Information - The Use of an AED

Background information for Key Stage 3 and parents.

What is an AED?

AED stands for Automated External Defibrillator and is used to help someone who has suffered a cardiac arrest. The AED is a very easy piece of equipment to use but is very clever as it can read the rhythm of the heart.

The heart muscles contract by electrical activity passing over the heart and causing the muscles to contract. When someone suffers a cardiac arrest, the electrical activity becomes confused and the muscles do not contract in a regular rhythm. The
AED can detect this and sends a shock across the heart to help the heart re-establish a regular rhythm. If the casualty has been collapsed too long, there will be no irregular electrical activity to detect and the AED cannot help it re-establish
a rhythm. This is one case where an AED will tell just to do chest compressions and will not deliver a shock.

AEDs come in two formats, Semi-Automatic and Automatic. In the case Automatic AED after you have attached the pads, it will carry out the checks, deliver a shock and instruct you what to do. The Automatic AED will progress unless you turn it off.
In the case Semi-Automatic AED, it will carry out checks and advise you that a shock should be delivered. The shock will not be delivered until you press to deliver the shock. The Semi-Automatic AED's provide extra safety and control for the user
in crowded areas, while Automatic AEDs are great for shopping centres for an untrained person to use.

Steps to using an AED

1. Danger
   Approach your casualty checking for any danger before kneeling down next to them.
2. Response
   On an adult to see if they are responding, gently shake their shoulders, talk to them and ask them to clasp your hand.
   If they are not responding and you are on your own, shout for help. Then continue to step 3.
   
3. Airway
   Open the airway to ensure the casualty can breathe. Place one hand on the forehead and two fingers under the chin. Tip the head back to open the airway.
4. Breathing
   Watch the casualties chest to see they are breathing normally, with the chest expanding to rise and fall.
   If they are not breathing normally, continue to step 5 (for more information on normally breathing see the session 'Information - Resuscitation').
   
5. Call the emergency services asking for an ambulance for an unresponsive non-breathing casualty.
   

6. If an AED is an available setup the AED, if it is not available, start Chest compression until the AED arrives.
   
   • Open the AED and turn on, if it does not turn on by opening the lid.
     
   • Deal with any concerns with the chest, including dry a wet chest and remove any metal in pads area.
     
   • Open the AED pads.
   • Attach the pads firmly to casualties chest, as per the images on the pads.
   • Ensure everyone is standing clear and follow the prompts on the AED.
   • If the AED recommends delivering a shock, ensure everyone is standing clear. If it is semi-automatic AED, pressed to deliver a shock.
   • Follow the prompts of the AED to start 2 minutes of chest compressions.
     
   
   
   Chest compressions
   
   • Cover the face and nose with a cloth to protect you from the risk of COVID.
   • Kneel next to the casualties chest.
   • Place the heel of your hand in the centre of the chest.
   • Place your other hand on top of your hand and interlock your fingers.
   • Bring yourself vertically up over the casualty with your arms straight.
   • Press down vertically onto the adult at depth of 5 to 6cm.
   • Release all pressure from the chest, but do not take hands off the chest.
   • Repeat compressing the chest at up to 6cm in-depth, at a rate of 100-120 compressions per minute.
7. Keep compressing the chest until one of the following happens
   
   • The AED tells you it is checking the casualty (commonly 'Analysing, stand clear') and ensure everyone stands clear. Follow the prompts on the AED to either restart chest compressions or to deliver a shock followed by restarting chest compressions.
     
   • An ambulance arrives and the paramedic asks you to stop
   • Your casualty shows signs of breathing.
     Check they are breathing normally for up to 10 seconds. If they are breathing, place in the recovery position, otherwise continue with chest compressions.
   • You are exhausted and it is not safe for you to continue
8. Once the situation is dealt with and you have passed the casualty over to the ambulance service, complete the following.
   
   • Pack up the AED equipment. Find out from the ambulance service and owners of the AED if they need information from the AED.
     
   • Clean up the equipment.
   • Clean your hands.
     
   • Talk to someone about what you have just been through.

Items to keep with an AED

The following items should be with an AED:

• AED pads, normally already connected
  
• Spare AED pads
• Tough cut scissors
  
• Small towel
• Razor
• Pocket mask (recommended)
  

Safety to consider when using an AED

• People
  Keep crowds or worried family members back from the casualty. You need to ensure people are not touching the casualty when the shock is delivered. If you cannot make the area safe, turn off the AED until people you can.
• Wet casualties
  If a casualty is wet from sweat or from being pulled out of the water, dry the chest where the pads will be attached.
  
• Hairy chests
  If the chest is very hairy, the pads may not get effective readings and the device will tell you to check pads. If the chest is very hairy, you can either shave the chest where the pads go, or when you find pads do not connect,
  pull them off and attach a new set. The pulling off of the pads will 'wax' the casualties chest.
  
• Metal
  Any metal around the area the pads will be attached needs to be removed. Examples of what metal objects there could be include: jewellery or underwired bras. You should remove the jewellery or cut through wires with tough cut scissors
  to ensure they are out of the way.
  If they are lying on a metal strip, ensure you are not also knelling on that strip, or slide them off it.
• Medical patches
  If you see medical patches on your casualty near where you will be attaching the pads, remove them and place them somewhere safe. We remove them as we do not know what chemicals are in them and how they will react to the electrical
  current. When you put them somewhere safe, do not attach them to you, as you do not know how the chemicals in them will affect you.
  
• Internal pacemakers or AED's
  You will notice a casualty has an internal pacemaker or AED, as they will have lump and scar high up on the chest. If they are unresponsive and not breathing, the device is not working. When you place your pads
  on the casualty, ensure they are not over the lump. If it is where a pad should go, move the pad higher up the shoulder away from the device.
• If a casualty is on oxygen or you are working with a first aider trained in oxygen, ensure oxygen is away from the casualty and AED when the shock is delivered.
  

After the use of an AED

• Leave the pads on, unless the casualty is stressed by them, in case they have another cardiac arrest.
  You
  can turn the AED off it stressing the casualty and turn back on if the casualty
  suffers another cardiac arrest. - is this needed, if so reword
  
• Place them in the recovery position.
• Protect their dignity by covering them with a blanket, jacket, jumper, towel etc.
  Do not leave their chest exposed after resuscitation.
  

Common questions

• Do I need to be trained to use an AED?
  No. An AED is a life-saving piece of equipment and talks you through all the steps to help save a life.
  The confusion arises from AEDs in work, under Health and Safety an employer has a responsibility
  to train you on all the equipment. If an employer provides AEDs, the individuals responsible for using them must be trained in their safe use, the same as any other business equipment.
• If there are two first aiders, what do we do?
  One person can be providing chest compressions, while the other person sets up the AED.
  If the hands for compression are in the way for placing the pads, stop compressions while pads are attached
  and then continue with compressions. Stop compressions when the AED tells you.
  
• Do I need to store a spare battery with the AED?
  No. The AED often have a shelf life or install by date. If you hold a spare, it might be nearly out of date before you install it. AEDs will warn you when the battery is getting low and you should
  order the battery at this point and install.
• Can I use an AED on metal stairs or metal boats?
  Yes. The metal is a large surface area and attached to the ground so it is earthed.