Anyone who has watched scripted television medical dramas has likely seen use of a manual defibrillator. Paddles are placed on the chest of someone going through cardiac arrest, and after shouting “clear,” the acting doctor or EMT uses the paddles to deliver an electric shock designed to re-start the heart.

Technological advances have put that potentially life-saving method into the hands of real-life civilians through an automated external defibrillator (AED). These are lightweight, portable devices designed to be used by people with little or no training. Federal legislation in 2000 and 2002 significantly expanded their use in public settings and led to further state-level legislation, all designed to create wider adoption in public and private areas.

What should you know about looking for a new or replacement AED for your facility? Here are some of the key questions to consider:

How do AEDs work?

Unlike the paddles of a manual defibrillator that are designed for use by healthcare professionals, portable AEDs use contact pads that stick to the chest of the person being treated. Though all AEDs use these pads, they operate in one of two modes and the distinction is important.

Once the pads are applied and the device is activated:

• Semi-automated AEDs analyze the heart rhythm, and if the apparatus decides a shock to the heart is necessary, commands from the device – usually by voice – will direct a user to push a button to deliver the charge.
• Automatic AEDs do the same analysis of the heart, but they deliver the shock with no action from the user at all.

All the models come with adult-sized and an option for child-sized pads that offer different levels of stimulation. The American Heart Association recommends using the pediatric pads on children between ages 1-8, and adult pads on people older than 8. The organization also recommends manual defibrillation for anyone younger than 1.

What features of AEDs should I consider?

Beyond the difference in operating modes, many AEDs have a lot of similar characteristics. In addition to doing most or all the work in delivering the shock, most models have extensive voice or video direction in placing the pads as well as in giving CPR. They are very light, between 3 and 7 lbs., and all models should be easy to carry. Some have cabinets that can be affixed to a wall for storing the AED in an easily accessible location.

Most AED models record data from each use. Some will allow users to connect the device to a personal computer via a USB cable, while some save the data on a removable memory card.

AEDs are typically powered by a lithium/manganese dioxide battery with a standby life between 4 to 7 years. The Mayo Clinic recommends replacing the batteries about every four years but check manufacturer's recommendations for specific model guidance. The contact pads also have an expiration date, typically 2 years.  Check manufacturer recommendations for this as well.

What regulations govern AEDs in the workplace?

OSHA does not require that companies keep AEDs in their facility, but the organization urges the practice. Devices are recommended to be placed where response can happen in 3 to 5 minutes, as well as locations such as:

• Remote locations, such as construction sites
• Near confined spaces
• Where electric-powered devices are used
• Outdoor sites capable of being struck by lightning

The Food and Drug Administration (FDA) is the federal agency charged with approving AEDs that go to market. Beginning in February 2015, the FDA determined that due to product recalls and malfunction reports, these systems and their accessories required more oversight and so manufacturers were required to get pre-market approval (PMA) for their AED systems. That order was later extended to accessories, and by November 2022 manufacturers who didn’t apply for their PMA were prohibited from selling those accessories.

The FDA continues to monitor the products once they reach the market, reviewing design changes and performance reports.

Also, all 50 states have some form of a public access defibrillation (PAD) program law. Each law has different tenets, but according to the Centers for Disease Control (CDC), the broader aims include:

• Increasing availability and use of AEDs
• Limiting liability of civilians who use AEDs
• Requiring public and private entities to implement a PAD program

How should we introduce AEDs into our workplace?

The American College of Occupational and Environmental Medicine published a position paper that it last reaffirmed in 2012, outlining guidance for bringing AED use into the workplace. Among the key recommendations:

• Establish a management system for all aspects, with clear responsibilities. This includes:
  • Having a qualified medical director oversee the program’s medical aspects, including written authorization to buy the AED and reviewing the recorded data from every incident where it is used.
  • Creating administrative oversight for other elements, such as compliance, training and support.
• Creating a written program for each location. This program should outline how the company will meet PAD regulations in the state or states where the organization is based.
• Integrating the AED program with the organization’s larger emergency response plan.
• Scheduling employee training and maintenance of the units

The Society for Human Resource Management outlines a similar set of tips, adding in the need to communicate the program broadly. Newsletters, posters and safety meetings and larger team meetings each provide avenues to help all employees understand the program.