How to Use an AED

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Categories: Using AEDs

If you’re in an emergency situation and you need instructions quickly:

If you’re just curious or you’re brushing up on your knowledge, read our full guide below.

Automated external defibrillators (AEDs) are designed to be user-friendly; with just a few simple steps, you can potentially save the life of someone who has gone into sudden cardiac arrest.

Because they’re commonly kept in homes, offices, churches, and other locations devoid of trained medical personnel, they’re equipped with streamlined operations and easy-to-follow instructions. That’s the good news. But while anybody can use one of these life-saving devices, there’s still a bit of a learning curve to consider, especially when you consider that every AED operates differently.

When to Use an AED

The first step is to determine whether a defibrillator is actually needed. An automated external defibrillator should only be used on someone suffering sudden cardiac arrest, presenting as unconscious and not breathing. It should never be used on a patient suffering a heart attack, who is still conscious and breathing. If a person is suffering from cardiac arrest, they’ll be unresponsive without a palpable pulse, and no breathing or just gasping (in the case of agonal respirations).

Start by shouting their name and asking for a response, while gently shaking the victim. Then check for signs of breathing. Administer CPR and defibrillation only if they’re not breathing and unresponsive. For more details, see our comprehensive guide detailing when not to use a defibrillator.

Before Using an AED

If someone goes into cardiac arrest, it’s important to call emergency services immediately. If multiple bystanders are available, have someone else call 9-1-1 and retrieve the defibrillator while you perform CPR. During cardiac arrest, the heart does not pump blood to the other organs, so organ failure can occur in just minutes. That’s why it’s important to start emergency procedures immediately while someone else calls for help. Brain death can occur within 6 minutes. Every minute is critical.

If nobody else is around, call 9-1-1 and turn on the AED. Consider putting the dispatch on speakerphone so that you can communicate the emergency while administering treatment.

Perform CPR While Waiting for the AED

If someone else is running to retrieve the defibrillator, start CPR immediately.

Push down firmly on the center of the chest with both hands at a rate of 100 to 120 beats per minute. Push to a depth of 2 to 2.4 inches. The chest should fully recoil between each compression. If you’re not sure about the speed, just follow the beat of the Bee Gees’ Stayin’ Alive.

As soon as the defibrillator is available, stop administering CPR and follow the device procedures below.

How to Use an AED on an Adult

Step by step instructions for using a defibrillator on an adult:

  1. Confirm that the patient is experiencing cardiac arrest (no breathing, unconscious).
  2. Turn on the AED. This is achieved by lifting the lid and/or pressing an “On” button.
  3. Expose the patient’s chest and apply the pads to their bare skin. Use the diagram on each pad as a guide.
  4. Connect the pads to the defibrillator if they are not already connected.
  5. Stand clear of the patient while the AED searches for a shockable rhythm.
  6. Follow the AED’s audible instructions. Press the “Shock” button only if instructed, or allow the AED to shock automatically for automatic AED models.
  7. When shock is complete (or if shock is not recommended), perform CPR until emergency services arrive or the patient regains consciousness.
  8. After 2 minutes of CPR, the AED may again prompt you to stop CPR to analyze, potentially resulting in additional shocks. Continue to follow the AED prompts, with 2 minutes of CPR between each analysis, until emergency services arrive.

If you’re just brushing up on your training and would like a more thorough explanation, refer to the sections below.

Turn on the Device

This is accomplished either by lifting the lid or by pressing an “On” button. The “On” button will often be green in color and contain the I/O symbol (the Philips HeartStart OnSite is one example). As soon as the device turns on, the audible and/or visual instructions will begin automatically.

Check for Readiness

All AEDs, like the Cardiac Science Powerheart G5, are equipped with a readiness light confirming that the device is operational. Some devices will also provide audible warnings if there’s a problem with the battery, pads, or internal components.

Because defibrillators perform daily, weekly, and monthly self-tests (and alert users of problems accordingly), you shouldn’t encounter any unexpected usability issues. In the unlikely event that the device does report a problem, do not use the device. Just perform CPR until emergency services arrive.

Apply the Electrode Pads

Proper pad placement isn’t just important for electric shock; it also allows the AED to assess the patient’s progress throughout the treatment.

Expose the patient’s bare chest, remove any medication patches, and apply the pads to the skin. Use the visual diagram on each pad as a guide for placement: one pad goes below the collarbone on the upper-right side of the chest, and the other pad goes on the lower-left side of the chest wall.

If the patient has a pacemaker, you’ll need to place the patch about two inches away from the implant. Do not place an electrode pad directly over a pacemaker.

Push down firmly on each pad so that the bonding agent adheres to the skin. If the patient has an especially hairy chest and the pads don’t stick properly, you may need to shave the area. If no razor is available, a strong-adhering tape may be used to pull the hair away from the skin.

The cables should already be connected to the defibrillator, but if they are not, you’ll need to plug them in before proceeding.

Stand Clear

Before administering shock, remove your hands from the patient’s skin and stand clear. Advise any onlookers to stand clear as well. Because a defibrillator transmits live electricity to the patient’s heart, it’s critical that no one touches the patient’s skin during this crucial time. Also take a moment to ensure that no part of the patient’s body is submerged in water.

Administer Shock if Necessary

AEDs are available in both automatic and semi-automatic varieties. A semi-automatic device will scan for a shockable rhythm and then instruct you to press a “Shock” button. This is usually a red or dark-colored button with a lightning bolt or a heart. Press the button if and when instructed to do so. The device will then shock the patient’s heart and analyze the response to determine if additional shocks are needed. Continue to press the button only if instructed to do so. As a safeguard, AEDs only ‘activate’ the shock button when a shock is actually advised. Due to this protection, it is not possible for lay rescuers to ‘accidentally’ shock a patient who should not be shocked. This is a comforting feature for non-trained responders, and is just one of many ways in which AEDs are built intuitively and safely for lay people use.

A fully automatic device will analyze the heart rhythm and then deliver shock automatically without intervention from the user. If your defibrillator is automatic, you’ll be instructed to stand clear and then notified as shocks are administered. All you have to do is wait and assess the patient’s response, resuming CPR immediately after the shock is delivered.

In some cases, the device will tell you not to shock the patient. There are four main types of heart rhythms that occur when the heart stops beating. Of those four rhythms, only two are shockable. If your device says “Shock not recommended” or something similar, just proceed to the next step, and continue CPR.

Continue CPR

When the device confirms that no additional shocks are recommended (or that no shocks are recommended to begin with), take a moment to assess the patient. If they are now conscious and breathing, remove the pads and stay with them until help arrives.

If the patient remains unconscious and unresponsive, it’s time to return to CPR. At this point, it’s okay to touch the patient again. The assessment has concluded and no electricity is being delivered to the heart. Resume chest compressions, but do not turn off the AED, or remove the pads. If your device provides additional instructions, be sure to do as prompted. As long as you keep the chest compressions going until help arrives, and continue to follow the prompts of the AED, the patient will maintain the best possible chance of survival.

How to Use an AED on a Child

Step by step instructions for using a defibrillator on a child:

  1. Confirm that the patient is experiencing cardiac arrest (no breathing, unconscious).
  2. Turn on the AED by pressing the “On” button and/or opening the lid.
  3. Press the child button, insert the child key, or attach the pediatric pads if available.
  4. Remove the child’s shirt and apply one pad to the center of the chest and one to the center of the upper back.
  5. Stand clear of the patient.
  6. Follow the audible instructions provided by the AED and press the “Shock” button only if prompted to do so.
  7. Perform CPR chest compressions until help arrives or the patient regains consciousness. Push the chest to ⅓ depth of the chest, no more than 2 inches (5 centimeters).

Automated external defibrillator adult pads are configured for use on patients over 8 years of age and over 55 pounds, but they can be used on patients of all ages.

If child pads are available alongside the defibrillator, they should be utilized for child patients under 8 years old or less than 55 pounds. If no child pads are available, then the AED should still be used with the pre-connected adult pads.. Some AEDs, like the Physio-Control Lifepak CR2, will also have a child button that allows you to adjust the instruction and voltage at the touch of a button. If your AED has a child button or separate child pads, make the necessary adjustments immediately.

When administering CPR to a child victim, the above steps are still applicable, but there are two important modifications that should be made:

  • Pad placement: For small children, one pad should be placed in the center of the chest while the other pad is placed on the center of the patient’s upper back.
  • Chest compressions: For older children and adults, you can compress the chest to a full 2.4 inches (6 centimeters). But for children under 8 years old and under 55 pounds, you should compress the chest approximately ⅓ of the depth of the chest, to no more than 2 inches (5 centimeters)

Can You Get in Trouble for Using an AED?

The prospect of using an automated external defibrillator can be intimidating. After all, you’re a civilian attempting to use a major medical device on an unconscious patient. If the patient dies, there’s the understandable concern that you may be held liable in some way.

The good news is that there are extremely strong protections in place for lay rescuers. As long as you do your due diligence and determine that the patient is suffering from cardiac arrest, you shouldn’t be held liable for any outcomes under normal circumstances. Good Samaritan laws protect people who provide emergency assistance to those in need.

In addition, as long as you follow the audible guidance provided by the AED, you won’t inappropriately harm the patient. You will only be advised to deliver shock if the device determines that a shockable rhythm is present, and AEDs are built in such a way that there is no way to accidentally deliver a shock to a patient who should not be. Nobody is asking you to play doctor. So just relax, follow the instructions provided, and stay with the patient until emergency services arrive.

Recap of How to Use a Defibrillator

Out-of-hospital cardiac arrest affects over 300,000 Americans every year. When used quickly and properly, an automated external defibrillator can increase a patient’s likelihood of survival from around 5% to over 70%, especially if administered within the first minutes of arrest. If you find yourself in the position of having to use one of these devices, just remember the following:

  • Stay calm
  • Have someone call 9-1-1 immediately
  • Confirm that the patient is unconscious and not breathing
  • Turn on the device
  • Follow every instruction as the device talks you through the process
  • If the device fails to revive the patient, continue performing CPR until help arrives

If you encounter a cardiac arrest sufferer and no AED is available, just perform chest compressions until help arrives. The whole process should only take five to 10 minutes, but those few precious minutes may make all the difference in the world.