PBC Information File:- Defibrillator Usage
This Document is not a “how to use” instructional note covering the club’s defibrillator. The machine itself guides the user through the process at the time of usage. Instructional opportunities will also be available if sufficient demand warrants a training session.
This document’s purpose is to provide answers to any query a club member may have regarding the usage of the defibrillator; ie answers those ‘what if’ questions. Simply go the appropriate topic as listed numerically.
This information sheet fundamentally only concerns those club members aged 16 and over.
1) Medical Emergency on the premises
2) Action by an Untrained person
3) Employing CPR (cardiopulmonary resuscitation): the initial response
4) Mouth-to-Mouth Breathing
5) Employing Defibrillators (AEDs)
6) Giving CPR (cardiopulmonary resuscitation) to someone with breasts
7) Applying a Defibrillator (AED) on someone with breasts
8) Civil Claims against battery or common assault
9) ‘Do Not Resuscitate’ Orders (DNR)
10) Could employing CPR or an AED (defibrillator) cause harm
11) Does Bystander Intervention greatly improve the chances of survival
12) Reluctancy to be involved
13) Civil Liability Insurance
14) Cardiovascular Implanted electronic devices (CIEDs)
15) Implanted Cardioverter-defibrillator (ICDs)
16) Implanted Pacemakers; employing CPR
17) Implanted Pacemakers; employing ARD (defibrillator)
18) Cardiac Event recorders
19) Silicone Breast Implants
20) Mastectomy
21) Maintenance of the club’s defibrillator
1) Medical Emergency on the premises: If a loss of consciousness and breathing has seemingly ceased such that a ‘cardiac arrest’ is suspected then the immediate priorities must be to commence cardiopulmonary resuscitation (CPR), call 999 and follow instructions from the ambulance service. In the mean-time it may be necessary to employ the defibrillator if there has been no immediate response from employing CPR; but CPR must be continued until the defibrator says “STOP CPR” so that the machine can analyse the heart’s rhythm.
2) Action by an Untrained person: The priority is to get blood circulating and provide oxygen to vital organs as quickly as possible. When their life depends on your assistance, they deserve the best possible chance of survival. Cardiopulmonary resuscitation (CPR) &/or the use of an automated external defibrillator (AED) both can significantly improve a person’s survival chances. Both can be delivered by untrained members of the public.
3) Employing CPR: Place one hand on the chest just below the breast line and then place the palm of the other hand over it. Continuously compress the chest. Press swiftly and forcefully, allowing the person's chest to rise back up after each compression of at least two inches. Aim for performing 100 to 120 compressions each minute.
4) Mouth-to-Mouth Breathing: Combining chest compressions with rescue breaths (mouth-to-mouth) is the most effective action as it provides both oxygen and circulation. After every 30 chest compressions, give 2 rescue breaths. (But this is recommended that it should only be undertaken by trained individuals.) In an emergency, hands-only CPR by untrained bystanders is acceptable as it simplifies the process and reduces any interruptions in chest compressions.
5) Employing Defibrillators (AEDs): To be effective, AED (automated external defibrillator) programs are designed to deliver a shock to a victim within three to five minutes after the person collapses. After the shock has been given the defibrillator will require CPR to be continued for two minutes before the AED re-analyses the situation. Should the defibrillator say that no shock is needed, then continue CPR for two minutes, then allow the defibrillator to re-analyse. Continue to follow its instructions. Do not touch the patient while it is defibrillating. The AED will determine whether the victim's heart needs an electric shock or not.
6) Giving cardiopulmonary resuscitation (CPR) to someone with breasts: Whilst CPR does not require any clothes to be taken off it does require the breasts to be touched through their clothing. CPR can be applied through heavy winter clothing but if the clothing is very thick it may be necessary to remove the top layer to allow for proper chest compressions to be applied. If it is known that a defibrillator is going to be employed then do not hesitate to get the clothes removed immediately for successful defibrillation requires the pads to placed directly onto bare skin.
7) Using a defibrillator on someone with breasts: Women are disproportionately affected by the notion that it would be a bad thing to expose or touch their breasts. But defibrillation does require the pads to be placed on bare skin. (Most definitely if an underwired bra is in being worn for the electricity will follow the wires rather than travel where it needs to.) Do not have any concerns about removing a bra and then later being accused of ‘inappropriate’ touching the person. You are trying to save their life! Cut the bra off, or move it out of the way. Once the pads are in place, then you can then recover the breasts with the bra to restore the person’s modesty & dignity.
8) Civil Claims against battery or common assault: A potential liability could arise from a civil claim for damages brought by the patient, or their family on the grounds that intervention occurred without consent and so constituted either an assault or a battery claim. How-ever being a bystander rescuer, (even if the patient could later present a ‘Do Not Resuscitate’ (DNR) order), you are generally legally protected under the UK’s Good Samaritan laws. These laws protect those who provide medical emergency-care in good faith. The law presumes that the invalid at the time of the incident was not mentally capable of giving their consent for CPR or use of an AED (defibrillator). More-over that the rescuer believed it to be in the person’s best interests to try to resuscitate them. In the UK, to date, no one has knowingly been prosecuted for starting CPR. (This Legal support comes within the “Social Action, Responsibility and Heroism Act 2015”)
9) ‘Do Not Resuscitate’ Orders (DNR): In a 'cardiac arrest' emergency attended by non-healthcare professionals, no time should be lost searching the person for evidence of a DNR order even if it is believed that the patient may have one. DNRs are mostly for when a person is an in-patient at a medical establishment whereon their wishes may have been established on admittance. There is at present no statutory requirement in the UK for rescuers to check for a valid DNR order before administering either CPR or employing a defibrillator.
10) Can employing CPR or an AED (defibrillator) cause harm: The likelihood of causing harm by using an AED is very small indeed. But for defibrillation to be successful it does need to be carried out within minutes of the onset of ventricular fibrillation, although successful revival can be better achieved if a helper provides cardiopulmonary resuscitation (CPR) immediately whilst waiting for the defibrillator to arrive. Of course, this entails recognising that the invalid has suffered ‘sudden cardiac arrest’ (SCA) in the first instance. How-ever an AED will only administer a shock when it detects ventricular fibrillation – a pattern consistent with a cardiac arrest. Patients in this state are clinically dead so it is difficult to see how the appropriate use of this device by a bystander could make the situation worse. Unfortunately applying CPR with sufficient pressure to be viable does bring risks of harm. The chest compressions involved in CPR can cause bruising or in some cases break ribs. This is more common in older adults or those with fragile bones. Other medical complications may also arise. Despite these risks, CPR can be crucial in saving lives, especially when performed correctly and promptly. Nevertheless it's always best to be ‘trained’ in applying CPR to minimize these risks.
11) Bystander intervention greatly improves the chances of survival in sudden cardiac arrest (SCA): Statistics tell us that bystander intervention greatly improves the chances of survival in sudden cardiac arrest (SCA). So a defence of ‘necessity’ would be available to a non-professional rescuer who has provided reasonable assistance in the circumstances. The legal test is whether the intervention has left the sufferer in a worse position than they would have been in had no action had been taken. But in the case of SCA, it is difficult to see how a volunteer rescuer’s intervention could leave someone worse off, since without their intervention death is probably inevitable. Thus in the circumstances of cardiac arrest when the victim would almost certainly die without resuscitation, the risk of incurring such liability is extremely small.
12) Bystander is reluctant to be involved: UK law protects a person if they are reluctant to act; (unless they were the prime cause of the person needing help).
13) Civil Liability Insurance: No insurance should be needed for lay members of the public carrying out benevolent intervention in good faith. How-ever should a club member demonstrate first aid and resuscitation techniques, including the use of AEDs, to other club members then the bowls club must ensure that the demonstrator, or the club itself, has appropriate personal insurance in place to cover the acts of its trainers. (A club member who is also a member of a charitable first aid organisations may well have indemnity cover which is only operative whilst working for that particular organisation.So this cover may not necessarily apply at other times.)
14) Cardiovascular implanted electronic devices (CIEDs): There are no special precautions required when delivering CPR chest compressions to someone with an implanted CIED. Your priority is to get their blood circulating and oxygen to vital organs asap!
15) Implanted cardioverter-defibrillator (ICDs): Do not place the external defibrillator electrodes over or close to any implanted electronic device. These ICD devices are designed to manage heart rhythms and can be crucial for the patient's health. Many have a built-in’ defibrillator’ function. These with a defibrillation function will already be delivering a sequence of electric shocks to the person’s heart in an attempt to terminate the arrhythmia. The patient will probably be experiencing muscle contractions which indicate that they are receiving shocks from their implanted ICD. If the shockable rhythm persist, external defibrillation may also be attempted. The AED will recognize these implanted shocks lasting around 30–60 seconds on each cycle. Heed the instructions from the AED. (Sometimes these ICD shocks do muddle the AED’s analysis so you may have to continue with CPR until the ambulance crew arrives.) If the ICD is simply a pacemaker type, refer to No. 16 below.
16) Those with pacemakers implanted in their chests: CPR should be carried out by compressing the centre of the invalid’s chest. Those with implants can also experience sudden cardiac arrest. Time is of the essence. If no ‘alert’jewellery is immediately obvious you may feel an implanted device under the skin.
17) Using a defibrillator on someone with a pacemaker: Pacemakers are designed to withstand shocks from AEDs. Position the pads around the upper right side of the chest at least 3cm away from the pacemaker.
18) Those with cardiac event recorders (implantable loop recorders or implantable cardiac monitors) implanted in their chests: CPR can be performed on someone with an implanted cardiac event recorder. The chest compressions should not affect the device and should be performed in the centre of the chest as usual. As for using a defibrillator; the pads of the AED are usually placed on the upper right side of the chest and on the side of the rib cage under the left arm, so they should not interfere with the implanted device.
19) Silicone breast implants: ‘Silicone’ breasts when not supported by a bra will droop slightly to the side so they should not hinder the CPR / defibrillator process. Defibrillators will work fine on patients with breast implants since the pads are not placed directly over the breast. Follow the AED’s instructions for correct pad placement.
20) Mastectomy: The defibrillation process is not impacted by any previous surgery to remove the breasts. The process only delivers an electrical shock to the heart to restore a normal rhythm.
21) Maintenance of the club’s defibrillator: Failure to maintain the AED or to train club members in its use could be seen as a breach of the statuary regulations regarding Health & Safety.
References: Mostly by Microsoft’s AI Bing interrogation, St John’s Ambulance Liaison and reference to the Resuscitation Council UK.
John Green
Company Secretary, January 2025.
