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You now have an AED. But where should you put it?

Congratulations! Your company or school has made an excellent decision and has obtained an AED, and thereby taken a big step towards reducing the chances someone near you will not survive sudden cardiac arrest (SCA).

You’ve taken CPR & AED training and made sure everyone can operate the unit, because time, as they say, is of the essence when SCA occurs.

So where is the best place to keep your AED so that it can be retrieved as quickly as possible?  According to the American Heart Association’s recommendation, an AED should be retrieved, activated, and the shock administered within three minutes of the victim’s collapse. Survival rates will decrease by 7-10% each minute that the AED is delayed.  Most AED manufacturers therefore recommend having at least one AED per floor in offices, schools, and other multilevel buildings.

Owners of AEDs need to figure out the most probable areas where a person may suffer SCA, as well as place the AED unit in a location that is easily accessible. This often turns out to be a near a reception area, lobby, lunch room, or centrally-located restroom facilities. Also keep in mind foot traffic patterns, places where people tend to congregate (conference rooms, copy machines, printer locations), and facilities where at-risk activity might occur (such as gyms or fitness centers). All these can be locations with a heightened probability of SCA occurrences, which makes the proximity of an AED even more critical.

Keep the following points in mind when placing your AED unit:

  • Make sure the AED is accessible to everyone and highly visible. Place signs on the wall that are elevated to ensure clear sightlines.
  • According to the Americans with Disability Act (ADA) guidelines, the height to reach the handle of an automated external defibrillator (AED) in a public place should be no more than 48 inches high. The maximum side reach for an unobstructed approach to an AED is 54 inches.
  • Never place an AED in a locked and/or out of sight area. Small lockable cabinets designed for AEDs have alarms to alert bystanders and guard against theft. Try to find a middle ground between a well-secured AED and an easily accessible AED.
  • Place the AED near a phone for use when 911 is called. There are AED cabinets available with an internal phone that can be used to notify EMS when the AED is accessed.
  • For rapid response, trained rescuers should be evenly spread out through the building (to train more of your employees, click here for information on our Workplace Training programs). Rescuers should not run with an AED in hand – if it becomes damaged in a fall, it can’t help anyone.
  • For schools, there are often parts of the building locked after hours or during outdoor activity. Make sure a clear path to the AED is available – or better yet, have an extra one to take outside for games or assemblies.
  • If your company operates in remote areas, especially where EMS may be significantly delayed or not available (marine vessels, offshore stations, construction areas) or hazardous locations (power lines/pipelines), each of those locations should have an AED.

Additional items should be placed with an AED to help the rescuers to perform CPR and to make sure the AED performs optimally. These may include:

  • a CPR mask for delivering safe and effective rescue breaths
  • gloves for personal protection
  • a safety razor if the victim’s chest hair interferes with AED pad adhesion
  •  blunt scissors or shears for cutting clothing away from the chest
  • absorbent towels in case the victim’s chest is wet or very sweaty
  • a biohazard bag for disposing of infectious materials

These items will help make CPR and AED use more effective by eliminating hazards to the rescuer and ensuring that the AED pads can be placed quickly and correctly.

When sudden cardiac arrest occurs in public, there are often several bystanders that can combine efforts to provide a more effective response.

One important aspect is making sure someone is getting the AED as quickly as possible. Rescuers should also ensure that CPR continues up until the point the AED issues the command to clear the victim for analysis. This means that the person who obtains the AED should be prepared to activate it and attach the pads while another rescuer continues to administer the CPR compressions and breaths. Do not stop the CPR until the AED tells you to, and make sure to resume CPR immediately after the shock is given.

One situation that may arise is that a private company may have someone come in off the street, inform them that a victim is in need, and request help by using the company's AED. Often the company may be reluctant to allow the use of the AED off their premises because of a fear of legal liability. In Seattle (and all of Washington state), there are Public Access Defibrillation guidelines (click here for a pdf) that address these liability concerns:

“The use of a medical therapy device by individuals who are not licensed or certified health care providers has resulted in concerns about legal liability. These concerns are addressed by RCW 70.54.310. The law provides that if standards in these guidelines are met, the acquiring entity, individual using the AED and the physician medical director receive limited immunity from civil liability. This immunity is similar to that provided by the “Good Samaritan” law of the State of Washington. “Good Samaritan" laws are intended to protect individuals who try to help people at the time of an emergency. “Good Samaritan” immunity does not cover acts of gross negligence or willful or wanton misconduct. The intent of the Washington State P.A.D. law is to establish standards for acquisition, training, maintenance, physician medical direction, and coordination with local emergency medical services that will assure that a person using an AED is ready, willing and able to operate a defibrillator in a safe and effective manner.”

What owners of AEDs need to remember is that an AED can only help victim of sudden cardiac arrest; it cannot injure the victim and an AED will not administer a shock to anyone who does not need it. By using an AED as soon as possible, and administering effective CPR, bystanders can continue to provide victims of sudden cardiac arrest the best possible odds of survival.

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Published on October 28, 2013