Early Defibrillation and
the EMT-Basic
Temple College
EMS Professions
Rationale

Most frequent initial rhythm in
adult cardiac arrest:
ventricular fibrillation
Rationale

Most effective
treatment for
VF: defibrillation
Rationale

Increased VF time = Decreased
survival probability
1 minute of VF =
~10% decrease in chance of
survival
Rationale


BLS cannot convert VF to
normal sinus rhythm
BLS only increases time
available to defibrillate
Principle of Early
Defibrillation
All personnel who respond to
cardiac arrests must be trained to
operate, equipped with, and
permitted to operate a defibrillator
Automatic External
Defibrillators
AED Definition

External defibrillator that
incorporates rhythm analysis
system
AED Types
Fully
Automatic
SemiAutomatic
Operational Steps
Assess scene, patient
Confirm cardiac arrest
Turn on power
Attach device
Initiate rhythm analysis
Deliver shock if indicated
Standard Procedures

Assess scene for safety
• Water
• Explosive atmosphere
• Patient on conductive surfaces
Standard Procedures
Do NOT use AED if patient is:
< 8 years old
Weighs < 55 pounds
Standard Procedures

Assess patient
• ABCs
• Presence of transdermal
medication patches (nitro patches)

Confirm arrest
• Unresponsive
• Apneic
• Pulseless
Standard Procedures




Start BLS
Attach defibrillator
Do NOT waste time setting up
O2, suction, IVs, etc.
Place pads in Lead 2 position
Standard Procedures



Stop CPR, analyze rhythm
Avoid patient contact during
analysis
If machine says “shock,”
• “Clear” patient
• Deliver shock
• Immediately reanalyze
Persistent VF



3 “stacked” shocks, no pulse
checks in between
If unsuccessful, 1 minute of
CPR
Then if no pulse present, 3 more
“stacked” shocks
Persistent VF



Always shock in sets of 3
Whenever chest is touched after
initial assessment, it should be
to perform CPR for 1 minute
Continue to shock until “no
shock indicated” message
received
Post-Resuscitation Care





Continue to support airway,
ventilation
Supplemental O2
Clear airway if vomiting occurs
Monitor vitals
Stabilize, transport, meet ACLS
team
Skill Maintenance

Practice
• Drill at least monthly
• Rotate responsibility for checking
machine
Quality Assurance

Case-by-case review of AED use
• Written report
• Voice/ECG recording
• Code summary tapes
Quality Assurance

System
• Frequency of use
• Success rates
• Early defibrillation may not be
effective in systems with
• Long response times
• No bystander CPR
• Delayed ALS follow-up
Public Access
Defibrillation
Summary
Shock Early and
Shock Often!