Now I Know My AEDs : June 1-7 is National CPR and AED Awareness Week

[Lane Therrell FNP, MSN, RN, NP]

Long before I became a nurse, I was required to learn CPR. It's difficult to imagine now, but the CPR instruction I grew up with did not include the use of automated external defibrillators (AEDs). While I've been familiar with the basics of when and how to use AEDs since it became a standard part of CPR courses (after 1999), it wasn't until recently that I realized how very little I actually knew about AEDs besides where they fit into the chain of survival.

I recently attended a local medical industry trade show where I learned some important and interesting facts about AEDs, including their rich history, things to consider when purchasing and maintaining them, and the complex laws and regulations governing their use. This article includes some of the nuggets of wisdom I thought were worth sharing with other nurses, who may be like me in thinking they know about AEDs, when they really don't. June 1-7, 2018, is National CPR and AED Awareness Week.

Knowing where AEDs fit in the chain of survival and the basic skills required to operate these life-saving devices for emergent care is necessary. In addition to CPR basics, having some additional knowledge about AEDs boosts your nursing practice and the quality of care you provide. Additional knowledge is especially important if your role includes quality control at your facility or are part of the team that chooses or replaces medical equipment and devices in your organization.

As a nurse, you may find yourself advising individuals on how to use and choose AEDs, since the devices are available for home use. According to the American Heart Association, 70 percent of out-of-hospital cardiac arrests happen in homes.

AED Facts

Automated external defibrillators (AEDs) are medical devices that have become mainstays of modern healthcare. They are designed to deliver an electric shock to reestablish a normal heart rhythm in the event of sudden cardiac arrest.

Anyone who can follow simple directions can safely and effectively operate an AED, and as such they are intended for use by the general public.

• Statistics vary, but many people in the U.S. experience sudden cardiac arrest each year- the American Red Cross states the number is 350,000 while the American Heart Association offers a more conservative estimate of 250,000.
• The American Red Cross believes AEDs can save 50,000 lives a year.
• Time is of the essence when using an AED, in other words, defibrillation is most effective the sooner it is performed. This means the devices need to be readily available.
• The American Red Cross has a goal of ensuring that all Americans are within 4 minutes of an AED and someone trained to use it.
• AED devices are found in most public locations, including airports, community centers, schools, government buildings, gyms and more. In many locations, AEDs are required by law.

AED History

AEDs have a rich and fascinating history, which sets the stage for understanding how we use and regulate the technology. Here are some fascinating milestones in the development of these live-saving devices.

• Research leading to the development of AEDs began in 1775, when Nicolai Abilgaard demonstrated that electric shocks could kill chickens.
• Experiments by Prevost and Batelli in 1900 showed that stronger electrical currents than the ones used on the chickens could re-start, or defibrillate, dogs' hearts.
• In 1947 Claude Beck and his capable surgical team performed the first successful defibrillation on a human during surgery.
• In 1956, Paul Zoll conducted the first successful external, or non-surgical, defibrillation on humans. The Zoll brand of AED devices remains popular to this day.
• In the mid-1960's, Frank Pantridge made the first portable defibrillators.
• In the early 1970's, EMTs began using AEDs without physicians present.
• In the 1980s and 1990s, other first responders (not just EMTs) began to be trained in the use of AEDs .
• In the 1990s the US Food & Drug Administration (FDA) approved AED use by laypeople.
• In 1999, the American Red Cross began including AED training in basic CPR instruction courses.
• AEDs have been available for home use in the US since 2005.
• The American Heart Association, the American Red Cross, and the National Safety Council collaborated to create National CPR and AED Awareness Week in 2007 to promote public knowledge of CPR and AED use.

Choosing an AED

There are many brands of AED, and not all are the same. Even thought all AEDs available for sale in the US must be cleared by the FDA and are designed to help your organization stay compliant with local laws, regulations, and guidelines, AED designs and features vary widely. Certain devices will help meet your needs better than others.

Choice of device is driven by many factors, including the environment where it will be used. Some AEDs would be better suited for use at a public swimming pool, for example, than others. The first step in choosing an AED is being clear about your goals and specific needs. Beyond that, here are some additional questions and considerations when shopping for an AED.

If you are in the market for purchasing an AED, become knowledgeable. Ask around, do your research, and get testimonials to make sure you have the right AED for your facility's environment.

What is your budget?

AEDs can be expensive, and there will be ongoing maintenance costs (see maintenance section below). While there are numerous community-based local programs that may help support your initial purchase if you qualify, make sure you understand whether and how these programs can support ongoing maintenance expenses once you have the device in place.

What is the device's IP rating?

The ingress protection (IP) rating, also known as the international protection rating, is a way of classifying how resistant your AED device is to penetration by other objects, including fingers, dust, water, etc. IP codes are used across numerous industries, but understanding how they apply to AED devices can help you make better decisions about which AED is right for you. (See IP link below for a more detailed explanation). Does your device need to be waterproof, or would it be more useful if it was impervious to dust instead?

Does portability matter?

Size, weight, and ease of transport may be critical considerations in the environment where your AED will be used. Playing out various scenarios of how the device might be used can help clarify this consideration.

Is your AED device compatible with local EMS devices or other existing systems?

This may matter in certain local areas, so be sure to ask.

Can the brand you choose be updated to keep pace with regulatory changes and new technology?

Most can, but some are better than others. Ask the manufacturer before you make a purchase.

Maintaining an AED

AEDs require regular maintenance to ensure instantaneous proper functioning. As with any device or tool, some AEDs are easier to maintain than others. Long-term maintenance considerations should be a central part of any decision-making process.

Even home-use AEDs need to be maintained over time. Maintenance includes periodically replacing the batteries as well as the electrically conductive adhesive pads. An AED's pads need to be replaced periodically because they are composed of tin, which tends to degrade the adhesive gel over time.

Again, make sure your AED budget supports the ongoing expense of replacing pads and batteries as well as other accessories, like wall-mount brackets, signs, and labels, which may be required by law in your area.

Laws and Guidelines Governing AED Use

Federally, in the US, the FDA ensures that AED manufacturers comply with regulations governing medical devices. While the Occupational Safety & Health Administration (OSHA) recommends that AEDs be included as part of workplace first-aid kits, and that workers receive training on how to use them, there is no statutory requirement at this time.

Therefore, the legal requirements regulating AEDs and how they are used are under state control, and vary by location. This matters for nurses in all roles, especially those who travel or work in multiple states, or begin practice in a different state.

All 50 states in the US as well as the District of Columbia have specific AED laws in place that limit liability for providers of AEDs as well as rescuers using them. Most states also have other specific statutory requirements for AEDs. You can access state AED statutes on the National Conference of State Legislatures page. Knowing the AED laws in the local areas where you practice nursing is your responsibility.

Conclusion

Now that you know a little bit more about AEDs than how and when to use them, you'll be able to choose the right device for your facility, keep it in good working order, and save lives as needed. I hope this article has inspired you to expand your knowledge beyond basic CPR training and learn even more about AEDs.

Questions for discussion:

What else do you know about AEDs that's not covered in this article? Are you satisfied with your facility's choice of AED?

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Sources and Resources

AED Grant Questions & Answers - AEDGRANT.COM ~ FREE AED GRANT MONEY!!! ~ AED Grant for Individual, and organizations.

Find AED laws for all 50 states. Laws for AED's in your state and what you need to do to start an AED program.

Automatic External Defibrillation: Overview, History, Machine Mechanics

Safety and Health Topics | Automated External Defibrillators (AEDs) | Occupational Safety and Health Administration

Automated External Defibrillators (AED)

Automated External Defibrillators: How to Use an AED

Automated external defibrillators: Do you need an AED?

Automated external defibrillators: Do you need an AED? - Mayo Clinic

CPR and AED Awareness Week

Cardiac Arrest Statistics

Frank Pantridge

How Do I Choose Which AED is Best for Me?

http://www.aeduniverse.com/AED_Buyers_Guide_s/96.htm

IP Rating

Learn About Automated External Defibrillators

OSHA Requirements for AED

Pioneers in Cardiology: Frank Pantridge

State Laws on Cardiac Arrest and Defibrillators - National Conference of State Legislatures

[jason4546]

Thanks for all the info. About AEDs! Very informative. I have a basic question since I have never used this in an emergency. The AED is used when the patient has no pulse and is not breathing and in full cardiac arrest correct? I'm a nursing student so I just want to make sure. Thanks!

[Lane Therrell FNP, MSN, RN, NP]

This is an important question, and I'm so glad you asked. The short answer is: Look at where the AED fits into the 'Chain of Survival.' You may not always need to use an AED when you're administering CPR.

When you look at the 'Chain of Survival,' you'll see that AED use is the 3rd or 4th step in the chain (depending on how you count the steps). The circumstances you suggest in your question would indicate that you immediately get help and start CPR. Once you start CPR, you are constantly monitoring the patient's response. You may not need to use an AED every time CPR is required; early chest compressions may be enough. But in the event that chest compressions and breaths are not enough, the AED is an additional tool in your live-saving toolbox.

Incidentally, when you're trained on the use of an AED, you'll see that the machines are programmed to assess whether the patient needs the defibrillatory shock or not. So even when you get the AED out and hook it up to the patient, you may not actually administer a shock. It's nice to have the capability though, because emergency situations are fast and fluid.

It may be helpful for you to review in detail how AEDs fit into the 'Chain of Survival.' For a very thorough and excellent explanation of the chain of survival, check out this article: The Chain of Survival | Sudden Cardiac Arrest Foundation

The chain of survival is covered quickly and briefly at the beginning of most BLS CPR courses, so it can be easy to skip over, but it provides the context for where the AED fits into the progression of actions any first responder should take.

I hope this helped clear things up for you. Good luck in your nursing program, and keep asking questions. :-)

[jason4546]

Thanks so much for explaining it further! The article was also very helpful.