Resuscitation of a non-breathing patient is more effective if you have the sequence of basic CPR clear in your mind as CPR is an integral part of using a defibrillator, increasing the chances of survival.

  1. Position your body to the patients side with your shoulders above their chest.
  2. Place the heel of one hand over their sternum (breastbone).
  3. Place the heel of your other hand over the first and interlock your fingers.
  4. Keep your arms straight and press down approximately 50 to 60mm & release.
  5. Perform 30 such compressions at a speed of 120 per minute (2 per second).
  6. Then perform 2 rescue breaths if comfortable doing so.
  7. Continue with 30 compressions to 2 breaths.

When giving rescue breaths do not forget to tilt the chin back to open the airway and pinch the nose. If a drowning victim, give him a head start with 5 rescue breaths before commencing with compressions and rescue breaths at 30:2.

As above except that you use one hand instead of 2 and give them a head start by giving 5 rescue breaths before commencing compressions.

Again, give them a head start with 5 rescue breaths. Then do 30 compressions using only 2 fingers, then 2 additional rescue breaths.
(When giving rescue breaths to a baby still gently tilt the chin back but then cover their nose and mouth with your mouth and give breaths).

If a bystander returns with a defibrillator ask if he will continue with CPR while you set the defibrillator up. If he is not willing or able leave the CPR for now and concentrate on the defibrillator.

If it is a baby or toddler ALWAYS obtain guidance from the 999/911 operator before using a defibrillator as some models are less appropriate for the very young.

Before you start applying the pads there are a few safety issues to be aware of.

  1. External dangers.
    If the casualty is laid in excessive water, as against simply a wet floor, laid on metal or in an area containing inflammable liquids of any sort, get help and move him to a safer area before shocking him. (Petrol stations are an obvious danger)
    The risks of anyone being injured in these situations is minute, but why take the risk.
  2. Bodily dangers, in so far as they can reduce the effectiveness of the pads.
  3. Excessive sweat to the chest:- Wipe of with towel or cloth.
  4. Excessive hair to the chest:- Shave off. (There should be a towel & razor in AED pack.
  5. Jewellery around chest area:- If there is such as a necklace or pendant, move it away from the chest.
  6. Patches:- Any patches stuck to the chest should be removed.
  7. Pacemaker: If there is a pacemaker to the patients right side, where the pad is going, place pad slightly below it.
  8. Clothing:- If the patient is wearing any clothing that may have metal or wiring around the chest area, such as an under wired bra, remove it.

As soon as you have the defibrillator start using it, having allowed for external and bodily safety issues. If no one else is able to continue CPR leave CPR for now and concentrate on the defibrillator.

Firstly, open the patients clothing to reveal the bare chest.
If the patient is female and you need to remove the bra, and hubby is there, explain what you are about to do and then move on quickly.
Arrange privacy if possible.
Quickly prepare the chest for the pads, drying or shaving etc; as required.
Place the defibrillator next to the patients head at your side and lift the lid fully open, this will turn the defibrillator on if semi or fully automatic.
If it is the style without a lid there will be an ON button on the top.
Some defibrillators come in an outer case that needs opening prior to opening the lid.

As soon as the AED is turned on it will tell you to:

  1. tear open package and remove pads.
  2. peel one pad from plastic liner.
  3. place one pad on bare upper chest (just below the patients right collarbone)
  4. place second pad on bare lower chest (slightly under the patients left armpit)

If the 2 pads have illustrations showing the location for each pad, place them in those positions.
However, if you then realise that you have put them the wrong way around, leave them in that position.
If you try and remove them it wastes time and they may not stick properly when re-positioned.
They will still work even if placed the opposite way round.
If the defibrillator comes with the leads already plugged in it will move straight on to the next stage.
If they are not plugged in it will instruct you to plug the lead into the defibrillator.
The pads are now in position and the defibrillator will prepare to analyse the patient (looking for a shockable rhythm). Some defibrillators will analyse automatically, others may instruct you to press the analyse button.

It is essential that the defibrillator only analyses the heart rhythm of the person in cardiac arrest, so you have to ensure no one, including yourself, is touching the patient.
The defibrillator will go on to say something like: Do not touch patient, analysing rhythm.
At this point sweep your arm around the patient saying loud and clear “Stand Clear”.

Watch bystanders as you do this to ensure that they follow your instructions.
The defibrillator will then instruct you as follows: (wording varies with different defibrillators)

  1. No shock advised, re-commence CPR.
    Or
  2. Shock advised. Charging. Stand Clear. Shock delivered. You may be instructed to push the flashing button to deliver the shock.
    Or
  3. It is now safe to touch the patient, give 30 compressions and then 2 breaths.

If you are uncomfortable doing rescue breaths just perform compressions.
It is essential that before the shock is delivered you perform another sweep of the arm and say “Stand Clear”. Again, loud and clear, ensuring that bystanders do as requested.
Throughout this whole process you are simply following the instructions given by the defibrillator. However, if the defibrillator instructs you to take the patients pulse ignore this and re-check the breathing again. It was the absence of normal breathing that started this procedure, not the lack of a pulse.

Continue until either the Ambulance crew request you to stop, you are too tired to continue or the patient recovers. If the patient recovers leave the pads in place, the defibrillator turned on, and place the patient in the recovery position. Continue to monitor patient.

Wherever possible get someone to take it in turns doing CPR as the compressions will then be more effective throughout and gives you a chance to get your breath back.

When the ambulance arrives they need to know:

  • The current state of the patient.
  • Any of the patients history that you have at hand.
  • The number of shocks given.
  • Any other relevant information.