ABCs of an AED

One of the topics we discuss in our classes is the appropriate use of an AED, or automatic external defibrillator. Historically, these life-saving devices had been only in the hands of EMTs, paramedics, and other health professional, but their ease of use, and decreasing cost has allowed them to pop up in schools, airports, and public buildings everywhere. But, what about having one at home?

Many models are still $2000 or more, but you can get refurbished AEDs for around $500. Obviously, $500 is still a healthy chunk of change, but considering an iPhone can be more than $1000, or you could drop $350 on a men's coach fanny pack, I guess it's all a matter of priorities.

Obviously, my job has made me more in tune with potentially life threatening events, and, as I'm getting older, having an AED in the house made sense to me.

What an AED does

There are many reasons why a person can suddenly collapse, and for some, there's simply nothing that can be done. But, the most common cause of sudden cardiac arrest is an abnormal heart rhythm called ventricular fibrillation.

The quick run down on here is that the heart is made up of four chambers, two on top, called atria, and two on the bottom, the ventricles. Most normal heart rhythms start in the right atria with a collection of certain cells that make up the "sinus node." When these cells send an electrical signal, that signal should travel down a well worn path to have the heart beat in a normal, organized fashion. Some abnormal heart rhythms may not be great, but still allow the heart to do its job, albeit less effectively. 

With ventricular fibrillation (v-fib) the contractions are so chaotic that the heart is essentially not functioning. If the heart isn't working, we don't pump oxygen to vital tissues, such as the brain and heart, and within a few minutes of v-fib, a person dies.

Many things can cause v-fib, from electrolyte abnormalities (problems with magnesium or potassium) to an enlarged heart or a heart attack.

An AED can detect this specific abnormal heart rhythm, v-fib, and send a jolt of electricity in an attempt to break the cycle and let the heart return to a normal rhythm. 

Does this fix everything? Certainly not, because whatever caused v-fib to occur in the first place is likely still in play. An AED will buy time by getting the heart to hopefully function normally for while, delivering oxygen, until help arrives. Paramedics can start an IV and give anti-arrhythmic medications and continue life saving measures while transporting a patient to a hospital.

An AED is an important part of the CPR algorithm, but of course, only if one is available.

Like I mentioned, they are showing up in more and more places, and they're coming down in both price and size. 

We've often mentioned in our classes that eventually AEDs will get small enough that they could be carried in a pack, and I'll be damned if I didn't see this, the Avive AED, it's 2.2lbs and pretty compact.

I will NOT be surprised if these start getting some use in the backcountry (although getting paramedics to the patient, and getting the patient out will still be two huge obstacles).

And, if you don't want to carry an AED with you, maybe one will be delivered to you by drone? It's been done in Sweden, and will likely be showing up in more areas.

If you want one for your home (or RV, or cabin, or backpack...), as with everything, you can find plenty of resources online. You can buy them from sites like the American Red Cross, or one of many other sites.

As a side note, I got mine through OneBeat Medical and it's a refurbished unit. They have a biomedical device team that goes through an 18-step inspection process on refurbished AEDs and their batteries are reported to last 4yrs and they come with a 3-year warranty. Seems like a decent unit to have around the house, I just with my wife would stop using it to charge her iPhone.

To learn more about how to use an AED, check out one of our classes!

In brief, this is how the fit in to the CPR process:

All AEDs are similar.  To operate an AED, refer to the AED algorithm.

1. Secure the scene and verify the victim is NOT in water.
2. Open and turn the AED on.
3. Stop CPR.  The effectiveness of shock delivery decreases significantly for every 10 seconds that elapses between compressions and shock delivery, so it is critical to deliver a shock quickly.
4. Expose the victim's chest and dry the skin if necessary.
5.  Open the AED pads and attach the pads to the victim's chest.  A hard lump on the victim's chest may indicate an implanted pacemaker.  Do not place an AED pad over the lump.  Remove any medication patch that is on the chest.
6. Instruct all bystanders to move away while the AED analyzes the victim's rhythm.  DO NOT TOUCH the victim during this analysis.  If you get a message to check the pads, press on each pad to ensure the pads are making full contact.  Occasionally, you may have to apply a new set of pads.
7. If the AED detects a shockable rhythm, it will verbally tell you to not touch the victim.  The AED will advise you to deliver a shock.  Ensure that no one is in contact with the victim.  Press the Shock button.
8. If the AED does NOT detect a shockable rhythm, it will tell you to resume CPR.
9. After performing CPR for 2 minutes, the AED will advise you to stop CPR and will analyze the rhythm again.
10. Repeat step 8 or 9 as advised by the AED.

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