Where’s the AED (Automated External Defibrillator)
When someone has a cardiac arrest and isn’t breathing, you should start CPR immediately, then send someone to fetch the AED.
Not all AEDs have locked cabinets, so you may be able to just pull open the door.
Some of the locked units have quite a lot of writing on them and you could be in panic mode, so may not see, “Call 999 for the access code”
Once you’ve dialed 999/112, you’ll be able to open the door. If you’re not by the cabinet, they’ll tell you if there’s a unit within a few minutes of where you are.
Take the AED out of the cabinet.
Switch ONPULL to activate
Once you’re back with the casualty, open the unit, unzip, pull the lever, switch it on if necessary.
Follow the voice instructions and do whatever they say.
Remove Clothing
Remove all clothing from the casualty’s chest, cutting it off if necessary.
Most AED packs include a set of heavy-duty shears, these will easily cut through cloth and underwired bras.
If there are bystanders, get them to hold up a blanket, rug or towel to preserve the casualty’s dignity.
Once you’ve removed the clothes, wipe dry the skin.
Look at the pads to see where they need to go, if the casualty has a lot of chest hair, be prepared to shave it.
There’s a razor in the pack, use it to clear the areas where the pads are to go.
Remove the pads from the backing and place them as shown in the diagram on the reverse side.
Don’t worry if you get them mixed up, they’ll work just as well in either position.
Before placing the pads, make sure they’re not touching any metal or jewellery, including piercings.
Remove all patches and plasters and avoid placing the pads over existing internal pacemakers or defibrillators. (If there’s an internal defibrillator beneath the skin, it has failed, so continue with pad placement adjacent to it)
Attach the Pads
Once the pads are attached, the AED should now be giving you further instructions.
If you’ve already been performing CPR it will tell you to stop and not touch the casualty, while it analyses their heartbeat.
Following a cardiac arrest, the heart won’t be beating normally, it will be quivering or fibrillating.
The AED will detect this, but if someone is touching them it will detect their pulse and stop the defibrillator from shocking.
When the AED has stopped analysing, having failed to find a heartbeat, it will tell you the patient needs a shock.
Deliver a shock
Some AEDs deliver this automatically, but others require the person using it to press a button to deliver the shock.
When you’re told the shock’s been given, if the heart hasn’t restarted, you’ll be instructed to begin CPR again.
The unit will give you the option to follow instructions for this and give you a rhythm to follow for the correct rate of compressions.
You should follow the audible instructions from the unit, administering CPR and shocks as directed.
Always continue this until medical professionals tell you to stop, the casualty comes round and makes definite signs of life, or you’re just too exhausted to carry on and there’s nobody to take over from you.
If the casualty comes around, never remove the pads, they could easily have another arrest. Because they’re single use they can’t be reattached.
Myths about defibrillators.
They start the heart – defibrillators stop the heart from quivering or fibrillating. This allows the heart to naturally “reboot” into a normal rhythm.
The casualty can be harmed by an AED – The person is clinically dead, you can only help them
You can be shocked by an AED – You can only shock someone if there is no heartbeat, this why it’s important not to touch them when the device is analysing.
You may not remember the days of the “Generation Game” on television, when Bruce Forsyth would bring on an expert with an unusual skill.
The contestants would watch a demonstration of the person’s talent, not always terribly complex.
It could be throwing a clay pot on a potter’s wheel, filling sausages, or learning a few dance steps.
Whatever the task they’d be asked to replicate it, after seeing it done once.
The fun then commenced, with the additional pressure of doing it in front of an audience.
Adrenaline rushes and panic sets in, laughter from the audience results in few of the contestants carrying out the task successfully.
If you compare this to learning basic life-saving skills, watching it done, is not enough.
Show a group something and ask them if they can repeat it? The majority will confidently say yes.
Testing beliefs
Stress test it, by getting them to actually do it, and more often than not, the answer is a definite no.
As a trainer I’ve noticed you can show learners things, but there really is no substitute for doing it.
For instance, putting someone in the recovery position, they invariably forget some of the steps.
However, given the opportunity to practice it, they become more confident and soon competent.
Learning from a screen
Increasingly we use video as a teaching resource and it has its place as a teaching aid.
But it cannot provide the feel of how hard and deep you must push on the chest to achieve effective CPR compression.
Feeling the difference between using two hands to achieve compression on an adult compared to just two fingers on an infant.
Being able to watch the chest rise when you give rescue breaths, gives a great indication that you’d do it right in a real emergency.
If you’re in a restaurant and someone chokes, knowing where and how hard to slap them on the back and the sort of force it takes to give an abdominal thrust.
You must remember, like the generation game, your adrenaline will kick in. Not because you’re being watched by millions of people, wanting you to make a fool of yourself.
Because you will be dealing with a real life and death emergency.
Practice, practice, practice
Practice is the answer and the more often the better.
Although your certificate last 3 years, we recommend refreshing your skills at least once a year.
Why is 10pm on Christmas Eve a dangerous time for Swedes.
Swedish research led by Dr David Erlinge, from the Department of Cardiology, Clinical Sciences, at the Lund University looked at the frequency of heart attacks at holiday times.
They have concluded that, the average daily number of heart attacks increases from 50 to 69 a on Christmas Eve massive 37% increase. Most of these occur around 10pm, following a day of too much food and excessive drinking
You may ask why Christmas Eve? The simple answer, in Swedish culture they celebrate on the 24th of December, not Christmas Day as we do in the UK.
Christmas Day
Therefore, it’s not unreasonable to suppose that, 10pm on Christmas Day in the UK, may be the most likely time for Brits to be having heart attacks, too.
Seemingly it doesn’t get much better on Boxing Day either, the increase remains high at 22%.
But the big surprise was New Years Eve, with no appreciable increase, and heart attack symptoms probably masked by alcohol.
New Year
However, New Year’s Day the heart attacks again rose by 20%. Put down to after effects of too much alcohol and food, sleep deprivation and cold weather.
Dr. Erlinge said, “The peak is very pronounced, exactly on Christmas Eve and the following two days, so, I think it is something specific about the way we celebrate these holidays.
“We do not know for sure, but emotional distress with acute experience of anger, anxiety, sadness, grief, and stress increases the risk of a heart attack. Excessive food intake, alcohol, long distance travelling may also increase the risk.
“Interestingly, the pattern of increased risk in the morning which dominates the rest of the year was reversed at Christmas. With an increased risk in the evening, indicating that the stress and eating during the day triggered the heart attacks.
“People could avoid unnecessary stress, take care of elderly relatives with risk of heart problems and avoid excessive eating and drinking.”
Beliefs
The researchers believe that the emotional pressure of Christmas. Stress, anxiety, sadness, anger, grief, family disputes, financial worries and memories of lost relatives and friends, all contribute.
Of course, environmental issues such as the “flu” season will pay a part. Over 65s being most liable to succumb, especially if they have heart problems.
“People need to be aware of the increased cardiovascular risk associated with emotional distress and excessive food intake that may occur during large holidays. We also need to care more about our elderly and sicker friends and relatives,” added Dr Erlinge.
You’re in a training workshop and the facilitator asks if anyone has any questions. But no one wants to stand out from the crowd.
You know that you didn’t quite understand something, but nobody else has put their hand up and asked the “dumb question”.
So, you just sit there, in sublime ignorance, possibly never knowing the answer.
Psychologists call it “pluralistic ignorance”. Typically, the only person being hurt by not asking the question is you.
But could “following the crowd”, become a matter of life or death?
The British Heart Foundation carried out a survey discovering that 1 in 3 people wouldn’t attempt Cardio Pulmonary Resuscitation (CPR) on somebody who collapsed in front of them.
Some even admitted, they wouldn’t even call an ambulance, expecting someone else had already done so, a situation described as “diffusion of responsibility”.
Therefore, because nobody else is doing anything, bystanders assume, it can’t be that serious, so they needn’t get involved, either – “pluralistic ignorance”.
They frequently lack the confidence to help or feel under qualified to do anything at all.
The bystander effect
This inability to act, is commonly known as the “bystander effect”
However, in the cold light of day, following the incident, you’re likely to be overwhelmed with guilt, horrified and embarrassed that you failed to help.
Psychologists studied this bystander effect, and now believe that simply knowing that it happens, may well overcome its effectiveness.
With knowledge of this effect, they may now react differently and come to the aid of someone in trouble.
If you were on your own and someone collapsed, you’d probably help.
Being in a crowd you become immune to their distress, prepared to be a spectator.
So now you know – what are you afraid of?
There’s no shame in looking a bit silly if you’re the only one reacting.
Just stand and watch and you may feel guilty at not saving a life, learn what to do and you could do just that.
