Who Should You Not Use an AED on: Understanding the Exceptions

Who Should You Not Use an AED on: Understanding the Exceptions

Automated External Defibrillators, or AEDs, are life-saving devices designed to shock the heart back into a normal rhythm during sudden cardiac arrest (SCA). They are incredibly effective and are becoming more common in public places like airports, schools, and shopping malls. However, despite their widespread use and critical function, there are specific situations and individuals on whom an AED should not be used. Understanding these exceptions is crucial for anyone who might encounter a medical emergency and consider using an AED.

The Primary Contraindication: A Person Who Is Conscious and Breathing Normally

The most important rule to remember is that an AED is intended for individuals who are experiencing sudden cardiac arrest. This means the person is:

• Unresponsive: They do not react when you tap them or shout at them.
• Not Breathing Normally: They are either not breathing at all, or they are gasping irregularly.

You should absolutely NOT use an AED on someone who is conscious and breathing normally. Applying an AED to someone whose heart is already beating effectively could be harmful and unnecessary. The AED's primary function is to detect and correct specific life-threatening arrhythmias (abnormal heart rhythms) that cause cardiac arrest. If the person is awake, talking, and breathing without difficulty, their heart is functioning as it should, and an AED will not help them. In fact, it could potentially disrupt their normal heart rhythm.

Specific Scenarios and Individuals to Avoid Using an AED On

While the conscious and breathing individual is the most prominent exception, there are other, more specific circumstances where AED use might be inadvisable or require extra caution. These are less about direct contraindication and more about potential complications or situations where the AED might not be effective or safe to use.

1. Individuals with a Pacemaker or Implanted Cardioverter-Defibrillator (ICD):

   If a person has a pacemaker or ICD implanted, you can still use an AED, but you must take precautions. These devices are implanted under the skin, typically on the upper chest. The AED's electrical shock can interfere with the functioning of these devices. If you need to apply AED pads:

   • Do NOT place the AED pad directly over the implanted device.
   • Try to place the pads at least one inch away from the device.
   • If the device has a palpable lump, place the defibrillation pad to the side of it.

   If you are unsure, it is still better to attempt resuscitation with the AED, following the device's prompts, while being mindful of the device's location. The risk of not using the AED on someone in cardiac arrest outweighs the potential risk of interference.

2. Individuals in Water:

   Water conducts electricity. If the person is lying in a puddle of water, or if there is standing water around them, it is dangerous to use an AED. The electrical shock could spread through the water and injure rescuers or bystanders. You must move the person to a dry area before applying the AED. If the person is wet, dry their chest as much as possible before attaching the pads.

3. Individuals on a Metal Surface or Conducting Material:

   Similar to water, being on a highly conductive surface like a metal surface or a wet surface can increase the risk of electrical current spreading. If possible, move the person to a non-conductive surface, such as a wooden floor or a blanket. Again, the priority is to attempt resuscitation, so if moving them is not feasible, proceed with caution, ensuring rescuers are not in direct contact with the conductive surface.

4. Children Under 8 Years Old or Weighing Less Than 55 Pounds (Infants and Young Children):

   Most standard AEDs are designed for adults. For infants and young children (under 8 years old or weighing less than 55 pounds), it is recommended to use pediatric pads or an AED with a child-mode or attenuator. These devices deliver a lower dose of electrical energy. If pediatric pads are not available, and the AED does not have a child mode, you can use the adult pads. However, ensure the pads do not touch each other on the child's chest. Place one pad on the center of the chest and the other on the center of the back.

   Crucially, even for children, if they are unresponsive and not breathing normally, an AED should be considered if available and deemed necessary by the device or trained responders. The "should not use" here is more about using the correct type of pad/setting for optimal safety and effectiveness.

5. Individuals Who Are Clearly Deceased:

   This may seem obvious, but it's important to state. If a person is clearly deceased (e.g., rigor mortis, decomposition), an AED will not be able to revive them. The purpose of the AED is to restart a heart that has stopped due to SCA, not to bring someone back from definitive death.

When in Doubt, Use the AED

It is vital to reiterate that the vast majority of people you will encounter needing an AED are in sudden cardiac arrest. These individuals are unresponsive and not breathing normally. If you are unsure about whether to use an AED, it is almost always better to err on the side of caution and use it. The AED itself is designed to analyze the heart rhythm and will only advise a shock if it detects a shockable rhythm. The prompts from the AED are your guide.

The primary goal in any emergency is to help the person. An AED is a tool to potentially save a life. Hesitation due to fear of making a mistake can be more detrimental than using the AED when it might not be strictly necessary, as the device will guide you.

Frequently Asked Questions (FAQ)

Q1: How do I know if someone needs an AED?

You should consider using an AED if you find someone who is unresponsive and not breathing normally. Look for signs of sudden cardiac arrest: the person does not respond when you tap them or shout, and they are not breathing or are gasping irregularly.

Q2: Why shouldn't I use an AED on someone who is conscious?

An AED delivers an electrical shock to correct specific life-threatening heart rhythms that cause sudden cardiac arrest. If someone is conscious, talking, and breathing normally, their heart is already beating effectively. Applying an AED in this situation would be unnecessary and could potentially disrupt their normal heart rhythm.

Q3: What if the person has a pacemaker? Can I still use an AED?

Yes, you can still use an AED on someone with a pacemaker or ICD, but with caution. Avoid placing the AED pads directly over the implanted device. Place the pads at least one inch away from the device to minimize interference. The AED will analyze the heart rhythm, and it's generally better to attempt resuscitation than to withhold it.

Q4: What should I do if the person is wet?

If the person is wet, it's important to dry their chest as much as possible before applying the AED pads. Water conducts electricity, so drying the chest helps ensure the shock is delivered effectively to the heart and reduces the risk of the current spreading to rescuers or bystanders.