After the Shock: What Happens After You Use Your AED?

As a CPR/AED-trained responder, you’ve received a lot of advice about how to prepare for sudden cardiac arrest. But what happens after an event occurs? Once the patient has been transported to the hospital by emergency medical services (EMS) crews there are a number of tasks to assure your AED and your team is ready to respond again.

Although you may not perform all the tasks described in this article, you should be aware of all activities that may be required after a sudden cardiac arrest. Some organizations contract to have these services performed such as servicing the AED, conducting a team debriefing or downloading AED data.

Complete the Response
CPR/AED classes generally cover what to do up through starting CPR and delivering a shock. But there are several important steps you must do afterwards. First, when EMS responders arrive, you will need to tell them some specifics about what happened. Explain the actions you or your team have taken:

  • whether or not you witnessed the arrest
  • how long the victim was down
  • and how many shocks you delivered

On arrival, EMS personnel will attach their own defibrillator to the patient and assume CPR responsibilities. They may or may not remove your electrode pads. (Some manufacturers’ pads connect directly to professional defibrillators.) Ultimately, the pads you attached must be disposed of and someone must clean up any leftover packaging or waste..

Put the AED Back in Service
After EMS and the patient have left the scene you must get your AED ready for the next response. "The most important thing is to get your AED back in service after it is used,” advises Paul Mendoza, paramedic and president of Advanced First Aid, Inc. which provides services for organizations with AEDs.

Each time your AED is attached to someone you must replace the electrode pads. Whether or not you need to replace the battery or charge pack depends on the make and model of your AED--follow your manufacturer’s guidelines. Check the “use by” or “install by” date on the replacements to be sure they have not expired. In some cases the unit may need to be cleaned or disinfected. In addition, you need to replenish medical supplies such as disposable gloves, razors or barrier devices that were used in the response.

Note: Follow your AED manufacturer’s instructions for replacing, recycling and disposing of batteries and electrode pads. Some batteries cannot be recharged or recycled. Also, some batteries require discharging before disposal.

AED Event Information
An AED collects event information during a cardiac arrest. This is a digital recording that can be transferred to a computer for later review. The recording includes the patient’s heart rhythm or EKG and the time of critical events such as when shocks are delivered.

Depending on your organization’s AED policy, you many need to retrieve event information from the defibrillator. Generally, you will retrieve the data if the victim was successfully resuscitated or the victim is a child. Some AEDs store event information on data storage cards while others use a cable or infrared device to transfer the data to a computer. Someone on your response team may need to provide the AED data to your medical director or contact your AED program management service. Consult your organization’s AED policy for specific details.

In addition, a copy of the AED event information may be required for review by your county or local EMS AED coordinator. If you are not sure what to do after an event, call your AED program manager or the company providing service for your AED.

Remember that medical information about an individual is protected and confidential. You should follow guidelines your organization’s guidelines for handling confidential event information. Your AED policy should address this.

Written Documentation
Someone from your emergency response team must document the cardiac arrest event in writing. Generally, this requires completion of a post-event form called a medical incident or accident report form. Complete this in writing as soon as possible after the incident. The form calls for details of the incident such as:

  • time of the event
  • name of person completing report
  • date, time location of the incident
  • whether or not the cardiac arrest was witnessed
  • who started CPR and when
  • when the AED arrive
  • who operated the AED
  • name of responding EMS agency

Medical Oversight and Quality Improvement
A key part of an AED program is medical oversight. This means a qualified physician or medical director must oversee the activities of your AED program. A medical director approves written guidelines for medical emergencies (an AED policy). The medical director also oversees training. Some organizations contract medical oversight to a vendor who provides the physician for this service.

Before an AED is put back in service, someone from your team may need to remove the electronic event data and deliver it to the medical director. Your medical director may want to review event data to suggest improvements or changes in practices or policies. In rare instances, doctors at the receiving hospital will want to review the data to help determine a cause for the cardiac arrest.

A medical director might suggest changes to improve effectiveness in areas such as training, AED location, procedures and responder roles. For example, in a recent event, someone attached an AED to a person complaining of chest pain who was conscious and breathing—something you should never do. In this case, training was modified to emphasize when to attach an AED.

Debriefing
After the medical director has seen the event data he or she may issue a report to your AED program manager. A review meeting may be conducted to learn from the experience and improve your organization's internal response procedures. The meeting should include all key participants including emergency response team members. The group will try to identify actions that went well and those where there is an opportunity for improvement. For example, items discussed in a debriefing might include the speed at which 911 was called, the AED location and how well CPR was performed.

In addition to technical aspects of cardiac arrest, lay responders or others may need significant support to ensure that the event does not have a negative impact their psychological and emotional health. Often called critical incident stress debriefing, this type of debriefing allows responders to discuss their emotions and concerns in a supportive environment. The session should be led by someone trained in critical incident stress debriefing techniques.

The person overseeing the debriefing should ensure the proper follow-up is given soon after the event. Your AED policy may provide guidelines. EMS systems have a formal debriefing procedures to help their professional emergency responders deal with death and tragic responses. This activity is beneficial for volunteer responders, too.

Summary

The first thing to do after using your AED is to install new electrode pads and service the battery (if the manufacturer recommends this). Also, you may need replace disposable items used during the response. Next, complete written documentation required by your organization's AED policy.

If needed, provide digital AED event information to your organization’s medical director. The person in charge of medical oversight may need to review the data recorded by the AED to suggest any improvements to your organization’s AED program. Finally, determine if a follow up debriefing is needed including a critical incident stress debriefing.

View article on medical oversight.