ACLS Library: Lifesaving with Automated External Defibrillators

More than a quarter of a million Americans die from sudden cardiac arrest every year—that’s one every two minutes. Patients in sudden cardiac arrest are nonresponsive and are not breathing normally or at all. There may be no signs of circulation. More than 20,000 of those patients might be saved through use of a “chain of survival” including cardiopulmonary resuscitation (CPR) and the portable lifesaving device known as an automated external defibrillator (AED). AEDs allow trained non-medical personnel to deploy usage upon the collapse of a person who is not breathing, is unconscious and appears to be in sudden cardiac arrest. If persons are trained to use the AED like they are trained in CPR, broadly as first responders, the American Heart Association notes that up to 50,000 people might be saved each year. Legislators have encouraged accessibility in recent years, rather than adding regulations and restrictions regarding AED usage. Every state in the United States has enacted laws or has adopted regulations regarding defibrillator use, as of 2001.

History

Heart surgeon, Claude Beck, who developed CPR, successfully defibrillated a teenage boy after he went into cardiac arrest after surgery in 1947. Made by his friend, James Rand, the device had two spoon-like silver paddles and was used only in open-chest situations. Paul Zoll invented the first closed-chest unit in 1956. Irish physicians used the AED within an ambulance setting in 1966, and Oregon emergency medical technicians (EMTs) used the device without a doctor present for the first time in 1969. 

How AEDs Work

Automated external defibrillators work by detecting cardiac rhythm and are only indicated for, and intended to be used on, victims of sudden cardiac arrest. Should normal rhythm be interrupted through ventricular fibrillation or pulseless ventricular tachycardia, the AED can deliver an electrical shock to treat the arrhythmia. The Occupational Health and Safety Administration (OSHA) states that for every minute of defibrillator delay for sudden cardiac arrest, chances of survival diminish 7 to 10 percent. The Cardiac Arrest Survival Act of 2000 provides nationwide Good Samaritan protection exempting anyone using an AED to save someone’s life from liability (42 U.S.C. 238q).

AEDs are simple to use. If you are a trained responder who finds someone unconscious and not breathing normally or not breathing at all, the procedure for use is simple:

• Assess scene for hazards.

• Call 9-1-1.

• Determine patient status: breathing, not breathing, level of consciousness.

• Explain to the 9-1-1 operator that a person has collapsed. Tell the operator that an AED is there and that you know how to use it.

• Place the AED next to the collapsed person’s shoulders.

• Turn on the AED.

• Follow the verbal and/or visual AED instructions.

Make sure that you stick around after the ambulance has taken the patient to the hospital so that any institutional reports may be accurately filled out, unless procedure dictates otherwise. AEDs are not meant to be used on patients less than 55 pounds or who are under age eight.

AED Plans

AED plans should spell out, in detail, institutional policy, authority and responsibility, locations, purchase and installation, maintenance and testing, registration and reporting, the institution’s medical emergency plan, training requisites and implementation along with training providers. All AED plans are federally required to have medical oversight by a physician familiar with its usage and sudden cardiac arrest. Home plans obviously will not have the same level of detail, as usage will likely be limited to those within the home. However, an AED plan should be discussed and/or written down so that all family members understand AED use and its repercussions. Public Access Defibrillation (PAD) programs promote accessibility and placement in casinos, airports, senior centers, health clubs and private homes. AEDs have been sold without a prescription since September 2004.

Costs and Accessibility

The costs for AEDs has reduced significantly, often less than $1000, enabling AEDs to be used even in home settings as technology has grown. Greater accessibility and training encourages greater success rates in saving lives. Still, it’s difficult to quantify and qualify statistical data into “rates of success.” Saving any number of lives, be it one or many, is thought to be a worthwhile investment, financially and morally. Still AED use, just like CPR administration, is highly dependent on each individual’s unique situation and response—survival rates outside of a hospital setting are still quite low either way—but well worth the time and investment to save any number of lives.

• Learn AED

• Red Cross First Aid/CPR/AED Training

• History of the AED

• Laws on AEDs and Cardiac Arrest

• Circulatory System Devices January 2011 Meeting Summary

• AED Policy Library

• OSHA Standards: AEDs in the Workplace

• Public Access Defibrillation

• National Safety Council AED Fact Sheet

• AED Emergency Plan Template