AED Questions

Evening Ladies and Gents,

The thread Doug started and Scafool's comment has sent me wondering down an ADD side road.

Many of you have heard I will be re-entering the wireless infrastructure industry soon (if someone will tell which cardinal point on the compass to follow).

Said line of work often leads me to be well and truly out in the boonies far from EMS help. This line of work might not be as dangerous as Alaskan crab fishing, but I have seen more than my share of grievous injuries, and sadly, several fatalities.

Considering the afore mentioned risks, my FAK is generally well stocked and I always wish I had more training.

I wish for (and will be getting) AED training out of my own pocket. Having looked at the price of a new AED I see a small problem, my budget. Next as I was shopping, I found refurbished AEDs. Now this brings to mind refurbished parachutes, not something I would want normally. (Unless the aircraft was NOT functioning as advertised and that was all that was available.)

Now for the questions:

1) Does anyone have experience with refurb AED's?
2) Any specific manufacturer better than the rest?
3) Is a vehicle mounted/charged (12VDC) option available?
4) Is a refurb AED like the refurb parachute, better than nothing?
5) If purchased new, what is the life cycle on something like this?
6) How often / how expensive is re-calibration?
7) How long is training?
8) What legal mess am I opening up?
9) Anything I missed?

Keep in mind, I will be purchasing this on my own dime if I do.

Since AED's are medical devices, regulated by the FDA, I assume there are fairly stringent requirements on any authorized refurbs, so functionally, it should be as dependable as a new one and I would personally trust it. I would never purchase a used AED that hadn't been sent back to the manufacturer, for liability reasons on the job, if nothing else. Do these refurb units you found explain who did the refurb?

Someone with actual EMS experience could chime in here, but since you'll be out in the boonies, time will still be a factor since people whose hearts have been shocked back into normal rhythm often require more advanced care within a short time to stabilize their condition. An AED can resolve certain conditions that you can't deal with otherwise, but it's not the end-all-be-all for all cardiac emergencies.

I had my first AED training last year and it's not burdensome. It was part of my first aid + CPR class. Kind of interesting actually, since I had never seen what is inside the unit. Hooking up all the cables to your new flat screen TV is far more complicated than using an AED. I think all AED's have some sort of voice or text prompt to guide you through the process so the hardest part is knowing how to open and apply the electrodes quickly and properly and familiarizing you with the general process the AED goes through so you know what the prompts are referring to.

The legal angle is a crap shoot, if you ask me. But you're doing it with the best of intentions and if you get training, then it seems like you would be OK. Even if the person dies, it's unlikely that waiting an hour for EMS with no AED would have turned out any differently. But who knows? Anything you do on company time potentially opens them up to liability and if you aren't provided an AED by the company, maybe that can be twisted into some sort of maverick act by a lawyer. Good luck with this!

I think you'll find that you'll need some sort of medical control in place. If that's the case, the rest is moot.

If you do it anyway, I can only imagine the liability you'd be facing if something were to go wrong.

The Chicago Fire Dept. was recently successfully sued when one of their AED's failed due to a dead battery, $3.2 million. If you were to have an AED out in the field and you attempted to use it on another person only to have it fail due to maintenance issues, well it doesn't take a lot of imagination to see what could happen.

I'd check with the state health dept. wherever you'd be using the device before making any purchases.

Having said all that, the one I have on hand for my job is nice, an Allheart model. It uses a non-rechargeable battery that's good for quite a few months of storage. The pads are datestamped and must be replaced regularly.

I knew this was not going to be as easy as I thought.

I am a bit embarrassed now.
I looked in the Alberta OHSA regs and didn't see any requirement for AED.
Not even on remote site employing more than 200 people.
It might not be in the regulation or I maybe I am just not reading the list right.
Where I do see them the most is in offices and public buildings that have large numbers of people like malls and colleges.
They have become quite common there.

They are not usually considered part of a mobile kit because they like plugging them in to keep the batteries charged.

Getting the certificate is still good. If you ask the safety officer he will be able to tell you if they supply them on your site.

I think, but don't quote me, that there are 'plug in' models. Though all the ones I've seen have 5-year lithium batteries.

No idea about refurbishes.

They're supposed to be checked daily, and theoretically run through an internal QA during the check. So theoretically there's no external calibration needed.

Training???? You don't need it - push the button that says start and follow the voice prompts.

The big thing with them is the pads have a shelf life. And even in that shelf life, you probably need extra. We went through 2 pairs on a 10 minute ambulance ride after the first pair literally burned through and developed a hole after repeated shocks.

Don't think that they're the be-all&end-all. In something like a trauma, they're not going to be much use (ie, you can't shock a heart that's bled out). So even if you use one and it works, there's a good chance that the person will re-arrest, if you truly are that far from some medical care. Simply b/c you haven't reversed the cause of whatever precipitated their arrest initially.

Have fun dishing out $3000. Wonder if your job will partially reimburse.

Learn something new every day. I assumed (yeah, I know) they were charging inside those little wall mount boxes.

Finally figured out for what AED was an acronym. Automated external defibrillator

It's good form to spell out an acronym during its first use. Don't assume everyone knows.

AED doesn't necessarily help people with an otherwise normal healthy heart that have a cardiac attack from an accident (or too many burgers) they only help people who get an irregular heart rhythm.
So they are more likely to be needed in a public place with a large cross-section of random people than a job site with otherwise healthy people who might have a heart attack.

The machines have a built in analysis system that can tell the state of the patient - they don't apply the shock and will tell you to do CPR if the heart has simply stopped. So are generally safe to use on anyone.

Yes to that NobodySpecial. I think part of the reason is cost and I think that cost is easier to justify in buildings serving a lot of people.
Part of the reason might be how hard it is to set up a location for them on a job site too, but your point about expected levels of fitness makes sense.
On the construction site you might see an AED unit where they are more concerned about electrical shock injuries, but they are not very common.
They do work though and I would like to see more of them and more people trained on them.
Well, as they say, if wishes were horses then beggars would ride.

About the batteries.
The lithium batteries can not be recharged.
Lithium batteries still self discharge over time, so lithium batteries have a claimed shelf life of 5 years but usually the recommended replacement is 3 years.
Reasoning is that they likely sat on a shelf for a year and that they have not been stored in ideal conditions once they are in the machine.

Even though the batteries are tested by the machine automatically every day a lot of people get the rechargeable batteries instead of lithium and just add recharging them to the list of things for maintenance.

The charging station is not usually part of the wall box. It is usually separate. (often on a dusty shelf in the mechanical room or the janitors closet )
The AED is normally kept in grab and go condition, which it would not be if you had to put the charged battery into it each time you needed it.

I am not really sure if the lithium works out to be cheaper than recharger or more expensive or if it is cost neutral.
I am not even sure what the life of the rechargeable batteries is and when they need to be replaced.

To expand a bit more. An AED, (automatic external defibrillator) will only shock if it detects a shockable heart rhythm, and there are only 2 rhythms that are shockable. If the patient has flat-lined an AED isn't gonna help other than to let you know it won't shock them. The only 2 shockable heart rhythms are Vtach and Vfib. No matter what you see on television, you can't restart a heart that's in asystole with an AED.

If there's no detectable electrical activity in the heart, the AED won't help.

Anyone care to guess where they were first publicly installed and used regularly?

Hmmm, obvious answers might be places like a government building, shopping mall, airport...but I'll go out on a limb and say maybe the first AED was installed at a school's athletic department? It is always so sad to hear about kids who drop dead after being hit in the chest with a line drive or who collapse from some undiagnosed heart condition.

Funny...nursing home never popped into my mind when I thought about this question. I wonder why. That also seems like an obvious first place to install these but it just didn't register in my brain until now.

I should have been more specific, the first public places where they were widely installed and used, not necessarily the very first place.

Hint. Think excitement, older folks, alcohol, smoking...

Square dancing? Ballroom? Surely not BINGO

The track?

OMG! Gambling Casinos?
I must ask about this one for sure.

Ding, ding, ding...we have a winner...!

Casinos and airports were the first broad usage locations for AEDs.

Bingo parlors are probably in there as well...;^)

I forgot to mention a few things:

A) These job sites are often very remote. Sometimes to the point that the materials are brought in by helicopter.
B) I know the AED is not a one stop fix-it, but I was hoping to buy time if appropriate for EMS (Ground or Air) to get there.
C) Since I am a consultant, it will be my money.

To give an idea of some of the remoteness of these sites, remember the last time you were 60 miles or more from civilization on a highway and the phone worked? That is the norm for this kind of work.

One of the things I do upon getting a new job site is create an emergency list with all the local contact numbers, good directions from the 2 closest Fire/EMS locations responsible for the area to the job, and directions from the job to the two nearest medical facilities. I also include GPS coordinates to the site, and we create a cleared helicopter LZ just in case. I also go visit the two closest FD/EMS stations and the local PD and distribute the directions/GPS info. These tower sites have address numbers, but that generally has nothing to do with finding them.

I will get the blank file off my PC laptop and share it soon. Someone might have something I missed, or it might help others who work remotely.

Check with the state health dept. of the state where you'll be using it, maybe there's a provision for your specific need.

>Desperado
It wouldn't be my first safety purchase for a remote job site.
But Amazon are selling them for home use for $1300. The ads are a little dishonest, a big scary chart showing how cardiac arrest kills twice as many people as all other accidents - true but an AED doesn't help for most sudden cardiac arrests.

There is a possibility they are useful on work sites for electric shock victims, at least for low voltage shocks that cause cardiac arrhythmia. If you happen to get a shock from an 11KV line - well, been nice knowing you!

The reason for putting them in malls is that with 100,000s of people passing through then the chance of a 1 in a million cardiac arrhythmia case becomes more reasonable.

There have been good results using defibrillators on people hit by lightning.
The American Heart Association has an article on it.

To answer your questions:

1) Does anyone have experience with refurb AED's?
Refurbished AEDs are pretty much as good as new, except often not the newest technology. I have used refurbished cardiac monitor/defibrillators over the years and think they are a good choice for agencies with tight budgets.

2) Any specific manufacturer better than the rest?
I have my favorites, but it is nothing more then personnel preference. Stick with the big names like Medtronics/Physiocontrol (aka LifepPak), Zoll and Philps.

3) Is a vehicle mounted/charged (12VDC) option available?
Yes, however for your application you would be better suited with a unit that has a 2 to 5 year battery and doesn’t require a charger.

4) Is a refurb AED like the refurb parachute, better than nothing?
No, see question #1 above… a refurbed AED is tested and like new. You need to make sure you purchase refurbs from the company that does the work.

5) If purchased new, what is the life cycle on something like this?
Really it is dependent on how it is abused/used. We have a defibrillator that is over 15 years old, it continues to function and pass annual tests… this unit was on a busy ALS engine company for 6 years as the primary monitor/defibrillator and as a backup since then.

6) How often / how expensive is re-calibration?
Again, depends on the unit, but if you get one of the 5 year shelf life… well, 5 years unless you use it or something happens to it.

7) How long is training?
An AED can be used by anyone, but I highly suggest at the minimum a basic CPR class with AED. For what you are doing, a 40hr First Responder course (like ARC’s Emergency Response) would give you some more training and tools for a wider scope of emergencies.

8) What legal mess am I opening up?
Yes and no, as a “Good Samaritan” you may be covered where you live/work (you will need to check local laws). However, there is always a potential legal problem anytime you render aide to an injured or sick person. There is also legal risk for NOT rendering aide, especially in a remote environment. Only you can ask yourself if the risk outweights the benefit or vice versa.

9) Anything I missed?

Most AEDs that are designed for applications like you are thinking of are pretty simple. The daily check is simply checking the indicator light/window on the AED to see if it passed its own daily self-test and is in the ready state. Most of these units have disposable batteries that require replacement every 2-5 years and you can get a spare battery to throw in trunk if you wanted. While these aren’t the units I chose for our fire department (mostly because of a different set of requirements) I would seriously look at Zoll’s AED Plus (which I believe uses Type 123 batteries).

As far as getting one legally, everyplace is different but I do know more than one person who has gotten one by getting s prescription from their doctor. With today’s technology, it would be really hard to do harm with one (but not impossible).

That statement is somewhat inaccurate.

While some people who suffer sudden cardiac death are simple dead right then and nothing is going to change that, the initial rhythm in many sudden cardiac is a rhythm that is "shockable" and thus an AED would be beneficial. While good quality CPR (especially CCC-CPR) has been shown to be extremely effective in sudden cardiac death, its effectiveness is maintaining or returning the heart to a state where defibrilation is effective (or more effective). Continuous Compressions do this by maintaining a good blood pressure with uninterrupted chest compressions and circulating the oxygen that was in the blood already at the time of collapse. This is also why CCC-CPR and AEDs are less or ineffective on Traumatic and other non-cardiac arrests.



Someone who has "too many burgers" doesn't have a healthy heart. While I will agree that sometimes these individuals are not savable, they are the people an AED will help. Yes the likely hood of using an AED is minimal, but there is a reason they are so many cardiac arrest saves in Las Vegas at Casino's, because they have AEDs and security knows how to use them with effective CPR... one of my paramedic students is alive today because of this.

I was just making the point than an AED isn't a magic box for everytime someone's heart stops.
It's fantastic for a limited number of heart conditions (and it's even cleverer in being able to detect these conditions and only shock if useful).

But showing a statistic that sudden cardiac arrest kills 2x as many people as all other accidents in order to sell an AED is dishonest. It's like selling parachutes in airports to passengers on 747s.

Personally, I have always been looking for the parachute vending machine in the airport. I always felt better in the past lugging that extra weight, even knowing that WAS how I would ultimately reach the ground if the plane was functioning as advertised.

Now we are getting somewhere.

The legal beagles have advised a blanket liability policy incase I wind up in court, but having a pool, GSD's, a CHL, teen drivers, and etc. I already have that.

My next step is training, training and more training.

I lost the original information sheet I keep at every job site, but I shall attach the basics. If anyone sees something I missed, please let me know.

Not to bag on you, but the above is a funny statement (which I realize was taken off Amazon)

I mean, seriously? "cardiac arrest" doesn't kill people - it's essentially the definition of dead.

My other pet peeve are news reports that show BLAH BLAH BLAH prevents X % of deaths... geez folks, death is 100%. Say it delays death, if you're going to blow smoke up someone's keister.

Back on topic.

A co-worker's favorite expression is "we're all going to die", when asked how bad any particular situation is. When the response is "really??", he answers "well sure, eventually."

If you count all the lives saved with seatbelts and airbags and the national 35 mph speed limit and the banning of lawn darts, it would exceed the national population.

Back on topic - Will you have a radio out there that can reach someone? I would put that before the AED, but the AED does sound like a good idea as long as everyone out there knows how to use it. If you're solo it would obviously be pretty useless.

1) Does anyone have experience with refurb AED's?
Yes and they are refurbished to mfgs specs. Nothing wrong with them.

2) Any specific manufacturer better than the rest?
Philips seems to be the all time favorite. Welch Allyn was all favorite at JFK left alone in the cases being checked once a week.

3) Is a vehicle mounted/charged (12VDC) option available?
They have build in batteries some models have interchangeable batteries. On some models you do the daily check which requires you to look at small lcd screen which shows you if unit is ready. We have some back up units that haven’t been used in 2 years and show full charge. Some old units had a standard battery charger and it required a 110V outlet. If you get that all you need is a good converter. Also pads have expiration date so you need to pay attention to that.

4) Is a refurb AED like the refurb parachute, better than nothing?
Yes but look at my comments in the end.

5) If purchased new, what is the life cycle on something like this?
I have AEDs that delivered 12 shocks in the field and battery was still good.

6) How often / how expensive is re-calibration?
Every time you turn it on for checkup unit recalibrates itself.

7) How long is training?
Hah. CPR plus AED use is about 2-3 days. But if you are going to go all the way get CFR-D training.

8) What legal mess am I opening up?
Huge. When traveling in Nepal I walked into a remote clinic and after looking around I asked where the defiblirator was. MD looked at me and answered: and if I bring them back what will I do with them since nearest hospital is 2 days away or $3000 2 hr flight away. So few things will happen if you shock somebody:
a) you shock them and they will regain pulse but no breathing so you have to keep breathing for them.
b) you shock them and there is no change in their status so you will continue cpr.
c) no shock so you will keep going with cpr.
d) you shock them and they will come right back and this is what early defibliration is all about. Put them in the right position and wait for the glory.

Now what if you need to continue with cpr or rescue breathing for your patient and they are going to survive only to be found to be brain dead? What if family decides to take a chunk out of you because your cpr have been not up to the AHA standards? And believe me they will win because anyone put on the stand will testify against you that cpr quality on one rescuer goes down the longer it is performed. I rotate my guys every two minutes.


9) Anything I missed?
Yes mate. Cardiac arrest is a serious business. It aint pretty and TV moments where you shock them and they walk home are far appart. Early defibliration and good cpr increases survival but you kill it with delay response of EMS due to your distance from hospital and travel times. Now there are different types of AEDs out there... Some will shock only Vfib and some will do Vfib and Vtach.

Being a vigilante first responder is great until you hit the law wall. That disgruntled family is going to go after company who is going to wash their hands off you faster than you can explain yourself. Than you are left alone. And homicide is just one of the charges that would come to my mind. And it sucks man because all you want to do is some good.

Maybe you can find a local volunteer EMS squad/corp that can let you work under their license. That would save you from a lot of trouble. Last time I checked AEDs were given out by prescription to people who needed them so that means you had to use them on your family. You needed an MD to sign off on one if I wanted to get one for an ambulance corp. I know there are docs out there that would give you anything you want but what if they gave you permission to get one for you and your family and you used it on the stranger and created a mess? It will be your butt on the lane mate….

Cell phone (that is why we are there after all) trunked radio (if we can hit a repeater) and SATPHONE if we are really in the sticks.

That's why I started smoking - the warning on the packet said 50% of smokers die. SO I reckoned I had a 1:2 chance of living forever!

Thank you for your response.

These are the kinds of issues I wanted to hear.

I promise I am not a vigilante first responder.

The problem I face is working in an industry that often places the crews I am responsible for in very remote locations respective to Fire/Rescue/EMS services. We are often a minimum of an hour from the nearest town that might even have a volunteer FD, but often even farther.

Once assigned a job site, part of my initial survey is finding the two closest Fire/Rescue services and visiting them in person. I provide the FD with a map to the location, and the GPS coordinates. We also establish a helicopter LZ and set up to mark it day or night (FD/EMS apparatus road requirements are considered). If said LZ is "off site", I also provide the location info to the FD. Cell/Radio towers are notoriously dangerous places for helicopters due to guy wires and the proximity of power lines.

Then I ask them for their input as to what they need from me should we have an emergency. Usually they ask how we plan to rescue someone from the tower, as they are not trained/equipped for high angle work. ALL of our employees are trained and certified for high angle rescue, and we have to re-certify every six months. Several of my guys have become volunteers in their respective communities because they have this training and the VFD doesn't.

Generally in this line of work if something bad happens the victim is DRT, and there is not much going to change it except a time machine. I am just researching this as a means to help if a "normal" bad thing happens like sudden cardiac arrest.

Right now, the budget precludes any purchase. That is allowing me to research this with my lawyers and two of the MD's I built homes for (1 trauma knife and 1 Cardio/Thoracic cutter), and get more training before making any decisions.

I was set for what Red Cross call Professional CPR/AED to cap off my basic CPR, but the class didn't fill so that is delayed until next month.

Thanks again for the information.

I think that at the end of the day you have to think about this: what if the shock was succesful and now you got to manage post arrest... Everything else prior to the use of aed is nothing in comparison to what happens than. If you have a plan for that situation than you are golden. I've been a medic for a while now and only twice in my career pts were able to breathe on their own after defib and required almost no follow up care. Rest of them required massive drug support and managment otherwise they would arrest again.

Hmm, I had not gotten that far down the road yet to think about meds. That one is way out of my level of experience and training....

More to think about.

That's exactly the kind of information I was hoping to hear to the question in my first post. Using the AED is just the beginning, not the end, of a crisis. But, if you're going to go so far as to routinely set up a landing site for a medevac helicopter at your work sites, as you said, it could still tip the scales towards the AED if the response time is not too long.

Also, the kinds of cardiac situations you'd typically face on your job site may not reflect what an urban medic sees, so Polak's experience may not be 100% transferable to your situation in terms of how much post-AED care would typically be required.

Today I went through American Heart Association basic First Aid, CPR, and AED training put on by the local fire department. I was suprised to learn that, because of the varied causes of collapse in breathing and heartbeat, CPR allows fewer than about 5% of victims to live, and that for infants the number is even lower. We were told that if the cause of collapse was ventral fibrillation that the general CPR numbers applied but with both CPR and AED the survival rate jumped to 40% plus.

Sobering.

Perhaps the most difficult technique for me to do properly was using the right amount of force to strike infants on the back to try to help them survive a choking incident - it felt like child abuse.

dweste

That is one I have had to do in real life on an infant of a family I know.

The bad feelings go away when you hear the baby start crying. It is also nice when they invite you to their high school graduation too.....

I'd be very suspect about that 40 % statistic. Doesn't jibe with any of the stats I've seen regarding the survival rate of patients where CPR and an AED was used.

A lot of stats are tossed around when it comes to things like survival rates, the reality is that unless the event is witnessed and CPR and an AED are used properly with additional medical treatment the survival rate hovers around 4-5 %. Those numbers go up to around 10% in some studies.

It is not like we are painting the grass or anything, we just ensure there is an area that will safely accept any size rotor cone, has clear approach/departure paths, prepared to mark (day & night), and is accessible with FD or EMS apparatus. (rolling stretchers are not ATV's)

You are right. I forgot that the 40%+ was for witnessed collapses and prompt use of CPR plus AED on victims suffering from ventricular fibrillation. Thanks for the correction!

P.S. CPR is hard work!

I am beginning to think this AED is analogous to my CHL in a way. I want it, but my lawyers aren't too sure. I will need the training. If I need it, I am going to need it RIGHT NOW. My friends, co-workers and family will feel safer for me having it, but wish it wasn't such a pain in the neck. I might have to use it to save a life, but I will pray every day that I never need to use it.

At least I won't be at risk of having to take another persons life to save a life.

I guess I will just have to take the risk, because if the technology is available I could not live with myself for letting fear prevent me from trying to save a life.

1st Training
2nd Legal Advise
3rd Medical Advise
4th Insurance Coverage
5th Budgetary Issues (concurrent with 1-4)
6th Purchase
7th continuing education and training

RE 7: I eventually will be working my way from EMT1 thru Paramedic once my itinerant life/employment re-stabilizes.

Please keep the info coming.

If you want to get some ballpark figures on cost, try BP Medical. They're a medical supply house in New York that I use. Very reasonable prices, pretty complete selection.

I know that you can get AED's for less than $3000 retail. Mine cost me $1500 but it was bought as part of a group buy of 6 from the same vendor.

You might also try "AED Superstore", good, very good in fact on prices but I have no personal experience with them. Gotta love the name...;^)

So, in short before I start rambling, is I think you should get one. They're relatively cheap, easy to use, and easy to maintain.

With that said, does your company pay for the re-certifications for the high-angle rescue? If so, they should cover the rest of the first aid training. If you are in the "wilderness", I would highly recommend taking a "Wilderness" class equal to your current certified level. They have Wilderness First Aid, Advanced Wilderness First Aid, Wilderness First Responder, Wilderness EMT, and Wilderness Paramedic. I think this will be more beneficial, as it transfers some of the liability to the corporation for equipment maintenance, and you don't have to pay directly for the classes.

Like Polak187 said, these individuals require advanced medical care for any problem the AED can help "solve". CPR is a labor intensive act, and you also need to keep in mind that you could be doing CPR for 20 minutes or more. Yeah, adrenalin will help, but there will be a point you and others cannot continue. It is kind of a given that any cardiac emergency in the wilderness or in a large natural disaster area will be fatal.

You should talk to a lawyer to fully asses your liability, especially if you become an EMT. There will be a different level of care there.

With some of the numbers you see for success rates of CPR and AED, people that have severe medical problems (i.e. heart disease, etc.) the tool is more of a way to help individuals feel that they tried to help. Not knocking it, I wish I had more time to train more people in emergency response, but sadly, that's what it seems to me to be a lot of the time.