Hands On Defibrillation

[Asclepius]

I read, with great interest, the article in this months JEMS concerning retraining rescuers to keep their hands on the patient during biphasic defibrillation. I was intrigued, but not convinced that it is entirely safe, so I emailed Zoll to inquire about the safety. I also Googled to see if there were any articles that spoke to the subject. Below is what I discovered. What do the rest of you know about this? Anyone else hesitant to keep their hands ON the patient DURING defibrillation?

I wrote to Zoll and asked them about the safety of keeping your hand on a patient during defibrillation. They responded that you should NEVER leave your hands on a patient during biphasic or monophasic defibrillation, because the rescuer could receive the shock themselves. That being said, I did look for scholarly articles that supported the claim that hands on defibrillation is safe for biphasic defibrillation. I would be interested in seeing some of the science behind this article. I wrote the AHA for their comment and have not received a response. What follows is the responses I got from Zoll and the link to one scholarly article that I found.

"Always stand clear of victim when delivering a shock. Defibrillation energy delivered to the victim may be conducted through the victim's body and cause a lethal shock to those touching the victim."

I responded for clarification and received the following response.

"ZOLL Medical does advise on how to train EMS personnel. ZOLL Medical can advise that EMS personnel should always stand clear of victim when delivering a shock. Defibrillation energy delivered to the victim may be conducted through the victim's body and cause a lethal shock to those touching the victim."

Then I found this article online: http://circ.ahajourn...tent/short/C...

Edited May 13, 2010 by Asclepius

[technocardy]

I have no evidence to support the hands on theory, nor do I have any evidence to support hands off theory. All I can say, is that my entire first aid/pre-hospital care career, I've always been told to stand clear of the patient while a shock is being delivered. I haven't actually seen people go down from having their hands accidentally on a patient, but I have heard stories of other providers going down while having their hands on a patient while a shock is being delivered. Will be interesting to see what AHAs response is.

[Kiwiology]

I note yet another quality, well well written and fully referenced piece of material appearing in JEMS ... not

Perhaps the author has some evidence for his claim?

[medicKristina]

See, I have to think that this would be one of those moments you would want to err on the side of caution (did I get that right....) and stand clear. Electricity + me = NOT OK!!

However, this quote from the article scares me a little: "This was below several recommended safety standards for leakage current". I don't believe ANY amount should meet safety standards for leakage of current. I may be crazy, but still...not OK with me.

It's also important to note that this study, done by AHA, was not with real rescuers. The conclusion is not a definite change in current training, but rather a first impression of what could be feasible: "Conclusions—Rescuers performing chest compressions during biphasic external defibrillation are exposed to low levels of leakage current. The present findings support the feasibility of uninterrupted chest compressions during shock delivery, which may enhance the efficacy of defibrillation and cardiocerebral resuscitation."

Again, not me. I will stand clear and make sure everyone I'm working with or around are clear too.

Edited May 14, 2010 by medicKristina

[armymedic571]

This is completely anecdotal......but how does this differ from some one who is touching a person who is tazed?

If I recall from less-leathal weapons training. Every person who was tazed, had two other people holding them to help them to the gound. Contact was never let go, and no one received any rougue shocks.....as I recall.

But like I said......That is just anecdote..... .

[mobey]

This is completely anecdotal......but how does this differ from some one who is touching a person who is tazed?

If I recall from less-leathal weapons training. Every person who was tazed, had two other people holding them to help them to the gound. Contact was never let go, and no one received any rougue shocks.....as I recall.

But like I said......That is just anecdote..... .

Not just anecdotal at all.

It has been studied and proven that CPR does not need to be interupted for "hands free defib"

Just a quick thought.... Anyone ever shocked a pt in thier ambulance, while touching the steel cot? You dont get a shock!

References:

(1) Lloyd MS, et al. Hands-On Defibrillation: An Analysis of Electrical Current Flow Through Rescuers in Direct Contact With Patients During Biphasic External Defibrillation

Circulation 2008;117:2510-2514.

(2) Kerber, RE. "I’m Clear, You’re Clear, Everybody’s Clear": A Tradition No Longer Necessary for Defibrillation? Circulation 2008;117:2435-2436.

We will probably never see the change made in practice, but maybe someday.

Thought #2.... Should we be shutting off the pneumatic CPR device for defib?

[HERBIE1]

Let's put it this way. Too many variables. What if the victim's skin is wet- sweaty, water, emesis, etc? That would conduct the electricity away from where you want it to go. What if the pads are not entirely snug against the skin- gaps, cracks, etc? What if some of the gel gets smeared as the pads are applied?

No way am I putting my hands on someone while they are being defibrillated. There is no reason why you cannot pause for the few seconds it takes to deliver the shock.

I do know of a guy who was accidently shocked when the floor of the rig was wet and the provider received a shock via the floor. Anecdotal? Yep, but good enough for me. The guy spent 23 hours in an CCU with arrythmias, but luckily no permanent damage.

[Richard B the EMT]

...and then there is the classic handstand on the defib paddles in a flooded tunnel, from the bad TV show "Rescue 77". I an unable to find the video of that on YouTube.

[AnthonyM83]

I've read articles that go both way on this issue. I have a feeling the type of gloves one wears can make a difference. I've had people give me anecdotal stories of people from specific agencies/hospitals going into cardiac arrest from touching the patient. It's not clear what kind of contact it was, though (gloves? arm touching patient's hand? etc) I've also read the articles saying people were unaffected by the shocks in one study that was done.

[Richard B the EMT]

I recently took a Continuing Medical Education (CME) class, combined BLS/ALS, where CPR and Defibrillation were done. Not only were we told not to touch the patient, but to disengage the Bag Valve Mask from the Endo Tracheal tube, as the weight of the BVM could possibly dislodge the tube during the body's convulsive motion on application of the shock.