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Many registered nurses have not received training in managing out of hospital medical emergencies. This article is the second of a four-part series on basic life support and explains how to use an automated external defibrillator

Many nurses will be familiar with the defibrillator on a resuscitation trolley in hospitals but may be less confident to use one as part of a resuscitation attempt outside of the hospital setting. This article, the second in a four-part series on basic life support, describes how to use an automated external defibrillator. Part one described how to perform cardiopulmonary resuscitation.

Citation: Hammett E (2021) Out-of-hospital resuscitation 2: automated external defibrillator. Nursing Times [online], 117: 10, 42-44.

Author: Emma Hammett is chief executive officer, First Aid for Life.

More than 30,000 people in Britain every year have a cardiac arrest in the community (British Heart Foundation, 2014). The London Ambulance Service NHS Trust (2019) reported that, in the year 2018-2019, 73% of out-of-hospital cardiac arrests happened in private locations (at home or in care homes) and 27% occurred in a public place. It is vital that anyone experiencing a cardiac arrest receives immediate, appropriate treatment with effective cardiopulmonary resuscitation (CPR) and automated external defibrillation.

Immediate, effective CPR improves survival and post-arrest quality of life (Perkins et al, 2016). Research has shown that deploying an automated external defibrillator (AED) within 3-5 minutes of collapse can result in survival rates as high as 50-70% but each minute of delay to defibrillation, in patients with a shockable rhythm, reduces the probability of survival to hospital discharge by 10% (BHF, 2017). Historically many registered nurses were not taught first aid, but this is changing as the Nursing and Midwifery Council (NMC) (2018) now requires that nurses learn skills in basic physical first aid.

This series provides an update on basic life support for out-of-hospital cardiac arrest and adheres to Resuscitation Council UK (RCUK) guidance by Perkins et al (2021). Management of cardiac arrest in patients with known or suspected Covid-19 is not included in the updated RCUK resuscitation guidance and is covered separately in a Covid-19 statement as seen in part 1 of this series (Hammett, 2021). It is important that nurses are also aware of guidance from the NMC (2017) and the Royal College of Nursing’s duty of care for nurses to act as a “good Samaritan”, which are outlined in Part 1.

The contraction and relaxation of the heart is regulated by electrical impulses originating in the sinoatrial node. The heart usually pumps at a regular rate of 60-100 beats per minute. Abnormal heart rhythms can occur for a number of reasons including in response to myocardial infarction and cardiomyopathies (Jarvis, 2021). Some rhythms, such as ventricular tachycardia (VT) and ventricular fibrillation (VF), interfere with the effective pumping of blood around the body and can lead to collapse and loss of life. Jarvis (2021) provides an overview of cardiac rhythm and conduction abnormalities.

An AED uses an electrical current to depolarise the electrical system of the heart. This enables the natural pacemaker of the heart, the sinoatrial node, to resume control and return the heart to sinus rhythm – similar to rebooting a computer.An AED will only allow you to administer a shock when someone is in VF (Fig 1) or VT (Fig 2). It will not advise a shock if the casualty is in sinus rhythm or asystole, where no pulse is present (Fig 3).

AEDs are accessible at numerous locations, including: train and tube stations, shopping centres, dental and GP practices, sports grounds and leisure centres. They are designed so any member of the public can use them, and may be:

In the UK, there are no legal restrictions on using an AED. A rescuer, whether a trained first aider or an untrained member of the public, who has acted to the best of their ability to help a person in cardiac arrest, should not be sued when using an AED, no matter what the outcome.

Ambulance services should have information on defibrillator locations, either through regional databases or national databases (Perkins et al, 2021). Various apps, such as PulsePoint AED and GoodSAM, can also be used to locate your nearest defibrillator. Examples of location signs for an AED are shown in Fig 4.

When you find a collapsed casualty you must consider the following:

When the AED arrives, it should be activated by opening the lid or pressing an obvious button. It will then provide verbal or visual instructions. The AED should come with pads, scissors, a pocket mask, razor and something to dry the chest.

One should continue with CPR, while the other:

If you realise you have put the pads on the wrong way round, do not remove them as the AED will still work; if the AED offers a trace, this may appear upside down, but this will not affect the functioning of the machine.

Electric shock – the risk from an AED is extremely small, however, it is always sensible to check no one is touching the casualty when the shock is given;

Jewellery – avoid placing the pads over metal jewellery, as it can conduct electricity and burn the casualty. Jewellery does not need to be removed;

Medication patches – remove any obvious medication patches on the casualty’s chest and do not place pads over them. Glyceryl trinitrate patches (which are used to treat angina) could explode if a shock passed over them;

Implanted devices – most pacemakers are on the left-hand side of the chest. Do not place pads over strange bumps or scars, which may indicate the location of an implant;

Breast tissue – ideally pads should not be placed directly on breast tissue as this could reduce the conduction;

Flammable atmosphere – turn off any piped oxygen because of the risk of fire, or put it at least two metres from the casualty while shocking. Do not use an AED in the presence of petrol fumes.

When the paramedics arrive, they will need to know:

It is normal to feel any of the following;

Dealing with a medical emergency in an unfamiliar situation can be extremely stressful and it is important to remember that some people need professional help and counselling after such an episode.

This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.

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