Pull the AED Off the Wall and Let It Do the Thinking

The single fact that gets people to act: an AED won't shock somebody who doesn't need shocking. It reads the heart's rhythm first, and if the rhythm isn't one a shock can fix, it says "no shock advised" and tells you to keep doing compressions. You can't zap a sleeping drunk. You can't zap a guy who fainted. The machine checks before it charges, every single time.

So the worst thing you can do with an AED is leave it in its cabinet. Which is exactly what happens, over and over, in gyms and church halls and office lobbies where a green box sits eight feet from a man on the floor and nobody walks over and opens it.

First, decide it's cardiac arrest

You're not diagnosing anything. Two questions only.

Is he responsive? Shake the shoulder, shout. Nothing.

Is he breathing normally? Look at the chest for no more than ten seconds. Occasional gasping, snoring or fish-out-of-water noises are not normal breathing. That's agonal gasping and it fools people constantly. If someone is unresponsive and not breathing right, treat it as cardiac arrest and move.

Call 911 and send somebody for the AED by name

Point at one person. "You, in the blue shirt, call 911, put it on speaker, come back." Point at another. "You, get the AED. It's in the green case by the water fountain."

Vague instructions to a crowd get you a crowd. Assignments get you a machine.

The 911 dispatcher is trained to coach you, and dispatchers can often tell you where the nearest registered AED is. Keep the phone on speaker on the floor next to you. You need both hands.

Start compressions while you wait

Heel of the hand on the center of the chest, other hand on top, elbows locked, shoulders over your hands. Push hard, about two inches deep on an adult, and fast, 100 to 120 a minute. Let the chest come all the way back up between pushes. Don't stop to check anything. Compressions are what keeps blood moving to the brain until the pads go on.

If you're alone with no phone nearby and no AED in sight, compressions come first and stay first.

Open the case and turn it on

Every AED made for public use works the same way at this point. There's a button, or the lid switch turns it on when you open it. Press it. Then shut up and listen, because from here the machine runs the call and you're the hands.

It will say something like "apply pads to patient's bare chest." Believe it.

Bare the chest properly

This is where people get squeamish and lose a minute they can't get back. Shirt comes off or gets cut. Bra wires have to be out from under the pad line, so cut the bra. Most AED cabinets include a small kit with blunt trauma shears, a razor and a towel. There's a reason for each one.

Wet chest? Wipe it dry with the towel. Water spreads the current across the skin instead of driving it through the heart.

Heavy chest hair under where a pad goes? Press the pad down hard, rip it off fast, and it'll take the hair with it. Then use the second pad. If there are only two pads, use the razor first. Pads need skin contact, not hair contact.

Medication patch on the chest? Peel it off with a gloved hand or the towel and wipe the spot. Never put a pad over a patch.

Pads go where the picture says

Look at the pad itself. There's a diagram printed right on it, because the people who designed these things knew you'd be terrified.

Adult placement: one pad on the upper right chest, just below the collarbone, beside the breastbone. The other on the left side below the armpit, over the lower ribs. The heart sits between them, which is the whole point.

For a child under eight or roughly 55 pounds, use pediatric pads if the unit has them, and many units have a child key or switch instead. No pediatric pads? Use the adult ones anyway, one on the center of the chest and one on the center of the back so they don't touch. An adult shock on a child is far better than no shock.

Pacemaker lump under the skin? Put the pad an inch or so away from it. Don't skip the pad.

Pregnancy changes nothing. Same pads, same places, same shock.

Clear, analyze, shock

Once the pads are on, the AED says "analyzing, do not touch the patient." Take your hands off. Look down the body and say it out loud: "Clear!" Make sure nobody's knee is against him, nobody's holding his hand.

If it advises a shock, it charges, and it either shocks on its own or tells you to press the flashing button. Say "Clear" again, glance, press. The body will jerk. That's normal and it's not a horror movie.

Then, without waiting, without checking a pulse, go straight back to compressions. The machine will tell you to. Do it before it finishes the sentence.

Two minutes on, then it reanalyzes

The AED runs on a rhythm: roughly two minutes of CPR, then another analysis. It'll prompt you. Swap compressors at each analysis if there's another person, because good compressions are exhausting and yours are worse by minute three than you think they're.

Leave the pads on. Leave the unit running. Keep going until EMS takes over, the person starts breathing and moving on his own, or you physically can't continue.

If he wakes up, roll him onto his side and leave the pads stuck where they're. He can go into arrest again, and you want the machine ready.

Where they actually are

Start noticing them now, not later. Airports have them at gates and near restrooms. Gyms, school gyms, big-box stores, hotel front desks, golf clubhouses, municipal buildings, most churches of any size. They're in white or green wall cabinets, often with a small alarm that sounds when you open the door. Open it anyway. Nobody has ever been sued for the alarm.

The PulsePoint AED app maps registered units, and a lot of counties keep a registry. Two minutes of looking around your own gym this week is worth more than reading this twice.

Every state has some form of Good Samaritan protection covering people who step in during an emergency, and the specifics vary. If that question genuinely worries you, ask an attorney licensed in your state. Don't let the question keep you standing there.

The honest trade-off

An AED isn't magic. Plenty of cardiac arrests are in rhythms a shock can't fix, and you'll hear "no shock advised" and feel like the machine failed you. It didn't. Compressions are still the job, and sometimes the outcome is bad no matter how right you did everything.

A home unit is worth considering if someone in your house has a known cardiac history, and it's a real expense, so price current models with a supplier and talk to the cardiologist first.

Here's what I'd tell anybody standing over a stranger with a green box in their hands and a knot in their stomach. The man on the floor is already in the worst condition a person can be in. You can only improve his odds.

Open the lid.