1. Heartsaver AED for the Lay Rescuer and First Responder
1998 American Heart Association

2. Extent of the Problem 1.1 million heart attacks
480,000 deaths due to coronary heart disease
250,000 prehospital cardiac arrests
Discuss the scope of the problem and the importance of the role of Heartsaver AED providers. Explain that they provide three very important interventions:
Calling EMS
Performing CPR
Using the AED

3. Chain of Survival
Discuss each link in the Chain of Survival and explain that Heartsaver AED providers account for three links in the chain:
Early access to EMS
Early CPR
Early defibrillation
Early Early Early Early Access CPR Defibrillation Advanced Care

4. Recognize Emergency and Call 911
Airway obstruction
Universal distress signal, blue skin
Respiratory arrest
Not breathing but has pulse
Cardiac arrest
Not breathing and no pulse
Briefly discuss the recognition of common cardiovascular emergencies and the importance of early access. Do not spend too much time explaining these conditions.

5. Activate EMS Know your local EMS number Give the location of call
Telephone number
The nature of the emergency
Advise that AED is on the scene
Don’t hang up until dispatcher advises
Review the steps for contacting EMS and the information to provide. Explain that dispatcher-assisted CPR and AED operation may be available in an EMS system to help the rescuer. Provide an example of how the rescuer may express the important information.

6. Signs of Cardiac Arrest
Unresponsive
Not breathing
No pulse
Explain the importance of assessment.
Provide rescue breathing only when there is no breathing
Perform compressions only when there is no pulse
Use the AED when there is no breathing or pulse

7. AEDs and Ventricular Fibrillation
VF is the most frequent initial rhythm in sudden cardiac arrest
VF is a useless quivering of the heart that results in no blood flow
Defibrillation is the only effective treatment for VF
Successful electrical defibrillation diminishes rapidly over time
Explain the importance of defibrillation in the treatment of VF and that CPR alone cannot convert this rhythm.

8. Time and AEDs Approximately 50% survival after 5 minutes
Survival reduced by 7% to 10% each minute
Rapid defibrillation is key
CPR helps extend survival time
Explain the importance of time. Emphasize the importance of attaching the AED as quickly as possible (in less than 90 seconds of placement of the AED next to the victim).
minutes

9. Priorities and the AED A – Airway B – Breathing C – Circulation
D – Defibrillation
Explain the importance of a systematic approach guided by the ABCD structure.

10. AEDs and Personnel One rescuer Two rescuers More than two rescuers
Unresponsiveness – Call 911 – Get the AED
Assess Breathing/Pulse
Attach AED
Two rescuers
#1 – Call 911/Perform CPR
#2 – Attach AED
More than two rescuers
#1 – Call 911
#3 – Perform CPR
Discuss the varying roles of one rescuer versus two or more rescuers. Emphasize that EMS must be called first and that the ABCD approach should guide you through the sequence.

11. Special Considerations
Is victim lying in water?
Is victim less than years old?
Is victim wearing a transdermal medication patch on his or her chest?
Does victim have a pacemaker or implanted defibrillator?
Explain the rationale behind these special considerations and how they play an important role in the safety of the victim, bystanders, and rescuers.

12. Operation of AED POWER ON the AED ATTACH pads ANALYZE rhythm
SHOCK (if advised)
Explain the simplicity of using the AED and demonstrate the operation of the specific AED that the rescuers will use in their system.

13. Electrode Pad Placement
Right electrode pad
To the right of the breastbone
Below the collarbone above the right nipple
Left electrode pad
Outside the left nipple, upper edge of the pad several inches below the left armpit
Show placement of pads using the slide and a manikin.

14. Effective Adherence of Pads
Sweaty chest
Dry with a towel
Do not use alcohol
Hairy chest
Shaving may be needed
Explain how to prepare the chest to ensure effective pad adherence. Explain that this may not be necessary in all victims and that it must be done very quickly to avoid delay in defibrillation.

15. AED Safety No patient contact during analysis and shock
Warn bystanders:
“I’m clear”
“You’re clear”
“Everybody’s clear”
Perform a visual inspection
Press to shock
Emphasize the importance of safety and clearing the victim. It requires both verbal communication and visual inspection of the victim.