Elsevier

Resuscitation

Volume 53, Issue 3, June 2002, Pages 277-280
Resuscitation

Do nurses and physiotherapists require training to use an automated external defibrillator?

https://doi.org/10.1016/S0300-9572(02)00023-0Get rights and content

Abstract

Healthcare staff with the duty to perform CPR should also be capable of using an automated external defibrillator (AED). We investigate whether nurses and physiotherapists can use an AED without prior training. Subjects were tested on a manikin during a cardiac arrest scenario. All 15 untrained subjects could deliver a shock with an AED in 68.8±29.2 s (time±S.D., range, 40–169 s). Most failed to position the pads correctly (53%) or follow correct safety procedures (67%). After a standardised training session, the time to deliver a shock improved significantly to 48.5±5.5 s (range, 41–61 s, P<0.01) and all subjects placed the pads correctly and followed a safe defibrillation procedure. This study shows that nurses and physiotherapists, with no previous AED training, can deliver a shock with an AED. Training improves speed of shock delivery, correct pad placement and safety. This study suggests that it is feasible to train healthcare professionals to use an AED with relatively little training. This should allow rapid deployment of AEDs in those areas of the hospital where cardiac arrests are infrequent and staff do not have rhythm recognition skills.

Introduction

First responders to cardiorespiratory arrest have the best opportunity of saving life by early defibrillation [1]. We believe that all healthcare professionals should have skills in basic life support (BLS) and use of an automated external defibrillator (AED). Currently in the UK there is no legal requirement for hospitals to train staff to use AEDs. Ideally all healthcare professionals with a duty to perform CPR should be trained, equipped and authorised to defibrillate with an AED as a minimum standard. This is important in the hospital setting as the majority of first responders to cardiac arrest do not have sufficient rhythm recognition skills to use a manual defibrillator. Successful AED use by laypersons [2], security guards [3] and airline staff [4] shows that these devices can be used even by those with no regular contact with ill patients. Gundry et al. [5] have shown that untrained school pupils can use an AED in a simulated arrest scenario. If this is also true for healthcare professionals it will allow a wider and more rapid deployment of AEDs in the hospital setting. This study was designed to test the hypothesis that nurses and physiotherapists with no previous training in defibrillation can successfully use an AED.

Section snippets

Setting and subject group

This study took place in the Resuscitation Training Department of Southmead Hospital, Bristol, UK. This 1100 bed teaching hospital serves a population of 254 000 in the north part of Bristol. Registered nurses and physiotherapists attending for resuscitation training sessions were enrolled into the study. All worked in areas of the hospital where an AED programme was being initiated. None had experience in AED use or training in defibrillation skills. All subjects consented to take part in the

Time to defibrillation

The mean time to defibrillation was 68.8±29.2 (time±S.D., range, 40–169 s) for Group A (untrained) (Table 1). After training the mean time to defibrillation for Group A was 48.5±5.5 (range, 41–61 s). The mean improvement in time after training was 20.3 s. This difference is both clinically and statistically significant (P<0.01). Group B, who only did the scenario after training, completed the first shock in a mean time of 47.7±12.7 (range 37–85 s). Group B (trained) times were not different to

Discussion

This study shows that nurses and physiotherapists who are not trained to operate an AED can deliver a shock in a reasonable time by following the AED instructions and voice prompts. Training improves AED use by decreasing the time taken to deliver the first shock, ensures correct pad placement and safe delivery of the shock.

Early defibrillation is the single most important therapy for the treatment of VF and pulseless ventricular tachycardia. The time interval between the onset of VF and the

Portuguese Abstract and Keywords
Os profissionais da saúde treinados para fazer Reanimação Cardio-Pulmonar devem ser capazes de usar um Desfibrilhador Automático Externo (DAE). Investigámos se os enfermeiros e fisioterapeutas eram capazes de usar um DAE sem treino prévio. Os indı́viduos foram testados num manequim durante um cenário de paragem cardı́aca. Todos os 15 indivı́duos foram capazes de dar um choque com um DAE, sem treino prévio, em 68.3±29.2 s (Tempo±SD, média 40-169 s). A maioria não

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    Early defibrillation is the single most important therapy for shockable SCA. The interval between the onset of SCA and the delivery of the first shock is a determinant of survival [20]. In China, nurses seldom use defibrillators even though they are always the first medical staff to discover SCA, mainly because they lack awareness and competence to defibrillate.

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Portuguese Abstract and Keywords
Os profissionais da saúde treinados para fazer Reanimação Cardio-Pulmonar devem ser capazes de usar um Desfibrilhador Automático Externo (DAE). Investigámos se os enfermeiros e fisioterapeutas eram capazes de usar um DAE sem treino prévio. Os indı́viduos foram testados num manequim durante um cenário de paragem cardı́aca. Todos os 15 indivı́duos foram capazes de dar um choque com um DAE, sem treino prévio, em 68.3±29.2 s (Tempo±SD, média 40-169 s). A maioria não foi capaz de colocar as pás correctamente (53%) ou seguir procedimentos de segurança correctos (67%). Depois de uma sessão de treino padronizada o tempo para o primeiro choque melhorou significativamente para 48.5±5.5 s (Média 41-61 s, P<0.01), todos colocaram as pás correctamente e cumpriram os procedimento de segurança na desfibrilhação. Este estudo mostra que as enfermeiras e os fisioterapeutas que não têm treino prévio em DAE podem desfibrilhar com DAE. O treino melhora quer o tempo até ao primeiro choque, quer no posicionamento correcto dos eléctrodos bem como os procedimentos de segurança. Este estudo sugere que é possı́vel ensinar profissionais da saúde na utilização de DAE com relativamente pouco treino. Isto irá permitir a rápida utilização de DAE naquelas áreas do hospital onde as paragens são menos frequentes e onde os indivı́duos não têm capacidade para reconhecer ritmos de paragem.
Palavras chave: Desfibrilhador Automático Externo; Treino; Primeiros a responder a situações de paragem
Spanish Abstract and Keywords
Personal de salud con la obligación de realizar RCP deberı́a ser capaz de usar un desfibrilador automático externo (AED). Investigamos si las enfermeras y fisioterapeutas son capaces de utilizar un AED sin entrenamiento previo. Los sujetos fueron examinados en un maniquı́, durante un escenario de paro cardı́aco. Los 15 sujetos no entrenados pudieron entregar una descarga con un AED en 68.8±29.2s (rango de tiempo±desviación standard, rango 40-169 s). La mayorı́a falló en ubicar correctamente los electrodos (53%) o en seguir correctamente los procedimientos de seguridad (67%). Después de una sesión de entrenamiento estandarizada, el tiempo para entregar una descarga mejoró significativamente a 48.5±5.5s (rango, 41-61s, P<0.01) y todos los sujetos ubicaron correctamente los electrodos y siguieron un procedimiento de desfibrilación seguro. Este estudio muestra que las enfermeras y fisioterapeutas, sin previo entrenamiento en AED, pueden entregar una descarga con un AED. El entrenamiento mejora la velocidad con que se entrega la descarga, la correcta ubicación de los electrodos y la seguridad. Este estudio sugiere que es factible entrenar a profesionales de salud para usar un AED con relativamente poco entrenamiento. Esto deberı́a permitir un rápido despliegue de los AEDs en las áreas del hospital donde los paros cardı́acos son menos frecuentes y el personal no tiene habilidades de reconocimiento de ritmos.
Palabras clave: Desfibrilador automático externo; Entrenamiento; Testigos reanimadores

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