An automated external defibrillator (AED) is a portable device used to treat sudden cardiac arrest, a condition where the heart’s electrical activity becomes chaotic, preventing it from pumping blood effectively. The primary purpose of an AED is to deliver a controlled electrical shock to the chest, which aims to reset the heart’s rhythm back to normal. Time is a significant factor in survival, with the chance of survival decreasing rapidly every minute. Immediate action is paramount, requiring rescuers to quickly prepare the patient and the device to deliver the shock as fast as possible.
The Primary Concern Metal and Electrical Current
The core issue with jewelry and an AED is the presence of metal, which is an excellent conductor of electricity. If an AED pad is placed directly over a metal object, or if two metal objects are in the path of the electrical current, it can create significant problems. This contact can cause the electrical energy to follow the path of least resistance through the metal rather than through the heart muscle.
A metal object in the path of the electrical current can lead to electrical arcing, which is essentially a spark jumping from the pad to the metal. This arcing, or the concentration of current through the metal, can cause localized, severe burns to the patient’s skin. The concern is not that the jewelry will interfere with the AED’s ability to analyze the heart rhythm, but rather the risk of patient injury and the possible diversion of energy away from the heart.
Practical Pad Placement Guidelines
Rescuers should assess the patient’s chest for any metal jewelry, including necklaces, body piercings, and metallic underwire bras. If a metal item cannot be quickly removed, the most practical solution is to adjust the placement of the AED pads. The goal is to ensure the pads are placed at least one inch away from any metallic object.
The standard placement for AED pads is typically the upper right side of the chest, just below the collarbone, and the lower left ribcage area, known as the anterior-lateral position. For common items like necklaces, the jewelry should simply be moved or pushed to one side of the chest, clear of where the pads will be applied.
If a bra has a metallic underwire that cannot be quickly cut or removed, rescuers should consider cutting the bra away from the body. Another option is placing the pads in an alternate configuration, such as the anterior-posterior (front-back) position, to avoid the metal entirely.
Prioritizing Speed Over Removal
The most important factor in a sudden cardiac arrest emergency is the speed of defibrillation. The probability of a successful outcome decreases by approximately 10% with every minute that passes without treatment. Therefore, the time spent attempting to remove jewelry must be balanced against the immediate need to deliver the shock.
If jewelry is difficult to remove, or if removal would take more than a few seconds, rescuers must prioritize immediate pad placement using the safe distance guidelines. Delaying the application of the AED and the delivery of the shock to remove non-obstructive jewelry is detrimental to the patient’s chance of survival. Cardiopulmonary resuscitation (CPR) and defibrillation should not be interrupted for any non-essential actions.