ACLS Library: Lifesaving with Automated External Defibrillators
More than a quarter of a million Americans die from sudden cardiac arrest every year—a death every two minutes. Patients in sudden cardiac arrest are not responsive and not breathing normally or at all. There may also be signs of poor to no circulation. More than 20,000 of those patients might be saved through the use of a “chain of survival” including cardiopulmonary resuscitation (CPR) and the portable lifesaving device known as an automated external defibrillator (AED).
AEDs allow trained non-medical personnel to deploy usage upon the collapse of a person who is not breathing, is unconscious, and appears to be in sudden cardiac arrest.
If individuals are trained to use the AED like they are trained in CPR, broadly as first responders, the American Heart Association notes that up to 50,000 people might be saved each year.
Legislators have encouraged accessibility in recent years rather than adding regulations and restrictions regarding AED usage. Every state in the United States has enacted laws or has adopted practices regarding defibrillator use as of 2001.
Heart surgeon, Claude Beck, who developed CPR had successfully defibrillated a teenage boy after he went into cardiac arrest after surgery in 1947.
Made by his friend, James Rand, the device had two spoon-like silver paddles and was used only in open-chest situations. Paul Zoll invented the first closed-chest unit in 1956.
Irish physicians used the AED within an ambulance setting in 1966 and Oregon emergency medical technicians (EMTs) used the device without a doctor present for the first time in 1969.
How AEDs Work
Automated external defibrillators work by detecting cardiac rhythm and are only indicated for and intended to for use among victims of sudden cardiac arrest.
Should normal rhythm be interrupted by abnormal heart rhythms such as ventricular fibrillation or pulseless ventricular tachycardia, the AED can deliver an electrical shock to treat the arrhythmia.
The Occupational Health and Safety Administration (OSHA) states that for every minute of defibrillator delay for sudden cardiac arrest, chances of survival diminish by 7 to 10 percent.
The Cardiac Arrest Survival Act of 2000 provides Good Samaritan protection exempting anyone from liability when using an AED to save someone’s life (42 U.S.C. 238q). These acts vary by state, but generally, they limit the liability of rescuers using AEDs and others involved in the AED program. Please read the Good Samaritan Act for your state for details.
AEDs are simple to use. If you are a trained responder who finds someone unconscious and not breathing normally or not breathing at all, the procedure for use is simple:
- Assess scene for hazards.
- Call 9-1-1 or activate the emergency response team.
- Determine patient status: breathing or not breathing, level of consciousness, and pulse or signs of circulation.
- Explain to the 9-1-1 operator or emergency operator that a person has collapsed. Tell the operator that an AED is there and that you know how to use it.
- Place the AED next to the collapsed person’s shoulders.
- Turn on the AED.
- Follow the verbal and visual AED instructions.
Make sure that you stick around after the emergency responders arrive so that any institutional reports may be accurately filled out.
Note. AEDs are not meant to be used on patients less than 55 pounds or who are under the age of eight.
AED plans should spell out, in detail, institutional policy; authority and responsibility; locations, purchase and installation; maintenance and testing; registration and reporting; the institution’s medical emergency plan; and training requisites and implementation.
The U.S. Food and Drug Administration (FDA) may require a prescription from a physician to purchase an AED. The role of the doctor ranges depending on the size and other components of the plan. The appointed program administrator should be held accountable for the day-to-day details of the implementation. The obligations of the practitioner may include signing off on or making suggestions on the training programs policies and procedures, evaluating data recorded on an AED during an emergency, and helping evaluate each use of an AED to advise any amendments.
Home plans obviously will not have the same level of detail as usage will likely be limited to those within the home; however, an AED plan should be discussed and written down so that all family members understand AED use and its repercussions.
Public Access Defibrillation (PAD) programs promote accessibility and placement in casinos, airports, senior centers, health clubs and private homes. AEDs have been sold without a prescription since September 2004.
Costs and Accessibility
The cost for AEDs has reduced significantly, often less than $1000-$3,000, enabling AEDs to be used in home settings. Greater accessibility and training encourage greater success rates in saving lives.
Still, it’s difficult to quantify and qualify statistical data into “rates of success”. Saving a number of lives, be it one or many, is thought to be a worthwhile investment financially and morally.
AED use, just like CPR administration, is highly dependent on each person’s unique situation and response—survival rates outside of a hospital setting are still quite low but well-worth the time and social obligation to save lives.