• What Are AEDs?
• Why Should We Use AEDs?
• Who should be trained to use an AED?
• Having AEDs available for public use.
• Where should an AED be placed?
• Am I Liable?

What Are AEDs?

Automated External Defibrillators (AEDs) may look like toys, but they can be used by lay people with only minimal training to revive people who are suffering a cardiac arrest. The AED is a small compact device, with only a couple of buttons and a pair of self-stick pads called electrodes. The electrodes are placed on the victims chest, and are use to deliver an electrical current to the victims heart.

When the electrodes are placed onto the victim, the AED defibrillator will analyze the victim’s heart, and determine if an electrical shock is indicated. If a shock is indicated, the AED will advise the user to deliver the shock by pressing the shock button.

As soon as the AED is activated, it will begin to give directions to the user. It does this by voice directions and text directions located on a screen on the AED. The sequence of the AED is so easy to use; the rescuer will feel confident they are doing everything correctly.

AEDs have been programmed to be able to accurately determine if the victim is indeed in cardiac arrest and needs to be defibrillated. They are virtually foolproof. Since it will not allow the user to deliver an unnecessary shock to the victim, the only thing the rescuer could do wrong is not follow the directions given by the AED. Even then the AED will function as needed. Today, AED’s shock in a bi-phasic wave form. In other words it shocks from both pads at the same time. This way, even if you get the pads in the wrong place or backwards, the shock can still be effective.

By watching television, most people know what a defibrillator is. The difference is, instead of a doctor calling out sophisticated medical commands, that only medical professionals would understand, the AED does all of the work, and all the rescuer has to do is make sure no other people are touching the patient and press a button if needed.

By quickly initiating 911 and getting an AED to the victims’ side within 3 minutes, drop to shock, we can expect increases in the survival rates of cardiac arrest victims

Back to Top

Why Should We Use AEDs?

Based on statistics from 1999, Sudden Cardiac Death (SCD) kills at least 400,000 - 460,000 people each year, there were 17,000 in the state of Indiana alone in 2006. This staggering number is more than the total deaths from all forms of cancer combined. These are the numbers we are faced with when considering the effectiveness of early defibrillation in the pre-hospital setting.

People commonly use the terms "Heart Attack" and "Sudden Cardiac Death" synonymously. The reality is, these two disorders are quite different. A "Heart Attack" is related to a blockage of coronary vessels around the heart. This blockage leads to damage to the heart because of a lack of blood supply to the effected region. "Sudden Cardiac Death" is an electrical anomaly. For one reason or another, effective electrical conduction to the heart stops and if not treated rapidly, the victim will die.

In the past, CPR has been the treatment for SCD. The victim is administered oxygen while the chest wall is compressed, causing the heart to be compressed and forcing blood through the heart to deliver the oxygen. Whether or not blood is actually moved through the body, and oxygen is actually delivered to the heart is dependant upon the quality of CPR given. While this treatment is certainly better than none, it is usually not very effective, and the survival rate is less than 5%.

An AED is proven to be a much more effective form of treatment for SCD. Since the most common rhythm during SCD is Ventricular Fibrillation, a fluttering of the ventricles of the heart due to an unorganized electrical activity of the heart, CPR has very little effect and the victim eventually dies due to lack of oxygenation. If the rescuer had used an AED the outcome would possibly be much different.

Defibrillation with an AED has shown results that far outweigh the "Less than 5%" survival rate of CPR alone. As high as 90% of SCD victims respond to defibrillation, and upwards of 40% survive to go home. These results are based on studies involving victims the received defibrillation within 4 minutes of a SCD. Defibrillation is most effective when used as soon after an arrest as possible. The chance of success decreases by seven to ten percent for every minute of the SCD without defibrillation.

With these glaring differences, you can definitely see why having an AED with trained personnel nearby is so important. They are especially important to have in areas where people are concentrated in higher numbers, because the odds of someone having a SCD obviously increase with more population.

Our suggestion from the CPR Institute of Indiana is to set your goal as “3 minutes from drop to shock”. In other words, you should have AED’s placed so that from the time someone “drops” from SCD until the time you can deliver a “shock” should be no more than 3 minutes. Remember, Time is Tissue, and the sooner we can get their own heart beating, the better chance they have to survive.

Back to Top

Who should be trained to use an AED?

Anyone can learn to use an AED when given a few minutes to experiment with it. However, during an actual event, there is no time to experiment. Without even minimal training, the rescuer may lack confidence and may even panic to the point of not trying.

CPR Institute of Indiana is a company comprised of Firefighters, EMT’s, and Paramedics that work with emergencies every day in our jobs. We pride ourselves on bringing a sense of reality to the classroom. So you don’t just learn from a book, but you learn what you will REALLY encounter, in an atmosphere that will not intimidate you so you can actually LEARN what you will need when the unthinkable happens.

CPR Institute of Indiana is certified to provide this training by both ASHI (American Safety and Health Institute) as well as The American Heart Association. In just a short amount of time, a person can be trained to use an AED with confidence and effectiveness. These classes are designed to accommodate large numbers of people at the same time, or small groups for office response teams, and will greatly improve the odds of a victim of SCD (Sudden Cardiac Death) in the vicinity of a trained rescuer.

However, with new technology in many of the AED’s available, even someone with no training can be effective in the use of an AED. Some have coaching built into the program to help “talk you through” a cardiac arrest. But even with this coaching, you still should know CPR for the whole process to work effectively.

Back to Top

Having AEDs available for public use.

Public access defibrillation (PAD) programs were approved by the American Heart Association in 1995. It was based on the concept that having an AED available to the public for use on a victim suffering sudden cardiac death (SCD) would greatly increase the chances of survival for the victim. With very little or even no training, a person could effectively use an AED long before the arrival of a Paramedic or an EMT. This decrease in the time before an electrical shock is delivered to a victim of SCD would vastly change all known statistics of survival rates from SCD.

In an article published by the New England Journal of Medicine in 2004, Public Access Defibrillation (PAD) studies showed that the use of an AED greatly improved the survival of victims of SCD. The results were based on a two year study of the outcome of victims of SCD who were given CPR alone verses victims that were treated with an AED. In programs with bystanders trained to call 9-1-1 and provide CPR without an AED, 15 out of 107 cardiac arrest victims survived to hospital discharge. In programs with lay rescuers trained and equipped to call 9-1-1 and deliver CPR plus use an AED, 30 of 128 cardiac arrest victims survived to hospital discharge. While these numbers may still seem to show a very low survival rate of SCD, they do prove that the chances of survival of SCD with an AED far surpass those of just CPR alone.

PAD programs are based on the premise that having an AED in locations of highly concentrated populations of people can increase the survival rate of SCD. These programs are geared toward providing minimal training to lay rescuers that may have to intervene when a victim falls of SCD. This training may only consist of a basic First Aid course with AED, but it does give with this training the knowledge and confidence to use an AED when the need arises.

All of these figures and facts are pointless if facilities do not take advantage of the programs available. It is a proven fact that a SCD will eventually happen in an area where people concentrate regularly, but the victims’ survival is almost solely dependant on whether or not the facility has taken advantage of placing an AED within reasonable distance of the victim. Remember, without an AED, the victim has a less than 5% chance of surviving, and that is only if a rescuer provides good effective CPR quickly. It is suggested that an AED is available to the patient in a time frame of “3 minutes, drop to shock” This gives them the optimal chance of survival.

Back to Top

Where should an AED be placed?

AEDs should be placed in areas that present the higher than normal chances that a person may fall victim of SCD (Sudden Cardiac Death). These areas may include places where groups of people gather, places where it may take longer than 2 minutes for an Emergency Medical Unit to arrive, places that may have a higher than normal concentration of people that are high risk of SCD, and places where people are doing activities that may cause them to be at higher than normal risk of SCD.

The following facilities should consider placing AEDs and implementing public access defibrillation programs.

In reality, anywhere that could have 50 or more people at any time should consider having an AED. Especially if it is an area that could cause emotional stress, physical exertions, have a client base that could be in an age range conducive to cardiac problems. This could be any age from 25 and above.

Back to Top

Am I Liable?

This is always a big question, and rightly so. But you can relax. Some of the AED companies have an indemnification policy that covers you, as well as the Good Samaritan laws that are present.

Good Samaritan laws have been passed in all fifty states that provide rescuers civil immunity in cases where they volunteer to help. This legislation also covers the use of AEDs and applies as long as the rescuer is not paid to perform rescue skills as part of his job. Persons such as, Paramedics, EMTs, Nurses, Doctors, and so on, are not covered under the Good Samaritan Act.

The assumption under Good Samaritan protection is that the rescuer follows normal guidelines and applies them reasonably and prudently. In an emergency, rescuers are called upon to make many fast judgments. As long as those judgments are reasonable, no legal consequences will follow.
Good Samaritan laws differ from state to state. Some protect rescuers who use AEDs even if they never went through training while others require completion of a state or nationally recognized class. Other states not only protect the rescuer but also the physician who serves as medical director, the owner of the facility where the AED is located, and even the person or entity that provided training in AED and CPR skills. Since such variation exists, you should take the time to familiarize yourself with the statutes that apply to your state.

Back to Top