AED pad placement

[knotical]

Not limited to diving, but:

How much variation is acceptable in AED pad positioning? Everything I have been taught and read says that when one pad is on the victims left side, the other should be on the victims upper right chest.
But recently I saw professionals who had placed one pad in the usual position on the left side, and the other with the bulk of the pad to the left of the victims centerline.

How much may pads be allowed to vary from the ideal positions taught, and what is the impact of such deviations? Could the AED still be effective with a pad displaced as it was by about 5-6 inches?

As it happened, there were other indications that the victim was deceased (bullet wounds to the head, pooled blood, etc.); and the AED was used primarily so the doctor on the radio could pronounce. Nevertheless, I politely questioned one of the EMTs, but he defended what he had done. I am not yet convinced.

 

[Riverrat Dave]

I have not heard of pad placement you describe, however there may have been circumstances with this patient that prevented the normal placement of the pads, I do not typically think the EMT's would share something like this as it may violate "privacy" laws, (just a guess).

 

[cutlass]

Three AED pad positions have been reported as effective; viz., section "Electrode-patient interface" in 2005 AHA info on AEDs and "Electrode Placement" subtopic under the AED main section 2005 AHA on CPR. By far, the most common and optimal is to have one pad on the victim's upper right chest and the other on the side of the left chest; i.e. the sternal-apical or modified Lead-II position. However, if there are obstacles to this preferred placement, two other configurations are available. The biaxial has the pads on opposed left-right sides of the chest. The anterior-posterior has one pad on the lower left sternal border and the other below the scapula on the left back.

Pad positioning is usually approximated according illustrated or demonstrated guidelines; these are only as accurate as the anatomatical description given. But in order to develop data, some AED studies have attempted to more rigorously describe placement boundaries. For example, the last paragraph under "Protocols" in this older 1999 paper: AED ease of use

There is not enough information or authority to specifically comment on the described scenario. What follows is only intended to be informational about general practices. Typically for traumatic injury, BLS, CPR, and immediate transport is appropriate. As for death in the field, on-site EMS personnel invariably have standing orders authorizing declaration of death when presented with catastrophic injury; e.g. decapitation or equivalent total crush injury, torso transection, decomposition or extensive charred deep burns, lividity with rigor mortis, etc. Otherwise, medical control (online physician) gets involved and there is consideration of factors such as nature of injury, persistent absence of life indicators of respiration, circulation, and neurologic responses, statistical futility as related to treatments applied and the victim's down-time history, responder and other casualty safety, needs of other casualties, and remaining transport and life-support resources.

 

[logos]

The way to think of it is that you want a straight line from one pad to the other to cross the heart. The rest is details.

For example an adult AED can be placed on a child by placing one pad on the chest and the other on the back.