AED stands for Automated External Defibrillator, and these life-saving devices deliver an electric shock to a person experiencing sudden cardiac arrest, potentially restoring a normal heart rhythm. These portable devices are designed to be used by bystanders, even those with minimal training, making them crucial in increasing survival rates during cardiac emergencies. AEDs are commonly found in public places, workplaces, and healthcare settings. This detailed guide will walk you through the proper use of an AED, providing the knowledge needed to respond effectively in an emergency. It’s important to remember that this information is for educational purposes, and professional medical advice should always be sought in actual emergencies.
1. Understanding Sudden Cardiac Arrest
What is Sudden Cardiac Arrest?
Sudden cardiac arrest (SCA) is a life-threatening condition that occurs when the heart suddenly stops beating or functioning effectively. Unlike a heart attack, which is caused by a blockage that stops blood flow to the heart, SCA happens when the heart’s electrical system malfunctions. This leads to an irregular heartbeat known as ventricular fibrillation, where the heart quivers instead of pumping blood. SCA can strike anyone, anywhere, and at any time, often without any warning signs.
Importance of Immediate Action
In the event of sudden cardiac arrest, every second counts. The chances of survival decrease by up to 10% for each minute that passes without treatment. Immediate action, including calling emergency services and starting CPR, is crucial. The use of an Automated External Defibrillator (AED) can significantly increase the chances of survival by restoring a normal heart rhythm. When SCA occurs, it’s essential to act quickly: call for help, begin CPR, and use an AED if one is available. These steps can make the difference between life and death.
1. Assess the Situation
Before using an AED, it's essential to ensure the safety of both the rescuer and the victim. Assessing the situation correctly can prevent further harm and ensure that the AED can be used effectively.
Ensure Scene Safety
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Check for Hazards: Scan the area for any potential dangers such as water, live electrical wires, flammable substances, or any other hazards that could endanger you or the victim. If the scene is unsafe, do not proceed until it is safe or until professional help arrives.
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Environmental Factors: If the victim is in a hazardous location (e.g., near moving machinery, in a swimming pool, or in a busy roadway), move them to a safer area if it can be done without causing further harm. However, do not delay the use of the AED if moving the victim would take too long or if you are unsure of how to move them safely.
Assess the Victim's Condition
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Check Responsiveness: Tap the person on the shoulder firmly and shout, "Are you okay?" If there is no response, assume that the person is unresponsive and proceed to the next steps.
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Assess Breathing: Quickly check for normal breathing by looking for chest movements, listening for breath sounds, and feeling for breath on your cheek. This assessment should take no more than 10 seconds. If the person is not breathing, or is only gasping (agonal breathing), they are likely in cardiac arrest and require immediate intervention.
2. Confirm Cardiac Arrest
Confirming that the person is in cardiac arrest is crucial before using an AED. An AED checks a person's heart rhythm using electrodes placed on the chest to determine if defibrillation is necessary. Cardiac arrest differs from a heart attack in that the heart suddenly stops beating effectively, leading to a lack of blood flow to the brain and other vital organs.
Signs of Cardiac Arrest
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Unresponsiveness: The person does not respond to attempts to wake them up.
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No Normal Breathing: The person is not breathing or is only gasping. Gasping is not effective breathing and should be treated as an indication of cardiac arrest.
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No Pulse: If you are trained, check for a pulse on the carotid artery (side of the neck). However, if you are not confident in finding a pulse, or if it would delay treatment, skip this step and begin CPR and AED use immediately.
3. Call for Emergency Assistance
Time is critical in a cardiac emergency. While preparing to use the AED, ensure that emergency medical services (EMS) are alerted.
Activate the Emergency Response System
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Call 911: Ask someone nearby to call 911 or the local emergency number immediately. If you are alone, make the call yourself. Provide the dispatcher with your location and explain that the person is unresponsive and not breathing. Mention that an AED is being used.
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Send for Help: If possible, designate a specific person to retrieve the AED while you begin CPR. Clear communication is essential—use direct commands like, "You, in the blue shirt, call 911 and get the AED!"
Gather Information
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Witnesses: Ask if anyone saw what happened. This information can be vital for EMS, as it may provide clues about the underlying cause of the cardiac arrest.
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Medical History: If there are family members or colleagues nearby, ask about the victim's medical history, known heart conditions, or medications they might be taking.
4. Retrieve and Prepare the AED
Once cardiac arrest is confirmed and emergency services have been contacted, retrieve the nearest AED. These devices are often stored in easily accessible locations within public and private spaces.
Locate the AED
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Public Spaces: AEDs are typically located in public places such as airports, shopping malls, gyms, and schools. They are usually housed in clearly marked, wall-mounted cabinets. Some cabinets may sound an alarm when opened—this is normal and serves to alert others that an emergency is in progress.
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Workplace or Facility AEDs: In workplaces or specialized facilities, AEDs may be located near the entrance, in break rooms, or in designated first-aid stations.
Turn on the AED
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Powering the Device: Open the AED case and turn on the device if it does not start automatically. Most AEDs will begin giving voice prompts or visual instructions once they are powered on.
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Follow Instructions: Listen carefully to the AED's prompts. The device is designed to guide you through each step of the process, ensuring that you provide the correct care.
5. Apply the AED Pads
Correct placement of the AED pads is crucial for the device to work effectively. The pads deliver the shock, so their placement must be precise.
Expose the Chest
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Remove Clothing: Quickly remove or cut away any clothing covering the victim's chest. Bras, necklaces, and other accessories should also be removed to ensure proper pad contact with the skin.
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Dry the Skin: If the chest is wet from sweat, water, or any other liquid, dry it thoroughly using a towel, cloth, or whatever is available. Moisture can interfere with the effectiveness of the shock and increase the risk of injury.
Place the Pads
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Upper Right Pad: Place one pad on the upper right side of the chest, just below the collarbone. This placement is important for the electrical current to travel effectively through the heart.
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Lower Left Pad: Place the second pad on the lower left side of the chest, a few inches below the armpit. This placement should be above the ribcage but away from the center of the chest. Ensure that the pads do not overlap or touch each other.
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Pediatric Pads: If the victim is a child and the AED has pediatric pads, use them. Pediatric pads are designed to deliver a lower-energy shock appropriate for a child's smaller body. If pediatric pads are unavailable, place one adult pad on the child's chest and the other on their back, between the shoulder blades.
6. Stand Clear and Analyze the Rhythm
Once the pads are properly attached, the AED will begin to analyze the victim’s heart rhythm. This step is critical for determining whether a shock is needed. The AED delivers a defibrillation shock if it detects an irregular heart rhythm that can be corrected.
Ensure No Contact
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Clear the Area: Announce loudly, "Stand clear!" and make sure no one is touching the victim. Even slight contact can interfere with the AED's analysis and may result in injury.
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Verify Safety: Double-check that everyone, including yourself, is clear of the victim before allowing the AED to analyze the heart rhythm.
Let the AED Analyze
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Automatic Analysis: The AED will take a few moments to analyze the heart's rhythm. Do not touch the victim during this time. The AED is assessing whether the heart's rhythm can be corrected with a shock.
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Follow Instructions: The AED will inform you if a shock is advised. If a shock is not advised, the AED will guide you on the next steps, typically continuing CPR.
7. Follow the AED Prompts
Based on its analysis, the AED will either instruct you to deliver a shock or continue CPR. It's crucial to follow these instructions precisely.
Shock Advised
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Prepare to Shock: If the AED advises a shock, again ensure that no one is touching the victim. Shout, "Clear!" to confirm everyone is at a safe distance.
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Deliver the Shock: Press the shock button on the AED when instructed. Some newer AED models deliver the shock automatically. After the shock, the AED will likely instruct you to immediately resume CPR.
No Shock Advised
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Resume CPR: If the AED does not advise a shock, begin CPR immediately. Start with chest compressions, as directed by the AED. Continue CPR following the guidelines provided until the AED reanalyzes or emergency responders take over.
8. Perform CPR
CPR is essential in maintaining blood flow and oxygen delivery to the brain and other vital organs. High-quality CPR increases the chances of a successful outcome when the AED is used.
Chest Compressions
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Positioning: Place the heel of one hand on the center of the victim's chest, just between the nipples. Place your other hand on top of the first, interlocking your fingers.
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Compression Depth: Push down hard and fast, compressing the chest at least 2 inches deep for adults. Allow the chest to fully recoil between compressions to maximize blood flow.
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Compression Rate: Aim for a rate of 100-120 compressions per minute. Counting out loud can help maintain rhythm.
Rescue Breaths
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Head-Tilt/Chin-Lift: If trained and able, provide rescue breaths after every 30 compressions. Use the head-tilt/chin-lift technique to open the airway.
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Breath Delivery: Pinch the victim's nose, create a seal over their mouth with yours, and give two breaths, each lasting about one second, ensuring the chest rises. If uncomfortable or untrained in providing rescue breaths, continue with hands-only CPR.
10. Special Considerations
Using an AED on a Child
When using an AED on a child, special considerations must be taken into account. Most AEDs come equipped with child pads or a “Child Mode” designed for children under the age of 8 or weighing less than 25kg. These child pads deliver a reduced energy level, typically around 50 joules, compared to the standard 150 joules for adults.
To use an AED on a child, follow these steps:
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Follow Manufacturer’s Instructions: Ensure you are familiar with the AED’s specific instructions for pediatric use.
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Place the Pads Correctly: Attach the electrode pads to the child’s chest as indicated by the AED. One pad should be placed on the center of the chest, and the other on the back, between the shoulder blades if using adult pads.
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Analyze and Follow Prompts: Allow the AED to analyze the heart rhythm and deliver a shock if necessary. Continue CPR as instructed by the AED until emergency services arrive.
By following these guidelines, you can ensure the safe and effective use of an AED on a child, providing critical assistance during a cardiac emergency.
11. Continue Following AED Instructions
The AED will continue to monitor the victim's condition and provide instructions on what to do next.
Repeat Cycles
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Shock Cycles: The AED may prompt you to deliver additional shocks if necessary. Always ensure the area is clear before delivering another shock.
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CPR Cycles: After each analysis, if no shock is advised, continue performing CPR as directed. The AED will periodically reanalyze the heart rhythm and provide further instructions.
Monitor the Victim
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Signs of Recovery: Keep an eye out for signs of recovery, such as breathing, coughing, or movement. If the victim shows signs of life, stop CPR and place them in the recovery position (on their side) while waiting for EMS to arrive.
12. Handover to Medical Professionals
When EMS arrives, it's crucial to provide them with detailed information about the situation and the steps you've taken.
Provide a Report
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Actions Taken: Inform the EMS team about the number of shocks delivered, the duration of CPR performed, and any changes in the victim's condition.
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AED Data: If the AED records data (some models do), inform EMS that the AED was used and share any relevant data.
Assist as Needed
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Stay Available: Remain available to provide any additional information or assistance that the EMS team may require.
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Follow-up: If the AED is part of a workplace or public safety program, follow the protocol for replacing the pads, checking the battery, and documenting the incident for future review.
Conclusion
Automated External Defibrillators (AEDs) are invaluable tools in the fight against sudden cardiac arrest, significantly increasing the chances of survival when used promptly and correctly. By following this detailed step-by-step guide, you can effectively use an AED to provide critical assistance during a cardiac emergency. However, it's important to remember that while AEDs are designed for ease of use, formal training in CPR and AED usage, such as that offered by MyCPR NOW, is essential for building the confidence and competence needed to act swiftly and effectively in real-life situations. Quick action saves lives, and being prepared is the best way to ensure that you can make a difference when it matters most.
