5-1 SEMI-AUTOMATED EXTERNAL DEFIBRILLATOR USE

General Considerations

• Take body substance isolation precautions en route to the scene.
• Initiate immediate ALS backup as appropriate
• Preparation for transport of patient should begin immediately as staffing allows.
• The patient should be transported when one of the following has occurred:
• The patient regains a pulse
• Two (2) shocks have been delivered by EMS staff
• Per medical control recommendation
• All contact with the patient must be avoided during analysis of rhythm and delivery of shock(s)
• Do not apply AED in children under 1 year of age. If patient is under one year of age, begin CPR and transport. Contact medical control for further instructions.
• A pediatric capable AED is preferred for age 1-8 years. However, a standard AED may be used if it is the only one available.

AED Application by Age

• Age 1 through 8 years
  • Perform CPR for 5 cycles (about 2 minutes) before undertaking other actions
  • Apply AED, using a pediatric capable AED if available
  • If only standard AED available, it may be applied. It is recommended to place the patches in anterior-posterior positions to avoid arcing.
• Age > 8 years
  • Apply standard AED

Resuscitation (EMS Provider)

1. Arrive on scene and perform initial assessment
2. Stop CPR if in progress
3. Verify pulselessness and apnea
4. If no CPR (or poor quality CPR) performed prior to your arrival and response interval from time of collapse is:
   1. Less than 5 minutes, the immediate priority is defibrillation
   2. More than 5 minutes, perform two (2) minutes of CPR prior to defibrillation.
5. If three or more shocks have been given by PAD and patient remains pulseless, consider one additional shock if indicated and begin immediate transport.
6. AED Activation and Use
   1. Attach and activate defibrillator
   2. Stop CPR
   3. Clear patient
   4. Initiate analysis of rhythm
   5. If AED advises shock:
      1. Deliver shock
      2. Immediately begin CPR and prepare for immediate transport
   6. After 2 minutes, stop CPR assess ABC’s
   7. If no return of carotid pulse, allow AED to re-analyze
   8. If shock advised, deliver shock and perform two minutes of CPR
   9. The sequence of two (2) minutes of CPR followed by one shock may be repeated a maximum of three times.
   10. After two shocks no delay should be made remaining on the scene. This may require the third shock being performed in the ambulance.
   11. If after the shock, patient exhibits signs of life (spontaneous respirations, purposeful motor activity) stop CPR and assess ABC’s.
   12. If breathing adequately, Administer high concentration oxygen by non re-breather mask and transport promptly
   13. If not breathing adequately, artificially ventilate with high concentration oxygen, transport promptly (consider insertion of advanced airway here).
   14. If AED advises no shock:
       1. Resume CPR and begin immediate transport
   15. After two minutes of CPR allow re-analysis
       1. If shock advised, deliver shock.
       2. If no shock advised for the second time, resume CPR and begin immediate transport.
   16. Consider insertion of an advanced airway when appropriate
       1. Airway should be inserted while chest compressions continue
   17. Once airway is in place, ventilations should be made at the rate of 8-10 per minute and CPR should be performed for two minutes between re-analyzing or pulse check.
   18. If at any time during transport pulses are lost, restart protocol.
7. Medical Control should be contacted as soon as possible to discuss further treatment option including termination of resuscitation.
8. If ambulance not at scene continue the sequence of two minutes CPR followed by analysis for as long as shockable rhythm persists or until transport becomes possible.

Document

• Clinical assessment
• Whether arrest was witnessed or un-witnessed
• Presence of by-stander CPR
• Defibrillator use including PAD
• Resuscitative measures and response
• Communication with medical control