I was recently amazed by a study conducted regarding AED implementation in public areas. It was one of the first studies to identify the potential impact AEDs could have on survival rates from sudden cardiac arrest. Over a two-year period, 11 out of 21 non-traumatic cardiac arrest patients survived (52%).
As surprising as the survival rate percentage was, the number that actually struck me the most was the fact that 6 of the rescuers in the 11 successful resuscitations had no prior training or experience in using an AED. Literally, they just decided to pick one off the wall and give it a go.
These devices are designed by the manufacturers to be ‘fool proof, allowing for the operating of one successfully. It is a key principle in AED research and development. Even though training increases the likelihood of successful AED use, it is highly likely that an untrained person can effectively use one as well.
A leading figure in AED development and training often mused, “If we can just get someone to pull an AED off the wall, we’ve probably done our job.”
Nice concept, but how are we doing in the real world? The reality is very different: The research supports the theory that the majority of laypeople are still not willing to use an AED. The reasons why may surprise you (or may not). It seems to have a whole lot more to do with user confidence than with AED operation:
People are afraid they will use an AED incorrectly
They are afraid of hurting the person the AED is used on
They are afraid of getting hurt by the AED
Maybe, as first aid instructors, we are not addressing these concerns as well as we thought. Maybe we need to start focusing a bit more on things that help build user confidence.
It’s one thing to learn how to operate an AED in a classroom, but it is a wildly different thing to actually use one in a real-life emergency. One of the highlights of usability is that AEDs are pretty much designed for an untrained user. Without user involvement, they complete an analysis of a heart’s electrical status and, importantly, make the actual decision that a shock should be delivered.
Audio voice instructions tell users what to do and simple graphic images on the pads show exactly where to place them. Impressing upon students the fool proof nature of using an AED can be a big part of building confidence in their ability to use one correctly.
Hurting a Person in Sudden Cardiac Arrest
Not limited to AED use, the classic classroom statement has been that “You can’t make cardiac arrest any worse.” Embrace that concept when building student confidence in deciding to get involved in performing CPR and using an AED.
Specifically, regarding an AED, a 40-year history has shown them to be extremely reliable in determining when a shock is needed. Essentially, they only shock when a shock is necessary. They don’t shock when one is not required. A user can’t accidentally or intentionally deliver a shock.
Getting Hurt by an AED
The first commercially available AED, the “Heart-Aid” from the Cardiac Resuscitator Corporation, weighed in at a whopping 10kg. To emphasise the inherent safe use of the device way back then, the running joke was to “not drop it on your foot” while using it.
The biggest concern of an AED user is accidentally getting shocked by that big jolt of electricity when defibrillation occurs.
Defibrillator pads replaced the need to use hand-held paddles while defibrillating. Adhesive on the pads secure them firmly to the chest wall and eliminate the need for a rescuer to hold them in place. Basically, AED defibrillation is hands-free. Pads are also very efficient in making sure a large portion of the electrical current goes through the body from pad to pad, and that very little current escapes onto the skin surface around the pads. While a user could experience a sensation of the current by accident, if in contact with the skin surface during defibrillation (especially around the pads), the amount of energy delivered is generally accepted to be too low to be dangerous (but probably annoying).
In the UK in 1999, the government-led ‘Defibrillators in Public Places Initiative’ promoted the use of AEDs by people other than health professionals. AEDs were placed in railway stations, airports, and other public places where cardiac arrest occurred most frequently. Staff working at these sites were trained in CPR and AED use. This strategy was effective and saved many lives.
As AEDs became more readily available, similar schemes were introduced in the UK and across the world and expanded to promote AED use by members of the public.
In the UK, many AEDs have now been purchased by organisations, including charities, local communities, businesses and commercial companies, gyms, schools and dental surgeries.
Some – but not all – of these AEDs are available for public access. Of those that are, many are not available 365 days per year and at all times of day or night, so do not provide the public with optimal access and the best chance of saving a life. The Resuscitation Council UK advise when buying one or more AEDs, consideration should be given to making them available 24/7 for full public access.
First Aid instructors should take a moment to reflect on how they build user confidence regarding what the study has showed us. Remember that most people trained and send out into the world are not willing to use an AED in an emergency. We need to be creative and see what we can do to help improve user confidence and future AED use. Let’s see what we can do to help turn this tide back.
Modern AED’s are incredibly safe and easy to use, as we begin to have more and more public access defibrators available in our communities we need to promote their use and install confidence in the general public to use them.
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