Sign Alarms................................................................................................10-3
Heart Rate Alarm Limits.....................................................................................10-3
Suspending and Silencing Alarms .....................................................................10-4
Deactivating and Activating Alarms ...................................................................10-4
Smart Alarms .....................................................................................................10-4
Recorder Operation .............................................................................................10-4
Diagnostic Bandwidth ........................................................................................10-4
5-Lead Monitoring................................................................................................10-5
Changing from 3-Lead Monitoring .....................................................................10-5
Changing from 5-Lead ECG Monitoring.............................................................10-5
Simultaneous 3-Lead Printing ............................................................................10-5
Vital Signs Trending ............................................................................................10-5
Viewing Vital Signs Trending Data on the Display.............................................10-5
Printing a Vital Signs Trend Report....................................................................10-6

E Series Operator’s Guide
vi www.zoll.com 9650-1210-01 Rev. T
NIBP Trend Operation .......................................................................................10-6
Clearing Vital Signs Trend Records...................................................................10-7
SECTION 11 GENERAL MAINTENANCE .............................................................. 11-1
Inspection ............................................................................................................. 11-1
Cleaning................................................................................................................11-1
Cleaning the Recorder Printhead.......................................................................11-1
Testing the E Series Unit..................................................................................... 11-1
Testing the Stripchart Recorder .........................................................................11-1
Testing the Defibrillator (Semiautomatic Mode) .................................................11-2
Testing the Defibrillator (Manual Mode) .............................................................11-2
Testing the Pacer (Pacer Version Only) ............................................................11-3
Changing Recorder Paper...................................................................................11-4
Setting Time and Date .........................................................................................11-5
Manual Method ..................................................................................................11-5
Automated Dial-up Method ................................................................................11-5
GPS Synchronization.........................................................................................11-6
Operator’s Shift Checklist for E Series Products (Manual)..............................11-7
Operator’s Shift Checklist for E Series Products (Semiautomatic) ................11-8
SECTION 12 BATTERY MANAGEMENT ............................................................... 12-1
Battery Care..........................................................................................................12-1
Battery Life Expectancy .....................................................................................12-1
LOW BATTERY Message..................................................................................12-1
Changing the Battery Pack ................................................................................12-1
Charging and Testing Battery Packs .................................................................12-2
Top Panel Battery LEDs ....................................................................................12-2
Troubleshooting .................................................................................................12-2
Achieving Optimal Battery Pack Performance..................................................12-3
SECTION 13 TROUBLESHOOTING GUIDELINES ................................................ 13-1
Monitor..................................................................................................................13-1
Recorder ...............................................................................................................13-3
Pacer (Pacer version only)..................................................................................13-4
Defibrillator...........................................................................................................13-5
AC Charger ...........................................................................................................13-7
APPENDIX A SPECIFICATIONS ................................................................................A-1
General................................................................................................................... A-1
Pacemaker (Pacer version) .................................................................................. A-2
ECG Monitoring..................................................................................................... A-3
CPR Monitoring..................................................................................................... A-4
Display ................................................................................................................... A-5
Recorder ................................................................................................................ A-5

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9650-1210-01 Rev. T E Series Operator’s Guide vii
PCMCIA Card ........................................................................................................ A-5
Battery Packs ........................................................................................................ A-5
Guidance and Manufacturer’s Declaration — Electromagnetic Emissions .... A-7
Electromagnetic Immunity Declaration (EID)..................................................... A-8
EID for Life-Support Functions ........................................................................... A-9
Recommended Separation Distances from RF Equipment for E Series
Life-Support Functions ...................................................................................... A-10
EID for Non-Life-Support Functions ................................................................. A-11
Recommended Separation Distances from RF Equipment for E Series
Non-Life-Support Functions .............................................................................. A-12
Rectilinear Biphasic Waveform Characteristics .............................................. A-13
Clinical Trial Results for the Biphasic Waveform ............................................ A-21
Randomized Multi-Center Clinical Trial for Defibrillation of 
Ventricular Fibrillation (VF) and Ventricular Tachycardia (VT) ................... A-21
Randomized Multi-Center Clinical Trial for Cardioversion of Atrial Fibrillation 
(AF) ............................................................................................................ A-22
Synchronized Cardioversion of Atrial Fibrillation .............................................. A-23
Shock Conversion Estimator............................................................................. A-24
ECG Analysis Algorithm Accuracy ................................................................... A-27
Clinical Performance Results............................................................................ A-27
APPENDIX B MEDICAL REPORT CAPABILITY .......................................................B-1
PCMCIA Data Card................................................................................................ B-1
Installing the PCMCIA Data Card......................................................................... B-1
Erasing a Memory Card........................................................................................ B-1
Transferring Data to a PC with a PCMCIA Data Card Reader ........................... B-2
Uploading Memory Card Data or Trend History to a PC or Handheld ............. B-2
RS-232 Serial Port .............................................................................................. B-2
Bluetooth Transceiver (Optional) ........................................................................ B-2
Communication Settings ..................................................................................... B-3
Transferring Data ................................................................................................ B-3
Activating Automatic Data Transmission........................................................... B-4
Transmitting 12-Lead Patient Records ............................................................... B-5
Troubleshooting.................................................................................................... B-5

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9650-1210-01 Rev. T 1-1
SECTION 1
GENERAL INFORMATION
NOTE: Your E Series®may or may not contain all the features listed in this manual, depending on your particular
configuration.
Product Description
The ZOLL®E Series products combine defibrillation, ECG display, advanced monitoring capabilities, and Noninvasive
Transcutaneous Pacing (NTP) with communication, data printing and recording capabilities in a single lightweight
portable instrument. The unit has been designed for all resuscitation situations; its small, compact, lightweight design
makes it ideal for accompanying patients during transport. The product is powered by alternating current (AC) or direct
current (DC) mains and an easily replaced battery pack that is quickly recharged in the device when it is connected to
AC or DC mains. In addition, the unit’s batteries may be recharged and tested using ZOLL Base Power Charger™ 4X4
or ZOLL SurePower™ Charger systems designed for standard interchangeable ZOLL battery packs.
The product is designed for use in both the hospital and the rugged EMS environment. All of its features add to its
durability in hospital applications. The device is a versatile automated external defibrillator with manual capabilities and
may be configured to operate in Manual, Advisory or Semiautomatic modes. Semiautomatic versions of the device
have a distinctive front panel with a single ON position. Conventional devices, which can be configured for Manual,
Advisory or Semiautomatic operation, have a standardized ZOLL operator interface. When operating in manual
configuration, the device operates as a conventional defibrillator where the device’s charging and discharging is fully
controlled by the operator. In Advisory and Semiautomatic modes, some features of the device are automated and a
sophisticated detection algorithm is used to identify ventricular fibrillation and determine the appropriateness of
defibrillator shock delivery. Units may be configured to automatically charge, analyze, recharge, and prompt the
operator to “PRESS SHOCK”, depending on local protocols. The unit is switched from Semiautomatic mode to Manual
mode for ACLS use by pressing the appropriate soft key on the front panel.
The E Series assists caregivers during cardiopulmonary resuscitation (CPR) by evaluating the rate and depth of chest
compressions and providing feedback to the rescuer. Real CPR Help®requires the use of CPR-D-padz®and the
CPRD-to-MFC connector. Real CPR Help is available in E Series units with software version 3.00.000 or higher.
Information regarding the unit’s operation, patient ECG, and other physiological waveforms is displayed on a large 5.63
inch diagonal display, which provides high contrast and visibility under virtually all lighting conditions. Operating and
warning messages are displayed on the monitor and the unit can also be configured with voice prompts to alert the
user to unit status. Self-diagnostic tests are performed when the instrument is turned on as well as periodically during
operation.
A sophisticated data collection system, an internal summary report feature with printer, and PCMCIA cards are
available for this unit. A PCMCIA card can be installed in the unit to record ECG and virtually all device data when the
device is turned on. The data stored on the PCMCIA card can be reviewed and archived on a properly equipped
personal computer using RescueNet®Code Review for Windows software.
An annotating strip chart recorder is included to provide immediate documentation and summary report functions about
patient care and treatment during use.
Some E Series products are intended for use in the Semiautomatic mode by first responders and emergency medical
technicians certified by an appropriate federal, state or local government authority. Some E Series products are
intended for use in Manual mode by personnel certified by appropriate federal, state or local authority to provide
advanced life support care.
Some E Series products are intended for use in the pre-hospital emergency medical care setting, indoors and
outdoors, including first response vehicles, fire vehicles, basic and advanced level ambulances as well as by both
Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) staff in hospitals under protocol control.

E Series Operator’s Guide
1-2 9650-1210-01 Rev. T
How to Use This Manual
The E Series Operator's Guide provides information operators need to know for the safe and effective use and care of
the E Series products. Before operating this device, be sure to read and understand all the information contained
within.
This manual is organized for Manual mode operators, Advisory mode operators and Semiautomatic mode operators. If
you will only use the device in Manual mode or Advisory mode you do not need to read Section 5. If you will only use
the device in Semiautomatic mode you do not need to read Sections 3, 4, or 6.
Please read “Safety Considerations” on page 1-11 thoroughly.
Procedures for daily checkout and unit care are described in “General Maintenance” on page 11-1.
This manual is supplemented by inserts for options available on the E Series. These inserts contain additional
warnings, precautions, and safety-related information.
Manual Updates
An issue or revision date for this manual is shown on the front cover.
If more than three years have elapsed since this date, contact ZOLL Medical Corporation to determine if additional
product information updates are available.
All users should carefully review each manual update to understand its significance and then file it in its appropriate
section within this manual for subsequent reference.
Product documentation is available through the ZOLL website at www.zoll.com. From the Products menu, choose
Product Documentation.
Unpacking
Before unpacking the E Series unit, carefully inspect each container for damage. If the shipping container or cushion
material is damaged, it should be kept until the contents have been checked for completeness and the instrument has
been checked for mechanical and electrical integrity.
If the contents are incomplete, if there is mechanical damage, or if the instrument does not pass its electrical self-test,
North American customers should call ZOLL Medical Corporation (1-800-348-9011). International customers should
contact the nearest ZOLL authorized representative. If the shipping container is damaged, also notify the carrier.
Accessories
The following table describes accessories available for use with the E Series.
Electrodes/Pads, Paddles, and Connectors REF
Adult, Multi-Function Pacing/Defibrillation stat-padz®
(12 pair/box)
8900-4003
Pediatric, Multi-Function Pacing/Defibrillation 
pedi-padz®(6 pair/box)
8900-2065
External Paddle Assembly Apex/Sternum with built in
pediatric electrodes
8000-1010-01
CPR-D-padz 8900-0800-01
CPRD-to-MFC Connector 8000-0370
Cables REF
Multi-Function Cable Assembly for use with external
paddles or multi-function electrode pads
8000-0308-01 (standard 8’)
8000-0308-02 (extended 12’)
AAMI 3-Lead ECG Patient Cable 8000-0025-02 (6’)
8000-0025 (12’)
IEC 3-Lead ECG Patient Cable 8000-0026

General Information
9650-1210-01 Rev. T 1-3
* The terms “ZOLL Multi-Function Electrode (MFE) Pads” and “MFE Pads” are used interchangeably throughout this 
manual.
AAMI 5-Lead Wire ECG Patient Cable 8000-1005-01
IEC 5-Lead Wire ECG Patient Cable 8000-0091
Power Cord Extension Cable (12”) 8000-0730
Batteries and Chargers REF
ZOLL Base PowerCharger 4x4 Battery Charger 8050-0012-01
Smart Battery Pack 8004-0103-01
SmartReady Battery Pack 8004-0104-01
ZOLL SurePower Charger 8050-0030-01
SurePower defibrillator battery 8019-0535-01
Miscellaneous REF
Storage Bag Set 8000-0916
Recorder Paper, 80mm Fan Fold 8000-0301 (20 packages)
8000-0302 (10 packages)
Defibrillator Gel 8000-0053
PCMCIA Data Cards (2 per package) 8000-0551 (8Mb)
8000-0552 (16Mb)
8000-0553 (32Mb)
RS232 Data Transfer Cable 8000-0605-01
ECG Simulator 8012-0206

E Series Operator’s Guide
1-4 9650-1210-01 Rev. T
Symbols Used on the Equipment
Any or all of the following symbols may be used in this manual or on this equipment:
Type B equipment.
Type BF equipment.
Type CF equipment.
Defibrillator-proof type BF equipment.
Defibrillator-proof type CF equipment.
Attention, consult accompanying documents.
Fragile, handle with care.
Keep dry.
This end up.
Temperature limitation.
Fusible Link.
Equipotentiality.
Protective (earth) ground terminal.
DANGER High Voltage present.
Alternating current.
Direct current.

General Information
9650-1210-01 Rev. T 1-5
Contains lead. Recycle or dispose of properly.
Keep away from open flame and high heat.
Do not open, disassemble, or intentionally damage.
Do not crush.
Nonrechargeable battery
Do not discard in trash. Recycle or dispose of properly.
Date of manufacture.
Use by.
Latex-free.
Do not reuse.
Do not fold.
Not sterile.
Nonionizing electromagnetic radiation.
Return to a collection site intended for waste electrical and electronic equipment
(WEEE). Do not dispose of in unsorted trash.
2%452.
,%!$
2%#9#,%
0B

E Series Operator’s Guide
1-6 9650-1210-01 Rev. T
Manufacturer.
Authorized representative in the European Community.
Serial Number.
Catalogue number.
Consult instructions for use.
IP34 Protected against ingress of solid foreign objects > 2.5 mm in diameter.
Protected against splashing water.

General Information
9650-1210-01 Rev. T 1-7
Defibrillator Function
The E Series products contain a DC defibrillator capable
of delivering up to 200 joules of energy. It may be used in
synchronized mode to perform synchronized
cardioversion by using the R-wave of the patient’s ECG
as a timing reference. The unit uses paddles or
disposable, pre-gelled, MFE Pads for defibrillation.
The E Series products must be prescribed for use by a
physician or medical advisor of an emergency response
team.
Intended Use — Manual Operation
Use of the E Series products in the Manual mode for
defibrillation is indicated on victims of cardiac arrest
where there is apparent lack of circulation as indicated
by these three conditions:
•Unconsciousness
•Absence of breathing, and
•Absence of pulse.
This product should be used only by qualified medical
personnel for converting ventricular fibrillation and rapid
ventricular tachycardia to sinus rhythm or other cardiac
rhythms capable of producing hemodynamically
significant heart beats.
In Manual mode, the E Series unit may also be used for
synchronized cardioversion to terminate atrial fibrillation
(AF) or ventricular tachycardias (VT) by using the R-
wave of the patient’s ECG as a timing reference. A
qualified physician must decide when synchronized
cardioversion is appropriate.
The Advisory function should be used to confirm
ventricular fibrillation and wide complex ventricular
tachycardia (greater than 150 beats per minute) in
patients meeting the three conditions indicating lack of
circulation (previously listed).
Intended Use — Semiautomatic Operation
(AED)
The E Series AED unit is designed for use by emergency
care personnel who have completed training and
certification requirements applicable to the use of a
defibrillator where the device operator controls delivery
of shocks to the patient.
They are specifically designed for use in early
defibrillation programs where the delivery of a
defibrillator shock during resuscitation involving CPR,
transportation, and definitive care are incorporated into a
medically-approved patient care protocol.
Use of the device in the Semiautomatic mode for
defibrillation is indicated on victims of cardiac arrest
where there is apparent lack of circulation.
Specifications for the ECG rhythm analysis function are
provided at the end of this section.
Intended Use — CPR Monitoring
The CPR monitoring function provides visual and audio
feedback designed to encourage rescuers to perform
chest compressions at the AHA/ERC recommended rate
of 100 compressions per minute. Voice and visual
prompts encourage a minimum compression depth of at
least 1.5 (3.8 cm) or 2.0 inches (5.0 cm), depending on
the configuration, for adult patients.
The CPR monitoring function is not intended for use on
patients under 8 years of age.
Contraindications for Semiautomatic Operation
Do not use the unit’s AED function on patients under 8
years of age.
The rhythm analysis function may not reliably identify
ventricular fibrillation in the presence of an implanted
pacemaker. Inspection of the electrocardiogram and
clinical evidence of cardiopulmonary arrest should be the
basis for any treatment of patients with implanted
pacemakers.
Do not use the rhythm analysis function during patient
movement on a stretcher or in an ambulance or other
conveyance. A patient must be motionless during ECG
analysis. Do not touch the patient during analysis. Cease
all movement of the stretcher or vehicle prior to
analyzing the ECG. If you are using the device in an
emergency vehicle, bring the vehicle to a halt before
activating the analysis function.
Defibrillator Complications
Inappropriate defibrillation or cardioversion of a patient
(e.g., with no malignant arrhythmia) may precipitate
ventricular fibrillation, asystole, or other dangerous
arrhythmias.
Defibrillation without proper application of electrode pads
or paddle electrolyte gel may be ineffective and cause
burns, particularly when repeated shocks are necessary.
Erythema or hyperemia of the skin under the paddles or
MFE Pads often occurs; this effect is usually enhanced
along the perimeter of the paddle or electrode. This
reddening should diminish substantially within 72 hours.
Defibrillator Output Energy
The E Series products may deliver up to 200 joules into a
50 ohm impedance. The energy delivered through the
chest wall, however, is determined by the patients
transthoracic impedance. An adequate amount of
electrolyte gel must be applied to the paddles and a force
of 10-12 kilograms (22-26.4 lbs) must be applied to each
paddle in order to minimize this impedance. If MFE pads
are used, make sure that they are properly applied.
(Instructions for proper application are located in “MFE
Pad Application/Connection” on page 1-9).

E Series Operator’s Guide
1-8 9650-1210-01 Rev. T
External Pacemaker Function (Pacer
version only)
Some E Series products may include an optional
transcutaneous demand pacemaker consisting of a
pulse generator and ECG sensing circuitry. Non-invasive
Transcutaneous Pacing (NTP) is an established and
proven technique. This therapy is easily and rapidly
applied in both emergency and non-emergency
situations when temporary cardiac stimulation is
indicated.
Proper operation of the device, together with correct
electrode placement, is critical to obtaining optimal
results. Every operator must be thoroughly familiar with
these operating instructions.
The output current of the pacemaker is continuously
variable from 0 to 140 mA. The rate is continuously
variable from 30 to 180 pulses per minute (ppm).
The pacing output pulse is delivered to the heart by
specially designed ZOLL MFE Pads placed on the back
and the precordium.
The characteristics of the output pulse, together with the
design and placement of the electrodes, minimize
cutaneous nerve stimulation, cardiac stimulation
threshold currents, and reduce discomfort due to skeletal
muscle contraction.
The unique design of the E Series products allow clear
viewing and interpretation of the electrocardiogram
(ECG) on the display without offset or distortion during
external pacing.
Intended Use — Pacemaker
This product may be used for temporary external cardiac
pacing in conscious or unconscious patients as an
alternative to endocardial stimulation.
Note: This device must not be connected to internal
pacemaker electrodes.
The purposes of pacing include:
•Resuscitation from standstill or bradycardia of
any etiology
Noninvasive pacing has been used for resuscitation
from cardiac standstill, reflex vagal standstill, drug
induced standstill (due to procainamide, quinidine,
digitalis, b-blockers, verapamil, etc.) and unexpected
circulatory arrest (due to anesthesia, surgery,
angiography, and other therapeutic or diagnostic
procedures). It has also been used for temporary
acceleration of bradycardia in Stokes-Adams disease
and sick-sinus syndrome. It is safer, more reliable,
and more rapidly applied in an emergency than
endocardial or other temporary electrodes.
•As a standby when standstill or bradycardia
might be expected
Noninvasive pacing may be useful as a standby
when cardiac arrest or symptomatic bradycardia
might be expected due to acute myocardial infarction,
drug toxicity, anesthesia or surgery. It is also useful
as a temporary treatment in patients awaiting
pacemaker implants or the introduction of
transvenous therapy. In standby pacing applications,
noninvasive pacing may provide an alternative to
transvenous therapy that avoids the risks of
displacement, infection, hemorrhage, embolization,
perforation, phlebitis and mechanical or electrical
stimulation of ventricular tachycardia or fibrillation
associated with endocardial pacing.
•Suppression of tachycardia
Increased heart rates in response to external pacing
often suppress ventricular ectopic activity and may
prevent tachycardia.
Pacemaker Complications
Ventricular fibrillation does not respond to pacing and
requires immediate defibrillation. Therefore, the patient’s
dysrhythmia must be determined immediately, so that
you can employ appropriate therapy. If the patient is in
ventricular fibrillation and defibrillation is successful but
cardiac standstill (asystole) ensues, you should use the
pacemaker.
Ventricular or supraventricular tachycardias may be
interrupted with pacing but in an emergency or during
circulatory collapse, synchronized cardioversion is faster
and more certain. (See “Synchronized Cardioversion” on
page 6-1).
Electromechanical dissociation may occur following
prolonged cardiac arrest or in other disease states with
myocardial depression. Pacing may then produce ECG
responses without effective mechanical contractions,
and other treatment is required.
Pacing may evoke undesirable repetitive responses,
tachycardia, or fibrillation in the presence of generalized
hypoxia, myocardial ischemia, cardiac drug toxicity,
electrolyte imbalance, or other cardiac diseases.
Pacing by any method tends to inhibit intrinsic
rhythmicity. Abrupt cessation of pacing, particularly at
rapid rates, can cause ventricular standstill and should
be avoided.
Noninvasive Temporary Pacing may cause discomfort of
varying intensity, which occasionally can be severe and
preclude its continued use in conscious patients.
Similarly, unavoidable skeletal muscle contraction may
be troublesome in very sick patients and may limit
continuous use to a few hours. Erythema or hyperemia
of the skin under the MFE Pads often occurs; this effect
is usually enhanced along the perimeter of the electrode.

General Information
9650-1210-01 Rev. T 1-9
This reddening should substantially lessen within 72
hours.
There have been reports of burns under the anterior
electrode when pacing adult patients with severely
restricted blood flow to the skin. Prolonged pacing should
be avoided in these cases and periodic inspection of the
underlying skin is advised.
There are reports of transient inhibition of spontaneous
respiration in unconscious patients with previously
available units when the anterior electrode was placed
too low on the abdomen.
WARNING!: This device must not be connected to
internal pacemaker electrodes.
Pediatric Pacing
Pacing can be performed on pediatric patients weighing
33lbs / 15kg or less using special ZOLL pediatric MFE
Pads. Prolonged pacing (in excess of 30 minutes),
particularly in neonates, could cause burns. Periodic
inspection of the underlying skin is recommended.
Paddle and Electrode Options
The E Series products will defibrillate, cardiovert and
monitor ECG using either defibrillation paddles or ZOLL
Multi-Function Electrode (MFE) Pads.
The pacer version of the E Series paces using ZOLL
MFE Pads.
ENERGY SELECT, CHARGE, and SHOCK controls are
located on the paddles and front panel. When using MFE
Pads, you must use the controls on the front panel of the
unit. To switch from paddles to MFE Pads, remove the
Multi-Function cable from the apex paddle and connect
the MFE pads to the Multi-Function cable.
You cannot activate the Advisory function unless MFE
Pads are attached to the Multi-Function Cable and used
as the ECG monitoring lead.
Adult and pediatric MFE Pads, stat-padz, and ECG
electrodes (not the ECG cable) are disposable, single-
use items.
MFE Pad Application/Connection
This section describes how to prepare the patient and
attach and connect MFE pads. Attach the MFE pads
according to the instructions on the electrode packaging.
1. Prepare the patient by:
•Removing all clothing covering the patient's chest.
•Drying chest if necessary
•Clipping excessive chest hair, if necessary, to
ensure proper adhesion of electrodes.
2. Connect MFE Pads to the multi-function cable (if not
already connected), as shown below.
3. Open the pad packaging and apply one edge of the
pad securely to the patient.
4. Roll the pad smoothly from that edge to the other
being careful not to trap any air pockets between the
gel and skin.
1.
2.
If it is not possible to place the back MFE Pad on the
patient's back, place it on the standard apex position
of the apex-sternum configuration. Effective
defibrillation will result, but pacing with the device is
usually less effective.
Ensure that all MFE Pads are making good contact with
the patient’s skin and are not covering any part of the
ECG electrodes. Note that:
•If the MFE Pads are not making good contact with the
patient, the messages CHECK PADS and POOR
CAUTION
Only use pads that are well within the expiration date
indicated on the package. Failure to do so could result
in false patient impedance readings and may affect
delivered energy.
WARNING
Poor adherence and/or air under the MFE Pads can
lead to the possibility of arcing and skin burns.

E Series Operator’s Guide
1-10 9650-1210-01 Rev. T
PAD CONTACT are alternately displayed, and
energy will not be delivered
•If a short circuit exists between MFE Pads, the
message DEFIB PAD SHORT is displayed.
Monitor
The patient’s ECG is monitored by connecting the patient
to the unit via the 3 lead or 5 lead wire patient cable,
MFE Pads, or through the paddles. Four seconds of
ECG is presented on the display along with the following
information:
•averaged heart rate, derived from measuring R to R
intervals
•lead selections —I, II, III, aVR, aVL, aVF, V (with
ECG cable), PADDLES, or PADS (APLS if connected
to AutoPulse®Plus)
•ECG size —0.5, 1, 1.5, 2, 3 cm/mV
•pacemaker output in milliamps (Pacer version only)
•pacemaker stimulus rate in pulses per minute (Pacer
version only)
•defibrillator output in joules
•other operational prompts, messages, and diagnostic
codes
Monitoring or diagnostic ECG bandwidth is selectable.
Recorder Function
The strip recorder normally operates in the delay mode
(6 seconds) to ensure capture of critical ECG
information. You manually activate the recorder by
pressing the RECORDER button. It is activated
automatically whenever a defibrillation shock is
delivered, a heart rate alarm occurs, or the rhythm
analysis function is activated. You can deactivate the
stripchart recorder during these events.
Batteries
The E Series products use easily replaced sealed, lead-
acid or lithium-ion battery packs that, when new and fully
charged, provide at least 2.5 hours of monitoring. Use of
the defibrillator, strip chart recorder, and pacemaker
reduces this time.
When a LOW BATTERY message appears on the
display and the unit emits two beeps in conjunction with
the displayed message, you must replace and recharge
the battery.
Internal Battery Charging
You can charge the battery within the device via AC
(alternating current) mains, or an optional DC (direct
current) input.
When the E Series products are plugged into AC mains
or to a DC power supply, the CHARGER ON indicators
operate in the following manner:
•The orange-yellow CHARGER ON indicator
illuminates continuously whenever the device is
turned OFF and charging the battery or whenever the
device is turned ON with a battery installed.
•The green CHARGER ON indicator illuminates
continuously whenever the unit is turned OFF and
the installed battery has been fully charged to present
capacity.
•The green and orange-yellow CHARGER ON
indicators illuminate alternately when no battery is
installed in the unit or when a battery charging fault
has been detected.
When the device is not connected to AC mains, the
CHARGER ON indicators remain extinguished. If your
E Series unit does not function as expected, refer to the
“Troubleshooting Guidelines” on page 13-1.
External Battery Charger
Use the ZOLL Base Power Charger 4x4 or ZOLL
SurePower Charger for external battery charging and
capacity evaluation. You can charge up to four battery
packs simultaneously; testing is automatic. See the
appropriate ZOLL battery charger operator’s guide for
more information.
Diagnostics
A computer contained within the unit performs self-
diagnostic tests whenever the product is initially turned
on and periodically during operation. During operation, a
Function* FAULT XX message is displayed if a fault is
detected. If this occurs, turn the unit off and then on and
recheck operation. If the unit is connected to AC power,
disconnect the power after turning the unit off, then
reconnect and turn the unit on again. Contact authorized
service personnel if the message continues to be
displayed.
* Function: may include Recorder, Pacer, Defib, etc.

General Information
9650-1210-01 Rev. T 1-11
Safety Considerations
The E Series products are high energy devices capable of delivering up to 200 joules. To completely deactivate the
device, you must turn the selector switch to the OFF position.
•In order to disarm a charged defibrillator, do one of the following: Turn the selector switch to MONITOR, OFF or
PACER (pacer equipped versions only)
•Change the selected defibrillator energy
As a safety feature, the device automatically disarms if left charged for more than 60 seconds (15 seconds for AED
versions).
WARNINGS - General
•Federal (U.S.A.) law restricts this device to use by or on the order of a physician.
•The use of external pacing/defibrillation electrodes or adapter devices from sources other than ZOLL is not
recommended. ZOLL makes no representations or warranties regarding the performance or effectiveness of its
products when used in conjunction with pacing/defibrillation electrodes or adapter devices from other sources.
Device failures attributable to the use of pacing/defibrillation electrodes or adapters not manufactured by ZOLL may
void ZOLL's warranty.
•Proper operation of the unit, together with correct electrode placement, is critical to obtaining optimal results.
Operators must be thoroughly familiar with proper device operation.
•Do not use the unit in Semiautomatic mode during patient movement. A patient must be motionless during ECG
analysis. Do not touch the patient during analysis. Cease all movement via stretcher or vehicle before analyzing the
ECG. If using the device in an emergency vehicle, bring the vehicle to a halt before using in Semiautomatic mode.
•Place the patient on a firm surface before performing CPR.
•The device is protected against interference from radio frequency emissions typical of two-way radios and cellular
phones (digital and analog) used in emergency service/public safety activities. Users should assess the device’s
performance in their typical environment of use for the possibility of radio frequency interference from high-power
sources. Radio Frequency Interference (RFI) may be observed as shifts in monitor baseline, trace compression,
display brightness changes or transient spikes on the display.
•E Series units equipped with the Bluetooth® option include an RF transmitter which transmits with 7dBm/5mW
power in the 2.4 GHz ISM band.
•Do not operate the unit without a battery during patient care. Keep a fully charged spare battery pack with the
device at all times.
•Regular use of partially charged battery packs without fully recharging between uses results in permanently
reduced capacity and early battery pack failure.
•Test batteries regularly. Batteries that do not pass ZOLL’s capacity test could unexpectedly shutdown without
warning.
•Replace the battery with a fully charged battery immediately after the LOW BATTERY or REPLACE BATTERY
message.
•Emergency defibrillation should be attempted only by appropriately trained, skilled personnel who are familiar with
equipment operation. Training appropriateness, such as Advanced Cardiac Life Support (ACLS) or Basic Life
Support (BLS) certification, should be determined by the prescribing physician.
•Synchronized cardioversion should only be attempted by skilled personnel trained in Advanced Cardiac Life
Support (ACLS) and familiar with equipment operation. The precise cardiac arrhythmia must be determined before
attempting defibrillation.
•Prior to attempting synchronized cardioversion, ensure that the ECG signal quality is good and that sync marks are
displayed above each QRS complex.
•Pacing must be turned off before defibrillating with a second defibrillator. Otherwise, the E Series unit may be
damaged.
•Carefully route the patient cables to avoid tripping over them.
•Carefully route the patient cables to avoid inadvertently pulling the unit onto the patient.
•Do not carry the unit while in use.
•These operating instructions describe thefunctions and proper operation of the E Series products. They are not
intended as a substitute for a formal training course. Operators should obtain formal training from an appropriate
authority prior to using the device for patient care.
•Do not disassemble the unit. A shock hazard exists. Refer all problems to authorized service personnel.