AEDs and Survival

AED

Automated External Defibrillator

One of the items that I see turning up in prepper medical storage nowadays is the Automated External Defibillator.  AEDs are user-friendly devices that even untrained bystanders can use to save the life of someone whose heart stops (“Cardiac Arrest”). Are these useful for those concerned about a collapse?

AEDs look like short, chunky laptop computers. Similar to the machines used to treat cardiac arrest in ERs, they are now found in restaurants, stores, and all sorts of places.  They are now considered so useful that the government proclaimed the first week of June to be AED Awareness Week. Let’s talk a little about AEDs and their use.

An AED gives you step-by-step voice instructions and won’t go to the next step until you have completed the previous step. Because its sequence is clearly diagrammed,  it seems to give a reassuring calm to rescuers who are inexperienced with  emergencies.

AEDs will not allow a shock to be given unless a person is truly in cardiac arrest, making it close to foolproof. You can’t shock a person who doesn’t need it, even if you wanted to. As long as you don’t forget to turn the device on, it’s very easy to use.

Before you use an AED on someone who has fallen down and is possibly in cardiac arrest, make sure you evaluate them first.  If you see a person pass out, or if you find them unconscious, confirm that the person can’t respond. Shout at and shake the person to make sure he or she isn’t sleeping. That is, if they’re an adult. Never shake an infant or young child, pinch them instead to see what they do. If the person in question is unresponsive, not breathing, and without a pulse. It’s time to get out the AED.

Of course, in modern times you’d call emergency services. If two rescuers are present, You could perform cardiopulmonary resuscitation (CPR) while the other person calls 911 and grabs the AED. Sudden Cardiac Arrest causes death in minutes if you don’t take charge, so make a decision without a lot of dilly-dally.

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If an AED isn’t readily available, do a couple of minutes of CPR, chest compressions at the rate of 100 beats per minute. When The AED arrives, take a quick look. You’ll see that the device consists of one or two control buttons and two sticky pads called “electrodes”.

The AED is a machine that produces an electric shock. For safety’s sake, check for any water near the victim BEFORE you use it. Water conducts electricity, so make sure to transport them to a dry area if needed.  Remove jewelry, piercings, and anything made of metal from the patient to avoid burns. Note: even a brassiere may have metal underwire, so it might be a good idea to remove it before using the AED. If the bra hooks in the back, you can cut it in the front center to pull it quickly away from the skin.  Also, there are a number of implantable medical items, such as pacemakers, that could also cause burns. These will likely be just below the skin on the left upper chest.  These types of patients generally have some type of medic alert bracelet indicating the device is in place.

AED procedure

So how does the automatic external defibillator (AED) procedure work? Expose the person’s chest (dry it if it’s wet).  Patients that have hairy chests may need to be quickly shaved in the two electrode locations to provide good connections.  Many AEDs come with a razor for this purpose. Remove medication patches and wipe the skin clean.

Turn the AED on. The machine will then give you step-by-step instructions. You’ll hear voice prompts and even see prompts on a screen. You’ll be told to place the sticky pads (Electrodes). One is placed about halfway between the right nipple and the right collarbone and the other is placed on the left side about two inches below the left armpit. Be careful to adjust the pads so that they are at least 1 inch away from implanted devices or piercings. This allows the electric current to flow between the pads without interference. Check that the wires from the electrodes are connected to the AED. If your placement of the electrode pads is faulty, the machine will probably tell you to “check electrodes” or a similar message.

Now, the moment of truth: Make sure no one is in contact with your patient.  Press the button that says ANALYZE and the device will look for the person’s heartbeat. In a very short time, the AED will sense whether the heart is beating or not. If there is cardiac arrest, the AED will tell you to push a button and deliver a shock. Stand clear of the person and make sure others are away before you push the shock button. Saying “clear” should do it, just like on “House” or “Scrubs”.

In modern times, start or resume CPR until emergency medical help arrives or until the person begins to move. Stay with the person until medical help arrives, and report all of the information you know about what has happened. After 2 minutes of CPR, you can use the AED again to check the person’s heart rhythm and give another shock, if necessary. If a shock isn’t needed, continue CPR until the patient is responsive.

I say “in modern times” a lot, and in today’s world, this is what you should do. But what about if the you’re off the grid long-term due to a disaster? Survival is a situation where using the AED becomes problematic, not because of lack of electricity for the device (it’s battery powered), but because you’re not going to be able to get them to a modern medical facility afterwards.  Someone who has a cardiac arrest isn’t sent home from the Emergency room in a couple of hours, they end up in a cardiac intensive care unit with all sorts of technology strapped to them.  That tech isn’t going to be around, so are you going to save that person with an AED even if it works?  Maybe not.

AEDs are still expensive. I recommend you spend your money first on other survival medical supplies like bandages, masks, gloves, and other items before you get your AED.  If the you-know-what doesn’t hit the fan, however, and you have the dough, it’s a great idea to have one, especially if someone is at risk for heart attack in your family.

(An Aside: the American Heart Association once recommended against using an AED on a child younger than 8 years old, but it has been pointed out to me that the current recommendation allows use as early as 1 year old!)

Joe Alton, M.D., aka Dr. Bones

AuthorJoe

Joe Alton, M.D.

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