An Automated External Defibrillator (AED) is a device that can give an electric shock to a victim of sudden cardiac arrest and potentially reverse this fatal condition and restore a victim's heartbeat. In the first few minutes of cardiac arrest the heart is fibrillating (chaotic electrical activity) and can be corrected by an electric shock. In December 2005 the American Heart Association simplified assessment protocols for aiding a victim in sudden cardiac arrest. It is now an uncomplicated two-part evaluation.
1. The victim does not respond when shaken and spoken loudly to.
2. The victim is not breathing.
If both criteria are met then Cardio Pulmonary Resuscitation (CPR) should be initiated and an AED should be placed on the victim as soon as possible. AEDs vary in size, shape and even color as part of the manufacturers marketing ploys to distinguish between them. All AEDs on the market have been cleared by the Food and Drug Administration as a safe and effective medial device. They are designed specifically for the non-medically trained user who is undoubtedly nervous and fearful.
AEDs have verbal cues that begin as soon as they are turned on. These instructions are very straightforward and talk the user through the simple steps of defibrillation. Some AEDs give more in-depth directions that cover the steps of CPR as well. One of the first instructions will be to place the pads (also called electrodes) on the victim's chest. The pads are in a sealed foil package and are pre-jelled with a conductive substance which is quite sticky. The package and often the pads themselves will have pictures that clearly show where to place them. One pad goes on the upper right side of the chest just below the collar bone and the other one goes on the left side below the ribs. The heart is in the center of the chest just left of the breastbone. The pads are placed so the shock actually travels from pad to pad inside the victim's body through the heart. One AED has a one piece pad that is connected in the middle between the two pads offering greater simplicity in placement.
There are several special considerations before placing the pads on a victim. There should be a "prep kit" with the AED that includes gloves, a razor, scissors and a dry wipe.
1. If the victim has a lot of chest hair (especially if the skin in not visible) they will need to have the excess removed. This should take about ten seconds using the disposable razor only on the areas where the pads are to be applied.
2. Jewelry around the neck particularly that hangs down into the chest area should be removed or pushed aside. Body piercings should be left alone regardless of location. The pad should be placed at least one inch away from body piercings.
3. A Band-Aid or adhesive type patch on the chest may be a meditation patch and should be removed and the area cleaned off with the dry wipe.
4. If the victim's chest is wet or sweaty it should be dried off before applying the pads.
5. If the victim has a pacemaker or internal defibrillator (you will notice a lump or visible scar) place the pad at least one inch away.
Once the pads are adhered to the victim's chest the AED will give a verbal cue to the user to stop touching the victim as it automatically begins to analyze the electrical activity in the heart. If the AED interpret the hearts electrical activity as fibrillation it will tell the rescuer to press the clearly marked flashing shock button. There should be no physical contact with the victim during analysis and shock. Some AEDs automatically shock after issuing a verbal warning.
Regardless of outcome all AEDs will instruct the rescuer to begin Cardio Pulmonary Resuscitation immediately after a shock is administered. American Heart Association protocol calls for two minutes of CPR before the AED automatically reanalyzes and if necessary advises another shock. This sequence of shocking followed by two minutes of CPR should be continued until the victim revives or until emergency medical personnel arrive and take over.
Sudden Cardiac Arrest is a leading cause of death that can occur without warning. Fortunately automated external defibrillators are becoming more and more prevalent outside of the hospital. CPR/ AED training classes are available through various agencies including the American Heart Association and the American Red Cross.
