AED Training, How to use AED'S

Learning to use an AED is highly intuitive and surprisingly simple. Many people report that it is far easier than learning CPR. Current AED courses usually last about three to four hours to allow ample time for hands-on practice and to help increase user competence and confidence. AED training and related resources are offered through the American Heart Association, the American Red Cross, EMP America, the National Safety Council and others. AED manufacturers also offer training resources.

Since most states regulate health care training for public safety personnel, it's a good idea to check with state authorities to make sure your training program is consistent with state guidelines. To do this, contact your state EMS agency.

AED training curricula vary, but generally emphasize:

• A working knowledge of CPR
• Safety for both victims and rescuers
• Proper placement of electrodes
• Delivering the first shock as quickly as possible, ideally within 60 seconds from time of arrival at the victim's side
• Plenty of hands-on practice, with one instructor and one AED or AED trainer for every four to six students

The following sample AED class outline demonstrates the simplicity of AED training.

Sample AED class outline

Prerequisite: CPR training

• Distribute course materials to students two weeks prior to class. Course materials may include instructional booklets and videos, local AED protocols, skills checklists, and operating guidelines for the specific device that will be used.
• Present introductory lecture. (20 minutes)
• Demonstrate how to use the AED. (20 minutes)
• Review local AED treatment protocols. (20 minutes)
• Supervise practice. Each student should have the opportunity to manage at least three scenarios. (60 minutes)
• Discuss medical direction, device maintenance, continuing education, documentation and quality assurance. (15 minutes)
• Administer written evaluation. (Optional) (30 minutes)
• Administer practical evaluation following skills checklist. (60 minutes)
• Provide remedial training for those who do not successfully complete evaluation process.

How to use an AED

The AED protocol has seven basic steps:

• Check unresponsiveness.
• Call 9-1-1 or the local emergency number (if applicable) and retrieve the AED.
• Open the airway and check for breathing. If there is no breathing or breathing appears abnormal, give two slow breaths.
• Check for a pulse. If there is no pulse, turn on the AED. A second rescuer should continue CPR until the AED is attached.
• Attach the AED electrode pads.
• Analyze the heart rhythm. Make sure no one is touching the victim.
• Press the "shock" button, if advised. Make sure no one is touching the victim.

Let's look at these steps in more detail to demonstrate how simple it can be to save a life.

Note: The following protocol addresses procedures for using an AED. It is essential that the AED student has had prior CPR training and understands CPR protocols.

Step 1: Establish unresponsiveness.

Step 2. Call 9-1-1 or the local emergency number (if applicable) and retrieve the AED.

Call 9-1-1 or the local emergency number as soon as you recognize the emergency. Even if you have an AED with you, it's important to notify EMS.

Note: Circumstances will vary. The responder with the AED may be part of the official 9-1-1 response. In this case, there is no need to call 9-1-1. In other cases, ensure that help is on the way.

Step 3. Open the airway and check for breathing. If there is no breathing or breathing appears abnormal, give two slow breaths.

Note: When the heart stops, even though there is no circulation, the victim may continue ineffective breathing motions.

Step 4. Check for a pulse. If there is no pulse, turn on the AED. A second rescuer should continue CPR until the AED is attached.

Note: If there is no pulse, turn on the AED power. Press the "on" button or open the lid, depending on the device. If a second rescuer is available, he or she should continue CPR until the AED is attached.

Step 5: Attach the AED electrode pads.

Bare the victim's chest and make sure it is dry. Remove the adhesive AED electrode pads from the package and attach them firmly to the chest, as illustrated on the package.

Note: It is very important to place pads correctly so that the electric current passes through the heart. One pad should be placed on the victim's upper right chest, the other on the lower left chest. Thick chest hair should be removed prior to pad placement to ensure adequate contact.

Step 6: Analyze the heart rhythm. Make sure no one is touching the victim.

Some AEDs analyze the heart rhythm automatically. Other models prompt you to press the analyze button. Follow the AED's prompt and call out, "Analyzing rhythm, stand clear!" or "I'm clear, you're clear, we're all clear!" or words to this effect. Make sure no one is touching the victim when the AED is analyzing.

If the AED indicates "shock advised" go to step 7.

If the AED indicates that the victim does not need to be shocked, check his or her pulse again. If there is no pulse, do CPR (ventilations and chest compressions) for one minute, advise onlookers to stand clear, and analyze again. Repeat this sequence of CPR and analysis every minute until help arrives.

Step 7: Press the "shock" button, if advised. Make sure no one is touching the victim.

If the AED determines that the victim does need to be shocked, it will prompt you to press the shock button. To ensure the safety of onlookers, make sure no one is touching the victim. Call out, "Shock indicated. Stand clear!" Or, say, "I'm clear, you're clear, we're all clear," or words to this effect. Then, press the shock button. Sometimes, the victim will be revived after just one shock.

After the first shock is delivered, immediately analyze again. If the AED advises that another shock is needed, press the shock button a second time.

After the second shock is delivered, immediately analyze again. If the AED advises that another shock is needed, press the shock button a third time.

After three shocks, if the victim still has no pulse, do CPR (ventilations and chest compressions) for one minute.

Then, if there still is no pulse, give additional sets of three quick shocks, interspersed with one minute of CPR, until the AED prompts that no shock is indicated.

Note: The AED will deliver appropriate energy levels for each shock. Continue cycles of one minute of CPR followed by heart rhythm analysis and appropriate shocks until advanced help arrives.

The most important thing to remember when using an AED is to confirm that the victim is unresponsive, not breathing normally and pulseless. For all such victims in confirmed cardiac arrest, turn on the power, analyze, and the AED will coach you through the rest of the steps with visual and/or audio prompts. There is no need to be anxious. Even if you get flustered, as people often do in emergencies, the AED will be your guide.

Words of caution

AEDs are very safe and effective when used properly. Therefore, it is important to follow the operating instructions that come with each AED. For all AEDs, there are certain basic precautions:

• Attach the AED only to victims who are unresponsive, who are not breathing normally and who have no pulse.
• AEDs, as currently configured, are intended for use among adult victims of sudden cardiac arrest, not children. If the victim appears to be less than eight years old or appears to weigh less than 25 to 30 kg. (55 to 65 lbs.), do not attach the AED.
• It is safe to use AEDs in all weather conditions, including rain and snow. In wet weather, wipe the chest dry before placing electrodes. If the victim is lying in water, move him or her to a relatively dry area before attaching the AED.
• Never place AED electrode pads directly on top of medication patches, such as nitrogylcerin. Patches should always be removed and the skin wiped dry before placing defibrillator pads on the skin. Make sure to wipe your own skin dry if you come in contact with the medication.
• If the victim has a pacemaker or an internal defibrillator with a battery pack (visible as a lump under the skin about two inches long), avoid placing pads directly on top of the implanted medical device, if it is possible to do so and still maintain proper pad placement.
• If the victim is lying on a metal surface, such as bleachers or a stretcher, avoid contact of the electrodes with the metal surface.

Keeping skills fresh

Experience in rural communities has shown that emergency responders may go for several years before encountering a victim in cardiac arrest. Lay rescuers may use an AED only once in a lifetime. Therefore, it is important to review AED skills on a regular basis. The ideal frequency for retraining is unknown, but most experts recommend reviewing AED skills every three to four months.

Brief review sessions (about 30 to 60 minutes long) are an effective way to keep AED skills fresh. Sessions should be used to review AED operation and maintenance, review standing orders, practice protocols using various scenarios, critique recent cases, and evaluate skills. As an alternative to classroom review sessions, computer-based interactive training is available from some AED manufacturers.

Training costs

AED training costs vary. One factor affecting training costs is whether personnel are paid for training time or training is done on a voluntary basis. Another factor is whether actual field AEDs or less expensive AED trainers are used for training. For the most part, since initial and refresher training requires relatively little time, the costs are minimal. Organizations that appreciate the value of early defibrillation consider AED training costs a worthwhile investment.

Licensure and certification

Guidelines for AED knowledge and skills are provided by the American Heart Association, and training programs are provided by the AHA, the American Red Cross, EMP America, the National Safety Council and others. Successful completion of an AED course means that certain classroom performance standards have been met. Licensure and certification, however, are usually a function of governmental bodies. If you have questions about how licensure and certification may apply in your community, contact state and local EMS authorities.

Summary

It's easy to learn how to use an AED. AED training materials are readily available from a variety of sources. Initial AED training takes about two to four hours and features an emphasis on practice. A ratio of one instructor and one AED or AED trainer for every four to six students is recommended. Short review sessions should be conducted regularly to help maintain skills.

National Training Organization

American Heart Association
7272 Greenville Avenue
Dallas, TX 75231-4596
Phone: 800-AHA-1793 or 214-706-1247
Fax: 214-987-9361
Web site: http://www.americanheart.org

American Red Cross
8111 Gatehouse Road
Falls Church, VA 22042
Phone: 703-206-7180
Fax: 703-206-7673
Web site: http://www.redcross.org/services/hss/

American Safety & Health Institute
8324 Corporate Way
New Port Richey Florida 34653
Phone: 1-800-246-5101
Fax: 727-817-0696
Website: http://www.ashinstitute.com

Medic First Aid/EMP America
500 S. Danebo Avenue
Eugene, OR 97402
Phone: 800-800-7099 or 541-344-7099
Fax: 541-344-7429
Web site: http://www.medicfirstaid.com

National Safety Council
1121 Spring Lake Drive
Itasca, IL 60143-3201
Phone: 800-621-6244 or 630-285-1121
Outside U.S.: 630-775-2056
Fax: 630-285-1139
Web site: http://www.nsc.org

American Red Cross AED resources:

• Automated External Defibrillators
• American Red Cross--Adult CPR/AED Training--Workplace Programs
• American Red Cross - Cardiac Chain of Survival-- Health and Safety Tips

WA Department of Health Approved PAD Training Programs:

• Washington State Approved Public Access Defibrillation Training Programs