By: Mike McEvoy, PhD, REMT-P, RN, CCRN
Medical science says the most valuable EMS equipment your fire department could own is an automatic external defibrillator (AED). No other emergency medical device or procedure even approaches the proven benefits patients get from an AED. Three factors can erase the value of your AED(s): access, maintenance, and familiarity. If an AED is not there when you need it, if it doesn’t work when you want it to, or if your firefighters aren’t completely comfortable using it, then you may be shocked by poor outcomes.
An AED should be available to every trained and authorized firefighter at all times. Aside from EMS calls, your fellow firefighters are statistically the most likely to need defibrillation, typically during an emergency response. Every firefighter should know where every AED is and have access to one at all times.
Dead batteries are reported by the Food and Drug Administration (FDA) as the most common reason for AED device failure. Be certain that someone is assigned to check batteries and replace or recharge them according to the manufacturer recommendations. Most rechargeable AED batteries lose 1/30 of their life each day. This would dictate recharging at least every two weeks to ensure the unit is always ready. Many newer AEDs have long-life lithium batteries. These also require a watchful eye as temperature extremes and usage patterns can significantly affect useful battery life. Routine checks should include resetting the AED clock for daylight savings time changes and an inventory of supplies kept with the AED such as a towel, scissors, razor, and spare electrodes. As medical devices, AEDs must be inspected regularly (at least annually) by a qualified biomedical service technician. Documentation of preventative maintenance contracts and inspections are crucial in the event of an adverse patient outcome that is shown to result from mechanical failure of an AED.
Operator familiarity is the final element in ensuring the best bang for your buck. Each operator should be familiar enough with each machine to use it quickly and smoothly. This means practice, practice, and practice. Nothing looks better than a craftsman familiar with his tools, and nothing looks worse than an EMS provider unfamiliar with his-especially in a life or death situation. Drills should include routine and ordinary AED situations as well as commonly encountered quirks and special-use situations.
Medical device reports filed with AED manufacturers and the FDA highlight several training needs. These include failure of an AED to detect a shockable rhythm when rescuers continue to ventilate a patient during rhythm analysis. Emphasize that no one should touch the patient during analysis by the AED. Pacemakers and implanted defibrillators also confuse rescuers. Other than placing AED patches away from implanted devices, ignore them. An erroneous belief exists that certain medication patches (such as nitroglycerine) are explosive. The truth is that medication patches, like implanted pacemakers and other devices, are simply poor conductors. Either remove the medication patches or apply the AED pads elsewhere. Explosions, fires, and serious burns have been reported from use of AEDs near oxygen sources. This has serious ramifications for EMS providers using Bag Valve Mask (BVM) devices with oxygen reservoirs. Emphasize disconnection of the BVM and removal of oxygen sources from the immediate area of the AED pads during shock delivery.
Training should also prepare rescuers for defibrillation in water, rain, and wet environments as well as on metal surfaces. Rescuers should know how to dump a charge from their AED if they decide a shock should not be delivered. Firefighters should also be prepared to recognize and respond appropriately to official Do Not Resuscitate (DNR) orders.
As you can see, owning a defibrillator does not guarantee benefits to your patients. Access, maintenance, and familiarity will make sure that your outcomes only shock your patients.
Mike McEvoy, Ph.D., REMT-P, RN, CCRN, is the EMS coordinator for Saratoga County, New York. For the past 13 years, he has worked in the Cardiac Surgical ICU at Albany Medical Center. He teaches at Albany Medical College and lectures at hospitals, colleges, and conferences. McEvoy is a paramedic for Clifton Park-Halfmoon Ambulance Corps and medical advisor for the West Crescent (NY) Fire Department. He currently serves as a member of the New York State EMS Council and the State Emergency Medical Advisory Council and chairs the EMS Section of the New York State Association of Fire Chiefs. His first career was with the Justice Department as a forensic psychologist.
