In many cardiac arrests, the heart goes into a disorganised rhythm and only an electric shock can restore it. The automated external defibrillator (AED) is a device that analyses the rhythm and says whether or not to give the shock. This lesson explains what the law says about AEDs and what a worker should know.
What it is for
The AED has self-adhesive pads that stick to the chest, and it analyses the heart rhythm by itself. The device speaks, gives clear instructions and advises a shock only if it will help. If the rhythm is not one that a shock helps, it will not fire. Even so, the rescuer must never touch the casualty at the moment of the shock.
The law
The use of an AED by someone who is not a doctor is governed by Decreto-Lei n.º 188/2009 (Decree-Law 188/2009), amended by Decreto-Lei n.º 184/2012 (the Azores and Madeira also have regional rules of their own). These laws created the Programa Nacional de Desfibrilhação Automática Externa (PNDAE) (National Automated External Defibrillation Programme), coordinated by the INEM. In short:
- AED programmes are licensed by the INEM. Each has a responsible doctor, its own devices, trained people and records of every use.
- To become an AED operator, you must complete a BLS with AED course given by a training body accepted by the INEM under the PNDAE and receive a delegation of competence from the responsible doctor of a programme.
- The course alone is not enough. The operator may only use the devices of the programme that delegated the competence.
- The 2012 decree made it compulsory to install AEDs in certain high-traffic places, such as large shopping centres, airports, commercial ports, major stations and sports and leisure venues with large crowds. The exact criteria are in the law.
This course does not give any of those qualifications.
For the ordinary worker
Anyone who works in a place with an AED should know:
- where the device is and how to reach it in seconds;
- that it is identified by its own signage, with a heart and a lightning bolt;
- who is designated and trained to use it;
- that the first thing to do in a cardiac arrest is to call 112 and ask for the AED.
During the call, the 112 operator guides the people on site and can say what to do with the device.
The sequence with the AED
According to what is taught in courses, someone with training does this:
- Switch on the device and follow the voice instructions.
- Attach the pads to the bare, dry chest, as the pictures show: one below the right collarbone and one on the left side of the chest. If the chest is wet, dry it; if it is very hairy, cut or shave it; if the person has an implanted device, the pads go further apart.
- Let the device analyse. Nobody touches the casualty.
- If a shock is advised, make sure nobody is touching the casualty and press the button, if the device is the kind that asks for it.
- Resume compressions straight away, until the device gives a new instruction.
While the pads are attached, the device reassesses the rhythm roughly every two minutes.
Precautions
- Never use the AED near liquids that the casualty is lying in: move them away or dry them.
- Remove medication patches from the area where the pads go.
- The device has batteries and pads with expiry dates: the person in charge must check the status indicator and replace anything that has expired.
- After each use, the programme must record the case and inform the INEM.
What is left out
This lesson is for awareness. It does not qualify anyone as an AED operator, nor does it say that anyone may use a device from a programme that has not delegated the competence to them. Anyone who wants to become an operator should speak to the employer and to the programme's responsible doctor.