There are of course many things you probably shouldn’t be doing with your defibrillator (A.E.D.). It’s not that you actually can’t use them on bears, but they have to be shaved first. Now usually we’re recommending the proper use of A.E.D.s but someone recently asked what were the times when you couldn’t use one, so here’s the top 10 considerations when not to use an A.E.D.
1. The Splash Test
While most of our training takes place in a classroom (or your own lounge) it’s a fact of life that this is seldom where we find our patients – unless you’re a school nurse, in which case ‘welcome!’. Mostly we’re going to find patients under the worst kind of conditions. After all, that’s when the accidents happen. When it’s dark and cold and raining…..
A.E.D.s use electric current. Rain is wet. These two don’t play nicely together. While it may be acceptable for things to be a little damp, if you kneel next to the person and there’s a ‘splash’ then you have to move them. There’s chance the current won’t go where you want it (into their heart) and it might even go somewhere you really don’t want it – like your knees (read this to find out what would happen!). If they’re in a puddle, move them. The same consideration applies to pool-side events, beaches, etc.
2. Remove Clothes – they get in the way
It might not matter at the pool or beach, but for much of the rest of the time, people wear clothes. Now from an A.E.D. & safety point of view, you could easily argue that people should walk around topless – but remember that the people who need a defibrillator are generally in their advanced years. Yes, exactly. So for everyone’s benefit, every A.E.D. bag should also contain a pair of scissors. When you attach the A.E.D. pads, they have to stick firmly to skin, not clothing. The clothing must be removed and scissors are generally the fastest way to do this. (See also point 8, about bears.)
3. Remove Medication too
(Not with scissors – it would leave a mark.) Generally, once the clothing has been moved out-of-the-way, if you see medication patches on the now exposed skin, they have to be moved. This doesn’t mean a cavity-search to try & find something, but anything you see has to go. Do so carefully and without getting medication on yourself. This is because electricity and nitroglycerin (in some heart medication patches) also do not play well together.
4. Don’t remove Pace-Makers
OK, so they’re surgically implanted, you can’t remove them without doing some damage. However you might find them once you’ve removed the clothing. They’re most easily recognised as a surgical scar on the front of the left shoulder, under the collar-bone. You may also see/feel a small square-ish lump under the skin. If you’ve got to the point where you’re applying an A.E.D. then the pace-maker clearly isn’t working! Go ahead and use the A.E.D. if appropriate. Just don’t put the pads over the pace-maker. There’s a reasonable chance that the device could be repaired, unless of course you fry it with electricity. (The same would apply to an implanted defibrillator that’s not working, and no you probably won’t know the difference.)
5. Don’t Touch the Casualty
Well… touch them to start with, you should have been doing C.P.R. while you were waiting for the defib. Don’t touch them once it’s time to deliver the shock. We wrote about what would happen in another post, briefly the person who did this said “It threw me across the room until I hit the wall. I couldn’t walk on that leg for several days.” Good enough for us! Also make sure no-one else is touching the casualty before you press that ‘shock’ button.
6. Don’t Defibrillate People who don’t need it
You should know this. If it wasn’t already clear, then you should take a training course so you know when to use the A.E.D. and when not to.
7. Don’t Defibrillate Yourself
Read this instead. It’s slightly less painful.
8. Don’t Defibrillate Bears
We said in point 2 that the pads need to make skin-contact and stick well. If you put pads onto your bear-of-a-bloke casualty and the pads are floating around on his manly chest-hair, you need to get busy with the razor (yes, really – and there should be one in every kit). To answer a few of the questions we’ve had in class over the years:
- No, it doesn’t matter what colour the razor is
- No, we don’t use shaving foam
- Yes, just the area the pad will stick to – not the whole chest
- True, this doesn’t usually apply to children or women
9. Other considerations
Yes, you can use it on someone who is pregnant. They still need keeping alive as best as we can manage.
No, you shouldn’t use it on children under 1 year of age. Above that, use child-pads if they are available.
Other than that – go ahead and attach the A.E.D. to any patient it seems appropriate for. It will tell you if you shouldn’t be shocking the casualty. Of course if you don’t know who it’s appropriate for…
10. If you’re not trained
Try to find someone who is. Whoever has the A.E.D. should hopefully have trained staff.
Otherwise – take a course!