First, what is an AED and how does it work? An Automated External Defibrillator or AED is a portable, battery operated electronic device about the size of a laptop computer. The AED automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a cardiac arrest victim and is able to treat the patient by an electrical shock which stops the arrhythmia, allowing the heart to re-establish an effective rhythm. AEDs are designed to be simple so that anyone can use one. So simple that I often start my classes by selecting someone from the class that has never seen an AED and I ask them to demonstrate how to use an AED by following the AEDs voice instructions.
In most cases, the victim collapses and the rescuer checks the victim to see if they are responsive. If they do not respond, immediately send someone to dial 911 (radio for help) and send another person to get the AED. Next, we tilt the victims head back and check for breathing. If after 10 seconds you do not see the victim’s chest rise or hear them breathing begin CPR. You will continue performing CPR until the AED is turned on, electrode pads connected and the AED gives an “all clear” message. At this point move away from the patient so that they AED can analyze the patient.
Once connected to the victim the AEDs typically gives either a “shock advised” message or a “no shock advised” message. If the AED indicates “shock advised” we must make certain no one is touching the patient and then deliver a shock. Typically this means pressing the flashing red shock button. If the AED indicates “no shock advised” this can mean one of 2 things. Either the victim is alive or that you should begin CPR. Check once again for breathing, if they are breathing put the victim in the recovery position (on their side). If they are not breathing start CPR – keep the AED connected and turned on with the pads in place. 2 minutes later the AED will once again check the victim.
Do I still need to perform CPR with an AED? Yes. CPR is very important and can greatly improve the victim’s chance of survival. You should perform CPR until the AED arrives. Once the AED arrives, turn it on and apply the AED pads to the victims bare chest and follow the AED voice prompts.
If defibrillation is so important, why should I perform CPR? CPR helps circulate oxygen rich blood to the victim's heart and brain. This circulation delays both brain death and the death of heart muscle. CPR buys us time until the AED arrives and CPR also makes the heart more likely to respond to defibrillation.
How often will the AED shock someone? AEDs programmed with the current CPR guidelines analyze the victim every 2 minutes. This means that the AED could potentially deliver a shock once every 2 minutes. The AED may not shock every time. Each time the AED analyzes the victim it determines if a shock is necessary.
Can I hurt the victim with the AED? No. AEDs are designed to only shock someone in cardiac arrest. You can only help.
Can the AED hurt the rescuer if used improperly? If you are touching the victim while a shock is being delivered this is possible. Always make certain that no one is touching the victim before the shock is delivered.
Can AEDs be used to treat children? Yes, for children ages 1-8 in cardiac arrest AEDs with pediatric pads or a pediatric key should be used. If an AED with pediatric capabilities is not available, a standard AED may be used. Please note – if children are ever onboard your boat, it is best to have the right tool for the job, get pediatric electrode pads.
What if the victim has a medication patch? Never place electrodes directly on top of medication patches. If the patch is in the way of the AED electrode pads, remove it and wipe off the area. Avoid touching the medication patch with your bare hands.
What if the victim has an implanted pacemaker or defibrillator? If the victim has a pacemaker or internal defibrillator you should try to avoid placing the electrode pad directly on top of the device. If you see a raised bump under the skin about the size of a silver dollar and it’s located where your pad should be, move the pad up slightly higher than this device.
Should I remove the AED electrode pads before doing chest compressions? No. The pads should only be removed by the paramedics of the doctors. Keep the pads in place and the AED turned on until Emergency Medical Personnel take over patient care. As long as the pads are in their correct locations on the victims chest, they will not interfere with chest compressions.
Should I take off the patient's clothing before using the AED? The chest should be exposed to allow placement of the AED electrode pads. A woman's bra should be removed and all necklaces and chains should be moved out of the way. You may need to cut off clothing to save time.
Can I place the AED electrode pads directly on a hairy chest? The AED electrode pads must be placed directly on clean, dry skin. If the chest is hairy it may prevent good adhesion of the electrode pads. If there is a lot of hair you must quickly shave them. If the chest is wet or oily, quickly dry it. Please note – only the areas where the pads are to be placed must be shaved or dried.
Can AEDs be used to treat a heart attack or chest pain? No, AEDs should only be placed on someone that is in cardiac arrest. This means they are basically dead, they are not breathing. Placing an AED on a live person will only increase their anxiety with no benefit.
After I successfully defibrillate the patient and they are breathing should I keep the AED on the patient? Yes. Keep the pads in place and the AED turned on until Emergency Medical Personnel take over patient care. The patient is still at risk of going back into cardiac arrest. The AED will continue to monitor them.
Are there different types of AEDs? There are several manufacturers of AEDs and all operate in a similar manner. The analogy I give my students is Ford vs. General Motors. If you know how to drive a Ford you are also able to drive a GM vehicle.
The information above is for informational purposes only and is not a substitute for professional classroom instruction by a qualified instructor with real CPR AED experience. At minimum you should take a refresher course every 2 years.
If you have any questions regarding CPR or AEDs please feel free to contact me. I love my job and always willing to talk to you about CPR and AEDs.
Keith Murray, a former Florida Firefighter EMT, is the owner of The CPR School. The CPR School provides CPR, AED First Aid Safety Training at your location as well as AED Sales and Service. Contact The CPR School at +1-561-762-0500 or www.TheCPRSchool.com or Keith@TheCPRSchool.com
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