Many times we are asked by students, “but how do I operate the AED”. We tell them turn it on. PUSH THE GREEN BUTTON (see figure 1).

Remember, some AED’s turn on when you lift their cover (see fig 2).

By pushing the on/off button the cover opens and the unit turns on (see figure 3).

When you open the cover or press the GREEN BUTTON the unit should go ON. If the lights come on and the voice prompts start you are ready to go. If they don’t you are not. Immediately check to see if you have a spare battery and replace the dead one. Hopefully, you will not waste too much time changing out the old and installing the new one. How can you forego this unpleasantness? Check the status of the unit before you try to use it. Look in the window on the front of the unit and look for a green indication or green indicator light. If you see one go ahead and use it. If you see any red marks or blinking red light, do not use the unit. Change the battery. That is how you avoid any missteps or danger to the patient.

The next question I hear is what does AED stand for? We tell them it is an abbreviation for Automatic External Defibrillator. To defibrillate means to stop fibrillating rhythms. First there is V-Fib (Ventricular Fibrillation) where the heart is basically sitting there shaking like a bowl of Jello. The second is V-Tach (Ventricular Tachycardia) where the heart is beating so fast that no blood can accumulate in the ventricle and so there is no blood to push from the heart to the brain. In both cases there is no blood in the ventricle and no pulse. So, the heart is beating. It just isn’t beating in a good way or rhythm.

The AED only recognizes TWO bad rhythms. Any other rhythm will not cause the AED to SHOCK. If the AED says “No Shock Indicated”, or pauses, you IMMEDIATELY START COMPRESSIONS. ANYONE in Cardiac Arrest will benefit from having AED pads placed on them as soon as possible after CPR is initiated. However, it is important to realize that effective compressions delivered at a rate of between 100 and 120 times per minute are a victim’s best chance for survival along with using the AED as soon as possible. As soon as the AED arrives it should be turned on and the pads applied to the victim’s chest.  The AED pads need to be placed efficiently and quickly to reduce the amount of time of no compressions to a minimum. The best way to do that is for one rescuer to continue doing compressions while a second rescuer is placing the pads on the chest according to the instructions (pictures) on the pads (see figure 3). Once the pads are placed most AED’s will say plug the pads into the AED. Some AED’s already have the pads plugged in (see fig 4).

That is why it is important to LISTEN to what the AED says once it is turned on.

What is the purpose of an AED?

The purpose of the AED is to STOP THE HEART, PERIOD. When the shock is administered, IT STOPS THE HEART. Then the heart’s internal electrical circuit is free to reset. That is why when it says Analyzing you have to remove your hands and keep them off the chest and away from the body until the AED shocks the victim or says “No shock indicated,” then it is safe for the second rescuer to begin chest compressions. There have been some misconceptions transmitted on some training videos. In one particular instance the responder continues compressions while the AED is charging. DON’T CONTINUE COMPRESSIONS UNLESS YOU KNOW THAT THE AED YOU ARE USING HAS MADE ALLOWANCES FOR THESE EXTRA COMPRESSIONS. IF THE AED SAYS “CONTINUE COMPRESSIONS UNTIL SHOCK”, THEN YOU CAN CONTINUE THEM, IF NOT THEN DON’T.

Chest compressions should be started immediately following a shock or if the machine pauses. The rescuers will continue to administer 30 compressions and 2 breaths until the AED comes back on and says “Stop CPR, analyzing.” Then you are into the next phase of AED operation, the switch.

The SWITCH involves the compressing rescuer moving to the head of the victim and the second rescuer moving from the head to the side and getting ready to start compressions when indicated. NO ONE touches the victim until the shock is delivered or the AED pauses. The switch if done properly should take no more than five seconds. Total time from Analyze to shock should be approximately 13 seconds. This would be optimum AED operation.

How to use AED on a Child or Infant?

Depending on the AED you have (you should always become familiar with the AED you are going to operate.) you will either have smaller pads (ped pads) or a Pediatric Dose Attenuator in your kit (see fig 5).

A good standard AED kit would have either 2 sets of Adult pads, 1 set of ped pads, a safety razor, and a spare battery plus a pair of gloves. Another type of AED (smart) would have only one size pads (roughly the same size as Adult) (see fig 6).

A safety razor, a pair of gloves, and a Pediatric Dose Attenuator. Whatever type of AED you have it should have everything that is needed to operate it efficiently. Included in or attached to the kit would be a CPR mask with a one way valve.

If you are doing CPR on a Child aged 1 to 8 use the ped pads or pediatric dose attenuator. If you don’t know how old the child is or if the child is greater than 8 years old, use the Adult pads or forego plugging in the dose attenuator. You can use the adult or smart pads on a child or infant as long as they don’t touch. The adult pad you place on the front of the baby or small child is the one which is designated as right front breast (see figure 7).

An easy way to make sure they won’t touch is to place one pad (right front) on the front of the chest and the other (under the left nipple) on the back directly behind it (see figure 8).

If you follow the steps outlined above, you should have no problem operating any AED and have the best possible chance of saving a victim in Cardiac Arrest.