Automated external defibrillators (AEDs) dramatically increase survival rates from cardiac arrest, but which action should you take immediately after providing an AED shock?
Knowing what to do after using an AED is not only essential for ensuring the best outcome for the victim. It’s also important for:
- Ensuring that emergency rescuers can provide the best possible care after the event
- Readying your AED to be used again
It all starts at the scene of the emergency.
How Do AEDs Help in the Case of Cardiac Arrest?
In a sudden cardiac arrest (SCA), the electrical activity of the heart is disrupted, leading to ventricular fibrillation rather than a normal heart rhythm. SCA is different from a heart attack, which a person could suffer without even realizing, as cardiac arrest always leads to death unless cardiopulmonary resuscitation and rescue breaths are given within those first few precious minutes.
If available, an external defibrillator can provide an electric shock that jolts the heart back into a normal rhythm. When used within minutes of SCA, a defibrillator can more than double the patient’s chance of survival[mfn]sciencedaily.com[/mfn] if it is combined with other lifesaving measures.
What to Do If You Witness a Cardiac Arrest
If you see someone collapse suddenly and become unresponsive with no signs of breathing or obvious signs of life, it’s best to presume that it’s a cardiac arrest and respond immediately. If the victim is an adult, call 9-1-1, send someone to fetch an AED, and begin compressions on the victim’s upper chest at a rate of 100-120 compressions per minute. If you are dealing with a child victim and no one else is there to help, administer CPR for two minutes before calling 9-1-1.
Once the AED arrives, place the pads on the victim as illustrated on the pads. Then follow the audible instructions until medical help arrives. Many models, like the HeartSine Samaritan PAD 350P, have two buttons—a power button and a shock button. This allows for simple operation during tense moments.
If the Heart Rhythm Normalizes
In the best-case scenario, the first electric shock will restore a regular heart rhythm and the patient will begin breathing, sometimes even waking up and speaking. In this case, you want to keep the person comfortable until emergency personnel arrive. In case the patient goes back into cardiac arrest, leave the electrodes on the patient’s chest and keep the AED turned on so that you can follow the AED’s instructions. Once professional emergency medical personnel arrive on scene, they will remove the electrodes when they deem it safe to do so.
If the Heart Rhythm Doesn’t Normalize
In many cases, one shock won’t be enough to restore a normal rhythm. If the victim doesn’t respond after the initial shock, keep the device turned on and continue to follow the audio prompts. Usually, you will be instructed to continue chest compressions to the beat of the metronome (approximately 100 to 120 beats per minute, or the beat of Stayin’ Alive). Every two minutes, the external defibrillator will tell you to stand clear so that it can analyze the patient’s heart rhythm and deliver another shock if needed.
After the Event
Eventually, the emergency rescuers will arrive and take the patient to the hospital. At that stage, there are a few simple steps that the AED program coordinator will need to follow:
1. Fill Out the Event Documentation
Many Counties and jurisdictions throughout the country have “Post-Event” documentation which must be filled out and submitted, often within 24-72 hours of an event. This documentation provides key information about the event, without disclosing any personal or HIPAA-protected patient information. County and State Emergency Medical Services (EMS) agencies track this information in their efforts to increase survival rates from SCA. Check with your local EMS agency to see if this is required. If you have a program management provider, they should complete and submit this paperwork on your behalf. Be sure to retain a copy of this documentation in your internal records for a minimum of seven years.
2. Download the Event Data
Many AED models, like the HeartSine Samaritan PAD 350P and HeartSine Samaritan PAD 450P, come with a large memory bank that records up to 90 minutes of event data with ECG results and the time of shocks given. After the event, you need to download this data and send it to your Medical Director if Medical Direction is a requirement in your state. Medical Direction is a requirement of most states, but you can check the requirements of your specific state on our legislation map here.
3. Refurbish Your AED to Ensure It Is Response Ready
While we all hope we won’t have to use an AED more than once, you never know when a person might experience life-threatening arrhythmias and need the AED again. After your AED is used in an emergency, be sure to replace the pads that were used with new pads, as well as any contents used from the ready kit attached to the AED. In addition, carefully inspect your AED for any damage, test the AED to ensure it is in working order, and make sure the battery still has sufficient life. If needed, replace the AED battery.
While professional first responders will typically disconnect your AED immediately upon arriving on the scene and attach their own more advanced defibrillator, occasionally first responders will take your AED with the patient to the hospital. If this happens you will need to follow up with EMS or your local hospital to have your AED returned.
4. Arrange for Debriefing and Counselling as Needed
After a cardiac event, the AED program coordinator should interview the people who responded (whether a layperson, trained staff member, or untrained bystander) to find out whether the organization’s policies were followed and whether these policies and procedures need updating. The program manager should also arrange for trauma and/or grief counseling for anyone who would value this support, as a cardiac emergency can be traumatic for those involved.
5. Keep Your Facility Up-to-Date
Once you’ve witnessed a cardiac arrest and used an external defibrillator, there are two common types of responses. One is to become hyper-alert and ramp up your training and device maintenance efforts. Another is to breathe a big sigh of relief that your AED saved someone’s life and presume that it’s not likely to happen again.
The reality is that around 1,000 people suffer from an out-of-hospital cardiac arrest every day in the United States[mfn]sca-aware.org[/mfn] and nearly 90% of these are fatal. Giving a shock within 4-6 minutes of a cardiac arrest can mean the difference between life and death. If you’ve seen this happen once, make sure you’re ready to respond again by following all of the AED service requirements and keeping responders up to date with CPR training that includes instruction on using AEDs.
How AED Program Management Can Help
There’s a lot to think about when you’re working out what to do after using an AED—especially if the victim was a staff member or a child who often visits your facility. To make it easier to keep abreast of the legal requirements for AED programs, our AED Program Management takes care of all of the details both before and after an event:
- Medical prescriptions and ongoing medical oversight for AEDs
- Keeping each AED up-to-date
- Tracking and notifications of pad and battery expiration, and assistance with obtaining new supplies
- Tracking CPR/AED training certifications of your staff as needed
- Taking care of EKG data download, Physician event review (as required), and all post-event documentation
- Complete device refurbishment including AED inspection, pad replacement, battery and first responder replacement as necessary, and final testing and cleaning
- Coordinating post-event requirements across multiple states that may have different legal frameworks for AEDs
What to Do After Using an AED: Recap
The main action you should take immediately after providing an AED shock is to leave the device on and attached. The device will continue to provide instructions, analyze the patient’s heart, and provide further shocks if needed.
Once the emergency personnel arrive and take over, the AED program coordinator and people who responded need to fill out all of the necessary paperwork and get the AED ready to use again.
Remember that when it comes to using an AED, sometimes the actions you take after a shock delivery are just as important as the actions you take before and during.
Information Sources
