Automated External Defibrillators (AEDs), are used to revive someone in Sudden Cardiac Arrest (SCA). SCA is a dangerous life-threatening condition that occurs when the heart suddenly stops beating. Without a proper heartbeat, victims of Sudden Cardiac Arrest will die within minutes.
Fortunately, there is a treatment! AEDs treat patients in SCA by sending a safe electric shock to the heart of a person in cardiac arrest that restores a normal heart rhythm.
Sudden Cardiac Arrest is a leading cause of death, claiming the lives of over 350,000 people every year! SCA affects men and women, young and old, and even those who appear to be in perfect health.
Statistics say that every minute following a Sudden Cardiac Arrest event decreases a person’s chances of survival by up to 10%. Therefore, it is critical to get assistance as soon as possible, including utilising an AED.
This guide will address exactly how to use an AED if the need arises.
Before using an AED
If you see someone collapse suddenly and they are not responsive, you need to CALL-PUSH-SHOCK. This means that you must immediately call 999, begin quality CPR, and use an AED to shock their heart.
CALL: Recognise Sudden Cardiac Arrest and Call 999
Check for Danger: perform a quick survey of the scene to make sure that it’s safe for you to help.
Check for Response: if the casualty is not responsive and not breathing normally, they might be in cardiac arrest.
If you have a phone immediately available to you, call 999. Otherwise, ask someone else to call 999. In either case, begin CPR as soon as possible.
According to the Resuscitation Guidance Council UK (RGCUK), “CPR is the single-most important intervention for a patient in cardiac arrest and should be provided until a defibrillator is applied to minimise interruptions in compressions.”
PUSH: Perform CPR
Start CPR: press hard (approx. 5-6cm) and fast (100-120bpm, or whatever song works for you) on the centre of the chest while someone is calling 999 and ask another person to get the AED.
After 30 compressions attempt 2 recuse breathes, repeat.
SHOCK: The RGCUK says, “Early defibrillation improves outcome from cardiac arrest.” When the AED arrives, follow these steps to use the AED:
Steps to use an AED on an adult
STEP 1 - Turn on the AED and follow audio instructions.
STEP 2 - Remove all clothing surrounding the patient’s chest (including bra).
STEP 3 - Apply the included electrode pads to the person’s bare skin. Make sure the person’s chest is dry.
STEP 4 - Allow the AED to analyse the person’s heart rhythm. Make sure no one, including you, is touching the victim. Touching the victim can interrupt the AED’s analysis.
STEP 5 - Deliver a shock (if needed): If the AED determines that the patient is in cardiac arrest and that a shock is needed, the way it delivers the shock depends on whether the AED is a semi-automatic model or a fully-automatic model.
Fully-automatic AED: if a shock is required it will charge and tell you to stand clear from the patient. Then, it will count down and automatically deliver the shock without requiring you to press a button.
Semi-automatic AED: if a shock is required, it will charge and, once ready to deliver a shock, it will prompt you to push a button. The button is usually flashing and easy to locate in the middle of an emergency, but make sure you don’t accidentally press the power button!
Make sure no one touches the person as the AED delivers a defibrillation shock.
STEP 6 - Perform CPR and re-analyse. AEDs are programmed with the American Heart Association’s guidelines. The current RGCUK’s protocols call for two-minutes of CPR in between AED heart rhythm analysis periods. Follow the AED instructions about when to resume CPR and when to deliver additional shocks.
STEP 7 - Continue listening to the AED until Emergency Services arrive and take over the rescue.
The differences when using an AED on a child
To use an AED on a child, you need to determine whether or not the AED requires a separate set of child electrode pads or if the AED has a built-in attenuator. For the most part, paediatric electrode pads work the same way as standard adult electrode pads; by enabling the AED to analyse a patient’s heart and, if needed, helping deliver a lifesaving shock generated by the defibrillator to the child’s body.
The primary difference is when the patient is a child, the energy level of the shock is attenuated (“reduced”) from the standard adult energy setting. In most cases, the energy is decreased from 150 joules used for adults to 50 joules, for children.
Depending on an AED’s make and model, the attenuation might be pre-set into a separate set of paediatric electrode pads, built for the sole and exclusive use of paediatric patients, or it might be built into the AED and activated using a button, “key,” or another switching mechanism.
If your AED requires a separate set of electrodes, you will need to install the child pads during the emergency, power on the AED, and listen to the voice prompts just like you would for an adult patient.
If your AED allows you to use the same pads for adult and paediatric patients, you only need to press the button to change the device to child or paediatric mode on your AED.
Additionally, the placement of the pads is different for children than for adults.
Steps to use an AED on an child
STEP 1 - Turn on the AED and follow the audio instructions.
STEP 2 - Remove all clothing surrounding the patient’s chest and ensure their skin is dry.
STEP 3 - Press the child button or insert the child key into the AED.
STEP 4 - Attach the paediatric pads, if available.
Usually, the proper location to attach AED pads on a child is anterior-posterior (or “front-and-back”) placement – which is when one electrode pad is placed in the centre of the child’s chest and the other pad is placed in the centre of their back.
Be sure to check your AED’s owner’s manual for specific electrode pad placement instructions. If you can’t find it there, most AEDs have an image printed directly on the electrode pads that signify where they should be placed on the patient’s body.
STEP 5 - Allow the AED to analyse the child’s heart rhythm.
STEP 6 - Deliver a shock (if needed): If the AED determines that the patient is in cardiac arrest and that a shock is needed. Make sure no one touches the person as the AED delivers a defibrillation shock.
STEP 7 - Perform CPR and re-analyse. AEDs are programmed with the American Heart Association’s guidelines. The current RGCUK’s protocols call for two-minutes of CPR in between AED heart rhythm analysis periods. Follow the AED instructions.
STEP 8 - Continue listening to the AED until Emergency Services arrive and takes over the rescue.
Just as with the adult process, if the AED does not find a shockable rhythm continue with CPR until paramedics arrive.
Summary
AEDs are critical in emergencies and are surprisingly easy to operate. Bystanders can grab a publicly available AED unit and use it to save someone’s life. Always check your AED’s user manual for specific instructions on how and when to use your AED.
Many AEDs are specifically built for lay people (the general public). AEDs have voice instructions to help coach responders through the rescue process. Since AEDs are programmed to only deliver a shock to patients in cardiac arrest whose heart is shockable, they are safe to use by non-medical people with limited training.
In fact, one of the Medicines and Healthcare products Regulatory Agency (MHRA) quality-assurance requirements is to make sure that the defibrillator is easy to use.
Frequently asked questions
Can you use an AED on a Pregnant Person?
Maternal cardiac arrest (when pregnant women suffer from Sudden Cardiac Arrest), is a substantial problem in the United States. It is important to learn about this issue and the actions that you can take to save potentially two lives at once! People often misperceive that pregnant women suffering from Sudden Cardiac Arrest should not receive resuscitation with CPR and defibrillation shocks from an AED. However, the standard protocol for resuscitation remains largely unchanged for pregnant women who suffer cardiac arrest outside of the hospital. Pregnant people suffering from SCA should receive the same quality CPR and AED shocks as anyone else. Defibrillation should be administered to pregnant people since it is not known to pose any significant risk to the parent or the fetus. Therefore, upon observing maternal cardiac arrest outside the hospital, a person should immediately call 999, lay the parent on their back, open the airway, check for normal breathing of breathing, and if they are not breathing perform CPR by alternating between 30 chest compressions and 2 rescue breaths. A person should also use an AED to shock the heart and continue CPR until emergency medical services arrive.
Can you use an AED on someone with a Pacemaker? Yes, you can! However, the AED pads should not come in contact with the pacemaker device. This is relatively easy since most pacemakers are implanted in an individual’s chest, and the AED pads go on the upper right and lower left rib cage. As long as you are using the AED properly, there shouldn’t be any cause for concern.
Can You Use an AED in Water?
No! Since AEDs deliver an electrical shock, you must take specific care when treating cardiac arrest casualties who have been submerged in water. When using a defibrillator on someone who has been submerged in water, it’s crucial to get the person on dry land first. You cannot apply the AED pads, which deliver the necessary electrical shock to the casualty’s chest, until the shirt has been removed and the skin dried thoroughly.
Once the person’s skin is dry, power on the AED and follow its instructions the same way you would during a normal response.
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