ZOLL Medical Corporation Sales Training

1. ZOLL Medical CorporationSales Training Today when we think about the purchase of defibrillators, we find ourselves asking different questions. A few years ago, we assigned a lot of importance to factors such as it�s size and weight. While they are still important, we now need to consider things such as biphasic technology, early defibrillation, and JCAH O compliance.Today when we think about the purchase of defibrillators, we find ourselves asking different questions. A few years ago, we assigned a lot of importance to factors such as it�s size and weight. While they are still important, we now need to consider things such as biphasic technology, early defibrillation, and JCAH O compliance.

2. M Series Agenda Monitor Defibrillator Clinically superior biphasic technology External Pacing Clinically superior pacing technology Solutions for Customer Goals VERY IMPORTANT- TIE THIS TO KNOWLEDGE OF AHA AND ASKING THE PROPER QUESTIONS TO UNCOVER TRANSPORT NEEDS (CCT) VERY IMPORTANT- TIE THIS TO KNOWLEDGE OF AHA AND ASKING THE PROPER QUESTIONS TO UNCOVER TRANSPORT NEEDS (CCT)

3. M Series Overview The Fuel Behind the Fire Compare ZOLL�s 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

4. ZOLL M Series Monitor

5. 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

6. 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

7. 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

8. 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

9. 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

10. M Series Monitor KNOWLEDGE

11. M Series Monitor KNOWLEDGE Clearing Vital Signs Trends Press & hold SUMMARY Erase Summary, Erase Trend, Erase All is displayed Press ERASE TREND

12. M Series Monitor UNDERSTANDING Practice Monitor In-Service

13. 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 you�ve 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?

14. M Series Monitor UNDERSTANDING Key Differentiators/Key Selling Points: Intuitive design Benefit: Put an M Series in front of a clinician, and they�ll 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 you�re standing to the side / at an angle?

15. M Series Monitor APPLICATION Practice Monitor Demo

16. M Series Monitor APPLICATION Customer Goals ZOLL Solutions

17. ZOLL M Series Defibrillator

18. M Series� Defibrillate Catherine Prophet April 2005

19. 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

20. 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

21. 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 EMPHASIZE HERE THAT THE CUSTOMER CAN CHOOSE �DO YOU WANT THE FIRST RESPONDER TO PUSH A BUTTON TO BEGIN ADVISORY (ADVISORY/ACLS MODEL) OR DO YOU PREFER THAT THE ACLS PROVIDER PUSH THE BUTTON WHEN THEY ARRIVE?(UNIV ERSAL /BLS AED)� � MANY NEW TM�S DO NOT GRASP THE DIFFERENCE BETWEEN THE MODELS ENOUGH TO EXPLAIN THEM. EMPHASIZE HERE THAT THE CUSTOMER CAN CHOOSE �DO YOU WANT THE FIRST RESPONDER TO PUSH A BUTTON TO BEGIN ADVISORY (ADVISORY/ACLS MODEL) OR DO YOU PREFER THAT THE ACLS PROVIDER PUSH THE BUTTON WHEN THEY ARRIVE?(UNIV ERSAL /BLS AED)� � MANY NEW TM�S DO NOT GRASP THE DIFFERENCE BETWEEN THE MODELS ENOUGH TO EXPLAIN THEM.

22. 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

23. 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 EXPLAIN WHAT THE MACHINE IS DOING AND WHY SYNC VS. DEFIB. EXPLAIN THE CONSEQUENCES IF THE CLINICIAN DOES NOT PUSH SYNC. EXPLAIN WHY THE MACHINE CONVERTS BACK TO DEFIB AFTER EACH SHOCK AND WHY WE WANT IT THAT WAY. EXPLAIN THIS IS STILL A VERY EFFECTIVE MEANS INTO A HOSPITAL TO SELL DEFIBS. EXPLAIN WHAT THE MACHINE IS DOING AND WHY SYNC VS. DEFIB. EXPLAIN THE CONSEQUENCES IF THE CLINICIAN DOES NOT PUSH SYNC. EXPLAIN WHY THE MACHINE CONVERTS BACK TO DEFIB AFTER EACH SHOCK AND WHY WE WANT IT THAT WAY. EXPLAIN THIS IS STILL A VERY EFFECTIVE MEANS INTO A HOSPITAL TO SELL DEFIBS.

24. 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

25. 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

26. 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

27. 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 stat�padz � speed pack, center energy feed Question: Do you want to lose precious response time by using pads without a preconnect feature on your defibrillator? pro�padz � 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? pedi�padz � liquid gel reduces dermal damage Question: Would you like to offer your pedi patients the best care for their delicate skin? CPR-D�padz � 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

28. M Series Defibrillation UNDERSTANDING Practice Defibrillation In-Service GOOD � AND ALSO EXPLAIN THE POTENTIAL PITFALLS � EX. MFC NOT PLUGGED IN TO PADDLES, MFC IN PADDLES BUT NURSE DOES NOT KNOW THIS ETC GOOD � AND ALSO EXPLAIN THE POTENTIAL PITFALLS � EX. MFC NOT PLUGGED IN TO PADDLES, MFC IN PADDLES BUT NURSE DOES NOT KNOW THIS ETC

29. 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 AHA�s 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

30. M Series Defibrillation APPLICATION Practice Defibrillation Demo

31. M Series Defibrillation APPLICATION Customer Goals ZOLL Solutions MIGHT ADD SOMETHING FOR �PRODUCT MIX� OR VARIOUS MODELS FOR THE SOLUTION TO REPONSE TIMES. ANOTHER HOSPTAL GOAL IS COST EFFECTIVE CARE WITH THE SOLUTION OF GREATER EFFICACY MEANING LESS COST, STANDARDIZATION OF OPERATING SYSTEM LOWERS TRAINING COST, PRODUCT MIX OFFERS ONE MANUFACTURER FOR VARIOUS DEPTS. Ie CCU, MEDSURG, EP AND OUTSIDE BUILDINGS. YOU GET THE POINT MIGHT ADD SOMETHING FOR �PRODUCT MIX� OR VARIOUS MODELS FOR THE SOLUTION TO REPONSE TIMES. ANOTHER HOSPTAL GOAL IS COST EFFECTIVE CARE WITH THE SOLUTION OF GREATER EFFICACY MEANING LESS COST, STANDARDIZATION OF OPERATING SYSTEM LOWERS TRAINING COST, PRODUCT MIX OFFERS ONE MANUFACTURER FOR VARIOUS DEPTS. Ie CCU, MEDSURG, EP AND OUTSIDE BUILDINGS. YOU GET THE POINT

32. ZOLL M SeriesExternal Pacing

33. M Series� Pace Catherine Prophet April 2005

34. 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%

35. 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 4:1 button to deliver pacing impulse for 1 out of 4 beat to determine underlying rhythm

36. 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 Don�t shave patient

37. M Series Pacing UNDERSTANDING Practice Pacing In-Service

38. M Series Pacing UNDERSTANDING

39. M Series Pacing UNDERSTANDING NTP 1000: 1983 Marketed in 1983 Pacemaker/Monitor Price $7200 Always sold at list Never did evaluations Pacing Electrodes only

40. 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

41. M Series Pacing UNDERSTANDING LARGER SURFACE AREA ELECTRODES CONSTANT CURRENT-RECTILINEAR WAVEFORM HIGH IMPEDENCE GEL LONG PULSE DURATION-UP TO 40 MS

42. M Series Pacing UNDERSTANDING Different Pacing Waveforms: ZOLL- Rectilinear Physio- Truncated Exponential Philips- Truncated Exponential

43. M Series Pacing UNDERSTANDING

44. M Series Pacing UNDERSTANDING

45. 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

46. M Series Pacing APPLICATION Practice Pacing Demo

47. M Series Pacing APPLICATION Customer Goals ZOLL Solutions

48. Selling Pacing:Who to talk to�What to say�

49. ZOLL M Series:Putting it All Together

50. User Goal

51. M Series Offers Solutions

52. M Series Offers Solutions

53. M Series Offers Solutions Driven by design principles of cockpit safety. Issues corrective prompt instead of describing error: �ECG LEAD OFF�

54. User Goal With public attention on AEDs, expectations, With public attention on AEDs, expectations,

55. M Series Offers Solutions

56. User Goal

57. M Series Offers Solutions

58. M Series Offers Solutions

59. User Goal

60. M Series Offers Solutions

61. User Goal

62. M Series Offers Solutions

63. User Goal

64. 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

65. Top 15 Cardiac Hospitals All Use ZOLL

66. M Series Configuration Critical Questions? Review configuration options on your own

67. 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