The sudden collapse of an individual is a stressful event, and the presence of an implanted medical device like a pacemaker can introduce hesitation for a bystander. This uncertainty can be overcome with clear, actionable knowledge regarding the specific steps to take. Rapid response and the correct application of emergency procedures are paramount to survival when a person’s heart function has failed. Understanding how to adapt standard emergency protocols for a person with a pacemaker allows for effective and timely care.
Immediate Emergency Response
The first priority upon witnessing a collapse is to ensure the safety of the scene for both yourself and the collapsed person. Once the area is secure, you must quickly check for responsiveness by firmly tapping the person’s shoulder and shouting a question like, “Are you okay?” A lack of response indicates unconsciousness, which requires immediate action.
You should immediately direct a specific bystander to call the local emergency number, such as 911, and ask them to locate an Automated External Defibrillator (AED) if one is nearby. If you are alone, make the call yourself and put the phone on speaker so you can continue to assist the person. Next, carefully position the individual flat on their back on a hard, firm surface, which is necessary for effective chest compressions.
After ensuring the person is flat, quickly check for normal breathing and a pulse for no more than ten seconds. If the person is not breathing or is only gasping, you must begin Cardiopulmonary Resuscitation (CPR) immediately. High-quality chest compressions are the most important intervention to circulate oxygenated blood to the brain and vital organs until professional help arrives.
Special Considerations for CPR and Defibrillation
Performing CPR on a person with a pacemaker remains the same standard technique, with the primary difference being a slight adjustment in hand placement. The pacemaker device is typically implanted just beneath the skin near the collarbone (clavicle), usually on the left side of the chest. Standard chest compressions are delivered to the center of the chest, which is generally clear of the device.
To prevent any damage or interference with the pacemaker, ensure your hands are placed on the center of the breastbone, slightly lower than the device site. This placement allows for the full depth and rate of compressions, which should be between 100 to 120 compressions per minute and at least two inches deep. The goal of CPR is to mechanically pump blood, and maintaining the correct depth and speed is far more important than worrying about the device.
If an AED is brought to the scene, its use is safe and strongly recommended, as the device is designed to withstand the electrical shock. Proper placement of the AED pads is a specific modification that must be observed to protect the pacemaker. You must visually locate the small bulge or scar from the implanted device and ensure that no AED pad is placed directly over it.
The pads should be positioned at least one inch, or approximately three centimeters, away from the device’s location. Placing a pad directly over the pacemaker could potentially cause a localized burn to the skin or damage the device itself, leading to a failure of the defibrillation shock. If the standard pad placement (upper right chest and lower left ribcage) interferes with the device, you should use an alternate placement, such as front-to-back, to ensure the electrical current bypasses the pacemaker.
Information to Provide Emergency Responders
When emergency medical services (EMS) arrive, the bystander’s role shifts to providing relevant information to expedite professional care. The first detail to relay is that the patient has a pacemaker or other implanted cardiac device. This immediately informs the responding team about necessary adjustments to their treatment plan.
You should clearly state the time the collapse occurred and what the person was doing immediately beforehand, such as reporting dizziness or chest discomfort. Any known medical history, like a recent illness or heart rhythm issues, can offer the EMS team valuable context. This information helps them determine the most likely cause of the emergency.
If the person wears a medical alert bracelet or necklace, or if a medical ID card is found in their wallet, present this to the responders immediately. These identifiers contain details, such as the device’s manufacturer, model number, and the date of its last battery replacement. Having this data allows the paramedics to communicate more effectively with the hospital and prepare for device-specific interventions.