AED's and Diving

[GoBlue!]

Great thread. I don't want to drive this too far off topic, but will all people with pacemakers have some sort of chest scar? I am not familiar with the procedure of having pacemakers implemented. I was just wondering what the procedure is to check for pacemakers before applying the AED electrode pads.

Matt

Matt- Pacemakers are generally implanted just below the clavicle nowadays, and usually cause a rectangular skin bulge of about a 1/4-1/2 inch or so. There will be a small scar as well.

Pacemakers of years ago were sometimes implanted in the abdominal wall, usually off to the side and just below the ribcage. Hardly ever see these anymore.

Jim

 

[HammerNoMore]

Note that the information I posted said not to put the electrodes on a PM if possible. I don't want to second guess the authors, but remember, if a person is showing no signs of respiration or cirulation, they are in the worst possible state of health.

"Dead is dead." If you don't notice/see a PM or you can't avoid it, worst case is they are left in the same state they were in. If they survive, but need a new PM, I'm sure they would be happy with the turn of events.

James

 

[Paul Evans]

I,am a AED trained HSE first aid appointed person for the Theatre, did the refresher a couple of days ago (we do it every 6 months).

The Theatre has a metal fly grid and we have been told under no circumstaces are we to use the AED there, we must remove the causuality to a safer place.

On the topic of movement, our units can get false readings if there is movement of the Unit or patient.

As for water, Pools of water are a big no no.

From the info I ahve I can see why an insurer would not be best pleased with one on a diving boat.

 

[otter-cat]

Below is a copy of a message I sent to DAN (Divers Alert Network) about AED's on boats, along with their reply. I hope this helps.

My question to DAN:
I was wondering whether it would be safe to use an AED on a diver on an
aluminum hulled boat. Is it possible for the charge to be transmitted
through the patient to the deck/hull of the boat, and then from the
boat to the other passengers on the boat?

DAN's Reply:
Thank you for your e-mail and membership support. This is a true
hazard when using an AED aboard a metal-hulled boat, especially with a
wet deck. Seawater has a greater conductivity to be considered. The
best
precaution would be to have the injured person either on rubber mats, a
wooden or plastic backboard or up on a padded bench. Any device that
creates a barrier between the injured and the deck is suitable provided
it is non-conductive. Your local EMS/Fire dept. can probably make other
suggestions as well. If we can be any further assistance do not
hesitate
to contact DAN.


Divers Alert Network

 

[ArcticDiver]

From these posts it is clear that different "experts" have differing ideas on proper use of the AED. Many of these differences arise out of differing assessments of what is expected to be a dynamic environment.

So, the one and only correct answer is to ask the AED's manufacturer. Each manufacturer has their own idea about the proper use of their machine. Follow those recommendations regardless of what any other "expert" may say.




As a side note there is a reason we clear the patient during manual defibrillation. That is because we don't want to accidentally defibrillate the medical staff. Even though the main current travels between pads/paddles there is some leakage outside the patient's body. That leakage has minimal or no adverse effect on the patient. But it can definitely get the staff's attention if they are touching metal that is touching the patient!

 

[fongwee]

Actually if you ask me, I would follow DAN'a advice. The prime concern is that the rescuer and surrounding people get shocked by the AED during discharge.

In any rescue, the rescuer's safety outweighs that of the victim. Better to have 1 injured than more. Thus I would actually follow as what DAN advises to put a non-conductive material between the patient and the boat as well as to wipe the patient dry. This certainly makes sense to me.

 

[ArcticDiver]

Following my own advice I checked with Zoll today about properly using their defibrillators on a patient who is lying on a conductive surface like a metal boat deck.

The Zoll representative told me the boat deck would have no effect on the Zoll's effectiveness in patient defibrillation. This is because the primary current path would be between the defibrillator contacts, which in the case of an AED would be the pads. However, it is a possibility that some minor current could be detected on the boat deck under the patient and for some distance from the patient. How much current and its' effect on rescuers is not entirely predictable. So, for rescuer safety they should take precautions to insulate themselves from the boat deck and from the patient. He suggested any available insulating material such as tennis shoes or rubber boots as well as being sure not to touch the patient during defibrillation.

I might add that it is important to dry the patient's chest in the area of the pads so that defibrillating current flows from pad to pad through the body and not over the skin surface as it might if the wet surface presented a lesser electrical resistance than the body.

 

[IlikeItwetPls]

Well it seems that most of the areas have been covered well; I might add that placing the electordes over a pacemaker might cause skin burning, but as stated by one poster, if there are no signs of life a little burned skin is of minor concern. Also, I've been told, many years ago when we use to use had held paddles for defibrillation the pacemaker battery might explode if placed directly on the pm.

Also, wet skin could cause arching of the current. I have defibrilated on metal surfaces before without any current trasferance to any rescuers, if that is any comfort.

Best to try for ideal situations, but remember...don't become a victum too.

 

[IlikeItwetPls]

Well it seems that most of the areas have been covered well; I might add that placing the electordes over a pacemaker might cause skin burning, but as stated by one poster, if there are no signs of life a little burned skin is of minor concern. Also, I've been told, many years ago when we use to use hand held paddles for defibrillation the pacemaker battery might explode if placed directly on the pm.

Also, wet skin could cause arching of the current. I have defibrilated on metal surfaces before without any current trasferance to any rescuers, if that is any comfort.

Best to try for ideal situations, but remember...don't become a victum too.

 

[IlikeItwetPls]

Well it seems that most of the areas have been covered well; I might add that placing the electrodes over a pacemaker might cause skin burning, but as stated by one poster, if there are no signs of life a little burned skin is of minor concern. Also, I've been told, many years ago when we use to use hand held paddles for defibrillation the pacemaker battery might explode if placed directly on the pm.

Also, wet skin could cause arching of the current. I have defibrilated on metal surfaces before without any current trasferance to any rescuers, if that is any comfort.

Best to try for ideal situations, but remember...don't become a victum too.