Automated External Defibrillators

Air Date: 5/5/2003

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You can't predict sudden cardiac arrest, but you can prepare for it...

Every day, more than 1,000 Americans suffer a sudden cardiac arrest... where the heart's rhythm suddenly becomes chaotic and the heart stops abruptly. Victims lose consciousness, with death usually following quickly... unless someone restores a normal heart rhythm within five to seven minutes.

Since most victims suffer an arrest away from a hospital, more than 95 percent of them die... because life saving easy-to-use automatic external defibrillators (AED's)are not there to apply an external "shock" to restore the hearts rhythm.

The American Heart Association estimates that 20,000 or more deaths could be prevented each year if AED's were more widely available to everyone... including your employees who might be first on scene of a cardiac arrest at your company.

REMSA has donated 19 AED’s in the Reno/Sparks community. Some of the public places of business that REMSA has donated AED’s to include: The Reno Tahoe International Airport, YMCA of Reno and Sparks, the High Schools of Washoe County School District and City of Reno Parks & Recreation.

What does AED stand for?

AED stands for automated external defibrillator (or automated external defibrillation).

What's an AED?

An AED is a device used to administer an electric shock through the chest wall to the heart. Built-in computers assess the patient's heart rhythm, judge whether defibrillation is needed, and then administer the shock. Audible and/or visual prompts guide the user through the process.

How does an AED work?

A microprocessor inside the defibrillator interprets (analyzes) the victim's heart rhythm through adhesive electrodes (some AED models require you to press an ANALYZE button). The computer analyzes the heart rhythm and advises the operator whether a shock is needed. AED’s advise a shock only to ventricular fibrillation and fast ventricular tachycardia. The electric current is delivered through the victim's chest wall through adhesive electrode pads.

Why are AED’s important?

AED’s are important because they strengthen the Chain of Survival. They can restore a normal heart rhythm in victims of sudden cardiac arrest. New, portable AED’s enable more people to respond to a medical emergency that requires defibrillation. When a person suffers a sudden cardiac arrest, their chance of survival decreases by 7% to 10% for each minute that passes without defibrillation. AED’s save lives!

Who can use an AED?

Most AED’s are designed to be used by non medical personnel such as police, firefighters, flight attendants, security guards, and other lay rescuers who have been properly trained. Having more people in the community who can respond to a medical emergency by providing defibrillation will greatly increase sudden cardiac arrest survival rates.

Why does someone having a heart attack need an AED?

When a heart attack becomes a full cardiac arrest, the heart most often goes into uncoordinated electrical activity called fibrillation. The heart twitches ineffectively and can't pump blood. The AED delivers electric current to the heart muscle, momentarily stunning the heart, stopping all activity. This gives the heart an opportunity to resume beating effectively.

Will an AED always resuscitate someone in cardiac arrest?

The AED treats only a heart in ventricular fibrillation (VF), an irregular heart rhythm. In cardiac arrest without VF, the heart doesn't respond to electric currents but needs medications. The victim needs breathing support. AED’s are less successful when the victim has been in cardiac arrest for more than a few minutes, especially if no CPR was provided.

Is an AED safe to use?

The American Heart Association (AHA) recommends that persons who live or work where an AED is available for use by lay rescuers participate in a Heartsaver AED Course. AED’s are so user-friendly that untrained rescuers can generally succeed in attaching the pads, pressing ANALYZE (if required), and delivering shocks. However, untrained rescuers may not know when to use an AED, and they may not use an AED safely, posing some danger of electric shock to themselves and others. Also, untrained rescuers probably would not know how to respond to the victim if the AED prompts "no shock indicated." An operator needs only to follow the illustrations on the electrode pads and the control panel and listen and follow the voice prompts (for example, "Do not touch the patient."). An AED will deliver a shock only when a shock is advised and the operator pushes the SHOCK button. This prevents a shock from being delivered accidentally.

What actions should a CPR responder take after using an AED on a person in cardiac arrest?

There should be some type of debriefing for EMS personnel or lay rescuers involved in a resuscitation attempt. Also, the voice-rhythm-shock record should be collected from the AED's event documentation system. The AHA strongly recommends that AED's used in a public access or home-responder setting have both rhythm and voice event documentation. AED’s can record and store (as a minimum) the following information:

• Patient rhythm throughout the resuscitation.
• Response of the AED (shock versus no shock; shockable rhythm versus non-shockable rhythm).
• Event and interval timing.
• Audio recording of the voices and actions recorded at the scene of a cardiac arrest.

Chain of Survival

What's the Chain of Survival?

The Chain of Survival is a four-step process of providing treatment to victims of sudden cardiac arrest. The first link in the Chain of Survival is early access to care. This involves recognizing the symptoms of sudden cardiac arrest and calling 911 or another emergency number to dispatch emergency medical services (EMS) personnel to the scene. The second link is early CPR. An individual trained in CPR administers ventilation and compressions to the victim until a defibrillator or emergency response crews arrive at the scene. These skills allow oxygen-rich blood to be circulated to the victim's brain. The third link is early defibrillation. Early defibrillation means having a properly working defibrillator immediately available at the site of an emergency and having a trained lay rescuer deliver an electric shock and/or all emergency responding units (fire, police, paramedics, etc) able to defibrillate when they arrive at the scene. The fourth link is early advanced care. Early advanced care means the ability to quickly treat a victim of sudden cardiac death with medications and advanced oxygen therapies.

Why is it important to call 911 first when a person collapses?

Although early defibrillation is the single most important treatment for ventricular fibrillation cardiac arrest, other treatments are also needed. Even if an AED is available at the scene, a victim of cardiac arrest needs effective CPR with oxygen, intravenous (IV) medications, often endotracheal intubation, and rapid transport to an emergency department. These other links in the Chain of Survival optimize a victim's chances of survival and recovery. In addition, not every cardiac emergency is due to ventricular fibrillation (VF). Victims of non-VF emergencies need other skills and treatments from EMS personnel.

What good does CPR do if a person really needs defibrillation?

CPR provides some circulation of oxygen-rich blood to the victim's heart and brain. This circulation delays both brain death and the death of heart muscle. CPR buys time until the AED arrives and makes it more likely that VF will respond to defibrillation shocks.

Why is early defibrillation so important?

Early defibrillation is important because defibrillation is the only known therapy for most sudden cardiac arrests. Most sudden cardiac arrests are caused by ventricular fibrillation, an irregular heart rhythm. VF causes the heart's electrical impulses to become chaotic. The heart stops suddenly, and the victim collapses and loses consciousness. Defibrillation can restore the heart's normal rhythm if it's done within minutes of the arrest. Each minute of delay in returning the heart to its normal pattern of beating decreases the victim's chance of survival by 7% to 10%.

AED Placement

What's public access to defibrillation?

Public access to defibrillation (PAD) means making AED’s available in public and/or private places where large numbers of people gather or people who are at high risk for heart attacks live.

What's REMSA and AHA’s position on placement of AED’s?

REMSA and AHA strongly support placing AED’s in targeted public areas such as sports arenas, gated communities, office complexes, doctor's offices, shopping malls, etc. When AED’s are placed in a community, the AHA strongly encourages that they be part of a defibrillation program in which

• Persons or entities that acquire an AED notify the local EMS office.
• A licensed physician or medical authority provides medical oversight to ensure quality control.
• Persons responsible for using the AED are trained in CPR and how to use an AED.

Why is notifying the local EMS office important?

It's important for the local EMS system to know where AED’s are located in the community. In the event of a sudden cardiac arrest emergency, the 911 dispatcher will know if an AED is on the premises and will be able to notify the EMS system as well as the responders already on the scene.

Why should a licensed physician or medical authority be involved with purchasers of AED’s?

This is a quality control mechanism. The licensed physician or medical authority will ensure that all designated responders are properly trained and that the AED is properly maintained.

Why should people who are responsible for operating an AED receive CPR training?

Early CPR is an integral part of providing lifesaving aid to people suffering sudden cardiac arrest. The ventilation and compression skills learned in a CPR class help to circulate oxygen-rich blood to the brain. After delivering a series of three electric shocks, the typical AED will prompt the operator to continue CPR while the device continues to analyze the patient.

If AED’s are so easy to use, why do people need formal training in how to use them?

An AED operator must know how to recognize the signs of a sudden cardiac arrest, when to activate the EMS system, and how to do CPR. It's also important for operators to receive formal training on the AED model they will use so that they become familiar with the device and are able to successfully operate it in an emergency. Training also teaches the operator how to avoid potentially hazardous situations.

Can anyone buy an AED?

AED’s are manufactured and sold under guidelines approved by the Food and Drug Administration. Current FDA rules require someone who purchases an AED to present a physician's prescription for the device.

What's the first step in the process?

REMSA can help you find out about local and state protocols and requirements for AED training and use.

What legislation is currently in effect to protect first responders who use an AED?

If the person is a trained and licensed medical first responder (MFR), an established standard of care is outlined in the law, and those operating within these guidelines are protected under these laws. These same guidelines pertain to the personnel in your EMS system. If they are not trained and licensed MFR's, check the state laws to determine if lay rescuers are given limited liability immunity. If not, they may not be protected from litigation. Agencies should seek legal counsel before implementing a defibrillation program.

How much does an AED cost?

The price of an AED varies by make and model. Most AED’s cost around $3,000.

What steps should an organization take to buy an AED for its premises?

Any person or entity wanting to buy an AED must first get a prescription from a physician. The AED should be placed in use within a defibrillation program that includes these elements:

• Training of all users in CPR and operation of an AED (AHA Heartsaver AED Course).
• Physician oversight to ensure appropriate maintenance and use of the AED.
• Notification of local EMS of type and location of AED.

Which AED model does the AHA recommend?

The AHA does not recommend a specific device. All AED models have similar features, but the slight differences allow them to meet a variety of needs. The AHA encourages potential buyers to consider all models and make a selection based on the buyer's particular needs. REMSA can help you with this decision.

Training

How can I enroll in a CPR or AED class?

The REMSA and the American Heart Association offer CPR and AED training through community training centers (CTC's).

What kind of training on AED’s is available?

The AHA has developed a new Heartsaver AED Course that integrates CPR and AED training. The course is 3 1⁄2 to 4 hours long.

Additional Resources

National Center for Early Defibrillation

AED Instructor Foundation

American Safety & Health Institute

Citizen CPR Foundation

Public Access Defibrillation League

Save a Life Foundation

450 Edison Way Reno, Nevada 89502 (775)858-5700 Fax (775)858-5720