Automated external defibrillators (AEDs) are appearing all over the UK, in both the workplace and public spaces. These machines are designed to treat patients suffering from a sudden cardiac arrest (SCA) as quickly as possible, vastly increasing their chances of survival.
However, many people are unsure about these machines and don’t know whether they need to have special training in order to operate them. Some people are concerned that incorrect use of an AED could do more harm than good, leading to loss of life of the patient and potentially even legal action against them. So do you need special training to operate an AED?
Anyone can use an AED
Although specialist AED training is available, and AED use is covered in all one day emergency first aid at work and three day first aid at work courses, it is important to remember that anyone can used an AED to save a life. If there is no trained person available at the time of the incident, it is better to use the machine as an untrained operative, than to not use it at all. The machine will take you step by step through the process so you just need to follow the instructions. You cannot make the patient’s condition worse and you cannot administer a shock that they do not need.
Resuscitation Council guidance
The Resuscitation Council state that ‘the use of AEDs should NOT be restricted to trained personnel’. Their published guidance says that although it is ‘highly desirable’ for people using an AED to have been trained in their use, there are often situations where no trained operative is present. Their advice is that ‘under these circumstances no inhibitions should be placed on any person willing to use an AED’.
The HSE agrees with the Resuscitation Council that AED equipment ‘is safe to use and can be readily used by untrained bystanders’. However, they also ‘welcome the presence of awareness training in first aid courses, as it instils greater confidence in the use of AEDs’.
The HSE guidance on defibrillator training goes on to say that ‘if your needs assessment identifies an AED need then we recommend your staff should be fully trained in its use’.
British Heart Foundation guidance
The British Heart Foundation recommend signage ‘designed to reduce the fear of using the defibrillator and encourage more people to use a defibrillator in an emergency’. Their downloadable Defibrillator / Heart Restarter sign clearly states that ‘anyone can use it, no training necessary’.
The benefits of training
As mentioned above, time is of the essence in an SCA situation, and literally every second counts. So having trained personnel, who are familiar with the AED equipment and know how to use it, can shave vital minutes off the time it takes to apply the required shock.
Training will make the operator more confident and competent, and crucially faster, in the use of the AED machine, and this will make their intervention more efficient and effective. Trained personnel are also more likely to step in straight away, where others may be more reluctant to get involved, once again saving vital minutes.
There are three levels of competence for AED operators.
- Untrained operator
- If you have no training at all, you will still be able to operate the machine in an emergency situation. Automatic external defibrillators are designed to be as easy as possible to use, and the machine will walk the untrained user step by step through the process using both auditory and visual cues. Some AED machines will deliver the shock automatically, while others require the operator to trigger the shock via a button. The equipment monitors the heart rhythm and will only deliver a shock if it is medically needed.
- Awareness trained operator
- All One Day Emergency First Aid at Work courses, and Three Day First Aid at Work courses will cover the essentials of AED use. This is called AED Awareness Training and is aimed at familiarising the candidate with the machine and its operation.
- Fully trained operator
We would always recommend as part of any company needs risk assessment that staff are FULLY TRAINED in the operation of an Automated External Defibrillator. In
- Bespoke AED Training will cover both the condition of sudden cardiac arrest and the use of an AED defibrillator machine in depth, including:
- The anatomy and physiology of heart conditions
- Treatment of an unconscious casualty
- How to open an airway and check for breathing
- How to perform CPR on a non breathing casualty
- How to check and maintain an AED machine
- What to check before using an AED
- How to use an AED
This two hour training course gives the candidate a comprehensive overview of the machine, how the AED defibrillator operates and its use. It will also cover other equipment that should be kept with the AED which is essential.
- Scissors/Cutting Shears You will almost certainly need to remove clothing rapidly in the case of an SCA. A pair of good shears such as tough cut scissors
- Razor A good quality disposable razor may be required in the case of a male with a hairy chest, as in this particular scenario there is the possibility that the pads may not stick to the chest. Quickly shaving a patch of the chest will enable the pads to stick to the casualty’s chest
- Small towel/flannel It is common for a casualty suffering a heart attack to sweat profusely and the chest must be dry to make sure the pads stick to the casualties chest.
It will cover a step by step process of actions that need to take place if an AED should be needed. This course is aimed at appointed first aiders and should be considered as part of the risk assessment for any company or organisation which is installing AED equipment.
This training can be delivered in-house, allowing staff to practice the techniques within the actual environment in which they will be used, making the training more relevant and effective.
Regular refresher training
A cardiac arrest is a very stressful situation, especially when it involves a close colleague or friend, and it is only natural that even the best trained people will struggle and perhaps panic under such pressure. This is why regular AED training is recommended, and regular drills should be performed within the organisation, so that the appropriate reactions become second nature for nominated first aiders.
What is Sudden Cardiac Arrest?
An SCA occurs when the heart’s normal, regular rhythm becomes disrupted. This is known as ventricular fibrillation and prevents the heart from acting as a pump. The resulting lack of blood supply to the brain can be fatal in just a few minutes.
An AED administers an electric shock to re-establish a regular heart rhythm and get the heart pumping blood around the body once again. Contrary to popular belief, a defibrillator cannot restart a heart that has stopped beating (known as an asystolic rhythm or flat-line).
Sudden cardiac arrest should not be confused with a heart attack, as this is a different condition entirely. A heart attack, or myocardial infarction, the blood vessels supplying the heart muscles become blocked and this restricts their ability to pump the blood.
The British Heart Foundation estimates that around 80,000 SCAs occur in the UK every year, with three quarters of these occurring outside of the hospital environment where prompt, professional help would be available. It is estimated that the Ambulance Service in England attempts 25,000 resuscitations every year, but only a few of these patients survive.
The ‘chain of survival’
The problem with most SCAs is that the ambulance service simply cannot attend fast enough to make a difference. If defibrillation is applied within the first three to five minutes, survival rates can be as high as 75%, however the chances of survival drop by 7%-10% for every minute of delay after this. Even if you live or work close to an ambulance station, three to five minutes is an almost impossible deadline for the paramedics. With an AED on hand, however, defibrillation can easily be applied within this window.
To increase the chances of survival, first responders must apply what is known as the chain of survival. This involves:
Step 1: Early access & recognition being able to recognise someone is in cardiac arrest and getting assistance.
Step2:Calling an ambulance without delay but ideally should be done by someone else while you look after the patient
Step 3: Performing basic CPRchest compressions will not only keep blood flowing to the brain, but also keep the heart in a shockable rhythm
Step 4:Using an AEDthis should be done as soon as possible, but you should not leave the patient or stop CPR to fetch the device. You should get someone else to fetch it for you
If the chain of survival is followed, then the chances of a positive outcome increase significantly.
Does your organisation need an AED?
There is currently no legislation that compels a company or organisation to install AEDs on their premises, and a recent survey of 1000 businesses found that less than half had installed such equipment.
Part of the reason for this is that cardiac arrest is more common in older people, and in the past, this has not been the demographic of the UK workforce. However, with the extension of the retirement age, more and more older people are staying in the workforce for longer and so this demographic is changing. This increases the risk of SCA in the workplace and thus the need for AEDs and for staff trained in their use.
While AED provision is not compulsory, employers do have a duty of care for their employees, customers and other visitors, and it could be argued that this duty includes providing life saving equipment. Sadly, in many cases, AEDs are not installed until their need is demonstrated the hard way, with the loss of a life.