When a person experiences sudden cardiac arrest (SCA), they have a window of about 10 minutes to be resuscitated. With each minute that goes by, their odds of survival decline by about 10%. An automated external defibrillator can restore normal heart function during those critical moments, saving the victim’s life. Nevertheless, while it’s important to know when to use a defibrillator, it’s just as important to know when not to use a defibrillator.
When to Use a Defibrillator
AED devices are kept in schools, churches, police stations, and other facilities where a cardiac emergency may occur. However, many people aren’t sure when the device is warranted. To put it simply, an AED is required in the event of SCA. No other health emergency warrants the use of a defibrillator.
With that in mind, it’s important to know how to spot a sudden cardiac arrest. The first sign is usually fainting. If someone appears unresponsive, try shaking, pinching, and shouting at them. If they appear unconscious or in a seizure-like state, and they don’t appear to be breathing, you’re most likely dealing with SCA. The next step is to administer CPR and defibrillation while someone else calls 911. Remember that every second matters.
When Should You Not Use an AED?
There are certain instances—even in the event of a cardiac arrest—when using a defibrillator may be unwarranted, ineffective, or even dangerous. You should avoid administering electric shock if:
The Person is Suffering From a Heart Attack
It’s common to confuse a heart attack with cardiac arrest, but these are completely different conditions with different protocols. A heart attack is a plumbing issue while cardiac arrest is an electrical issue. An automated external defibrillator will not help a heart attack victim; on the contrary, it may put them in greater danger.
The good news is that it’s easy to tell the difference between a heart attack and cardiac arrest. If the person is in pain but still breathing and responsive, it’s most likely a heart attack. If the person is unresponsive and not breathing, you’re probably dealing with cardiac arrest.
The AED Is Faulty or Has Expired Parts
AEDs perform daily, weekly, and monthly self-tests to ensure readiness. When you turn on the device, it should confirm—via a green light or other on-screen indicator—that the device is safe to use. Also check the expiration date on the battery and pads. The device won’t be able to do its job and may endanger the victim if it has a low or expiring battery. Wait for emergency services to arrive if there are any readiness concerns with the device.
The Victim Has a DNR
This is more of an ethical issue than a safety issue, but it’s important to address. If you see a “Do Not Resuscitate” tattoo or DNR bracelet on the victim, defibrillation may violate their wishes.
You probably won’t be subject to legal recourse for treating the individual. Good Samaritan laws will protect you in most cases. Nevertheless, if you do see evidence of a DNR before taking action, you’ll need to make the difficult decision of whether to honor the victim’s expressed wishes or save their life regardless.
Additional Warnings for AED Users
In some cases, you’ll need to take extra precautions with cardiac arrest sufferers. While the following conditions should not deter you from using an AED, they should influence how you administer treatment.
The Victim Is Wet or Lying in Water
Water and electricity don’t mix. If a cardiac sufferer is wet or lying in water, move them away from the liquid and dry their chest off completely before attempting to administer shock. In addition, if there are any combustible materials nearby, such as solvents or fuel, move away from the source of the materials before using the device.
The Victim Has a Medication Patch or Pacemaker
A pacemaker is easy to spot. It’s about half the size of a deck of cards and will cause a hard lump in the victim’s chest. Do not place an AED pad directly on top of a pacemaker. Place it as close to the target area as possible without touching the pacemaker.
If the patient is wearing a medication patch on their chest, quickly remove it and rapidly wipe the area before applying the pad. Do not attempt to place the pad directly over the patch.
The Victim Has a Hairy Chest
Excess body hair can interfere with the AED’s ability to detect a shockable rhythm. If a razor is available, try to shave the target area before applying the pads. If no razor is available, apply as much direct pressure to the pads as possible to ensure conduction. Just make sure not to touch the victim’s bare skin while administering shock.
Types of Defibrillators
There are three common types of defibrillators: ICDs, WCDs, and AEDs.
Implantable cardioverter-defibrillators (ICDs) are implanted in the chest and designed to prevent an irregular heartbeat from triggering sudden cardiac arrest. These devices are commonly implanted in patients who previously experienced cardiac arrest and those who have a type of arrhythmia that disrupts the natural flow of blood.
Wearable cardioverter defibrillators (WCDs) are similar to ICDs, but they’re worn externally and used to prevent cardiac arrest in instances of short-term risk, such as when a patient is recovering from a heart attack or transplant.
Automated external defibrillators (AEDs) are portable machines that deliver shock in the event of a sudden cardiac arrest. They are neither worn nor implanted; rather, they’re stored away for emergencies. When SCA occurs, an AED sends a shock to the heart to restore normal rhythm.
ICDs and WCDs are provided by medical professionals and subject to medical supervision. This article focuses exclusively on AEDs. In an emergency situation, this is the type of defibrillator you’ll be dealing with.
In most cases, an automated external defibrillator works without causing harmful side effects. However, if the device is improperly administered, it may fail to deliver the necessary shock. This may keep the victim in cardiac arrest and potentially contribute to further myocardial damage.
If the person is allergic to the materials used in the creation of the pads, they may experience contact dermatitis. This usually isn’t permanent or life-threatening. By heeding the guidelines above, you can minimize the likelihood of side effects occurring.
You Have Just Minutes to Decide
It’s not difficult to determine when to use and when not to use a defibrillator. To recap it as simply as possible, it all rests on three basic questions:
- Is it cardiac arrest?
- Is the AED operable?
- Is it safe to deliver electric shocks to the victim?
If you can answer yes to all three questions, it’s time to grab the defibrillator. If the answer to any of the above questions is no, consider other options.
You never know when a cardiac emergency will strike, so make sure to keep a working AED machine on hand at all times. Someday, it may save a life.