AED Q&A

AED Frequently Asked Questions

What's public access to defibrillation?
Public access to defibrillation (PAD) means making AEDs available in public and/or private places where large numbers of people gather or people who are at high risk for heart attacks live.

What is an AED?
The automated external defibrillator (AED) is a computerized medical device.  An AED can check a person's heart rhythm.  It can recognize a rhythm that requires a shock.  And it can advise the rescuer when a shock is needed.  The AED uses voice prompts, lights, and text messages to tell the rescuer the steps to take.

AEDs are very accurate and easy to use.  Lay rescuers with a few hours of training can operate an AED safely.  There are many different brands of AEDs.  But the same basic steps operate all AEDs.  The AHA does not recommend a specific AED.

What's the AHA position on placement of AEDs?
The AHA (American Heart Association) strongly advocates that all EMS first-response vehicles and ambulances be equipped with an AED. The AHA also supports placing AEDs in targeted public areas such as sports arenas, gated communities, office complexes, doctor's offices, shopping malls, etc. When AEDs are placed in a community, the AHA strongly encourages that they be part of a defibrillation program in which:

Why is notifying the local EMS office important?
It's important for the local EMS system to know where AEDs are located in the community. In the event of a sudden cardiac arrest emergency, the 9-1-1 dispatcher will know if an AED is on the premises and will be able to notify the EMS system as well as the responders already on the scene.

Why should a licensed physician or medical authority be involved with purchasers of AEDs?
This is a quality control mechanism. The licensed physician or medical authority will ensure that all designated responders are properly trained and that the AED is properly maintained.

Why should people who are responsible for operating an AED receive CPR training?
Early CPR is an integral part of providing lifesaving aid to people suffering sudden cardiac arrest. The ventilation and compression skills learned in a CPR class help to circulate oxygen-rich blood to the brain. After delivering a series of three electric shocks, the typical AED will prompt the operator to continue CPR while the device continues to analyze the patient.

If AEDs are so easy to use, why do people need formal training in how to use them?
An AED operator must know how to recognize the signs of a sudden cardiac arrest, when to activate the EMS system, and how to do CPR. It's also important for operators to receive formal training on the AED model they will use so that they become familiar with the device and are able to successfully operate it in an emergency. Training also teaches the operator how to avoid potentially hazardous situations.

Can anyone buy an AED?
AEDs are manufactured and sold under guidelines approved by the US Food and Drug Administration. Additionally, every state has its own AED legislations in place. Everyone who is compliant with federal and state protocols can purchase and implement an AED program.

What is the "Cardiac Chain of Survival?"
Early defibrillation by an AED is one of the four links in the "Cardiac Chain of Survival" for victims of sudden cardiac arrest. The first step in early activation of the Emergency Medical Services (EMS) by calling 9-1-1 or the local emergency number. The second step is to provide early CPR to the victim, the third step is to provide early defibrillation (with an AED), and the final step is early advanced life support, which includes care by paramedics and transport to a hospital.

Can I hurt someone by using an AED?
AEDs are designed to be safely and easily used by people with appropriate training. AEDs are programmed to only deliver electric shocks to patients that present 2 possible forms of irregular electrical impulses of the heart.

Is there liability for misusing an AED?
The following factors highlight why business-based AED programs generally constitute a low-risk endeavor:

No lawsuits, verdicts, or appellate cases are identified involving the use of a defibrillator in the business environment to help a victim of sudden cardiac arrest (SCA).

SCA victims are, in effect, already dead. Use of an AED can only help, it cannot hurt.

Many if not most businesses carry liability insurance coverage protecting the business in the event of an AED related lawsuit.

Many states have laws limiting the types and scope of negligence lawsuits permissible against lay individuals rendering emergency medical care (tort limitation, Good Samaritan, and a variety of immunity laws).
In sum, increased liability risk, if any, associated with adoption of a business- based AED program is quite minimal. In contrast to limited risk, the benefits of AED program adoption are quite remarkable.

Is there liability for failure to have an AED?
There have been lawsuits brought alleging negligence for failure to have AEDs and other elements of emergency response plans available. Some of these actions have resulted in settlements of dismissal on technical grounds, but there has not been any definitive judicial ruling on this issue to date.

AED use is rapidly gaining acceptance as the standard of card. Under the Cardiac Arrest Survival Act, the Federal government is mandating the placement of AEDs in all federal buildings. The Federal Aviation Administration recently submitted rules pursuant to the Airline Passenger Safety Act requiring most commercial aircraft to be equipped with appropriately stocked medical kits and AEDs.

It is anticipated that future legislation and case law will provide more definitive guidance on this issue. Given the advances in AED technology, their low cost and there proven ability to save lives, it is possible that judges and juries may be more likely to sanction a business for failing to adopt and AED program.

AED Background

Sixty-one million Americans have cardiovascular disease, resulting in approximately 1 million deaths per year. One-third of these deaths (300,000-400,000) are due to cardiac arrest, the sudden and unexpected loss of heart function. Survival rates for out-of-hospital cardiac arrest are only 1 to 5 percent. Most often cardiac arrest is due to chaotic beating of the heart (ventricular fibrillation), which can be restored to a normal rhythm if treated early with electric shock (defibrillation). Treatment of witnessed ventricular fibrillation with immediate defibrillation can result in greater than 90 percent survival. With each minute of delay in defibrillation, nearly 10 percent fewer survive, so that at 10 minutes, survival is dismal. In June 1999, Chicago’s O’Hare and Midway Airports installed automated external defibrillators (AEDs) to respond in 1 minute to cardiac arrest. In the first 10 months, 14 cardiac arrests occurred, and 9 of the 14 victims (64 percent) survived.

The concept of public access defibrillation (PAD) gained momentum when the American Heart Association Task Force on the Future of CPR challenged the medical device industry to create AEDs that would make early defibrillation accessible to the public. The rationale for PAD was based on the concern that in many densely populated areas, traditional EMS responders cannot respond in sufficiently short time to perform resuscitation and maximize survival. It was determined that the training and equipping of non-traditional (non-EMS) responders to use AEDs and provide resuscitation until arrival of EMS was a practical and appropriate solution to that problem.

To date, 48 states have passed legislation describing the process of acquisition and use of an AED by lay responders. Since the Food and Drug Administration regulates AEDs as prescription devices, acquisition requires medical involvement. However, details of such requirements for medical involvement vary across states. Elements commonly addressed in state legislation include immunity for rescuers, acquirers, and enablers; training requirements for users; medical supervision or involvement; and EMS notification.

1. Training designated rescuers in CPR and how to use an AED.
Anyone expected to use an AED should be trained in how to use it and in CPR. Such training lasts about 31⁄2–4 hours with participants receiving a course completion card after successfully demonstrating skills proficiency through written and performance evaluation.

2. Having physician oversight to help ensure quality control.
The Federal Drug Administration (FDA) requires a physician’s prescription to buy an AED. Some states require further physician involvement to provide medical oversight of the PAD program and to help ensure the program’s safety and effectiveness.

3. Integrating with the local Emergency Medical Services (EMS) system.
The local EMS needs to know where AEDs are placed in a facility. The public dispatch office may be able to add the AED’s location to their 9-1-1 computer screen.
Communicating ahead of time with the local EMS will save crucial seconds (or minutes) in a cardiac emergency, improving the chances of survival.

4. Using and maintaining AEDs according to the manufacturer’s specifications.
All AEDs work in a similar fashion. However, it’s important for users to be trained to use their specific device the way it was intended to be used.
AEDs require fairly low upkeep, but regularly scheduled maintenance will ensure their “readiness” in the event of an emergency.
Reviewing the manufacturer’s maintenance agreement will provide more information on maintenance requirements.