The Safety of EMS Personnel During Defibrillator Use

Emergency Medical Services (EMS) professionals often grapple with the question of safety when applying defibrillators to patients. A widely discussed concern is the potential for injury if the rescuer makes contact with a patient during defibrillation. This article explores the myths and realities surrounding this issue, backed by scientific understanding and real-world examples.

Introduction to Defibrillation Myths

EMS practitioners often face eerie tales of rescuers suffering injuries from inadvertent contact with a patient during defibrillation. These stories, akin to urban legends, are rooted in a mix of fear, misunderstanding, and a lack of documented evidence. One such tale involves a medical professional experiencing actual injury from being in contact with a defibrillated patient. While such occurrences are highly feared and discussed, they are virtually non-existent in reality.

Real-World Experience: A 2012 Incident

Consider a 2012 video where a physician performed chest compressions during a resuscitation while his hands were positioned between the defibrillator pads. The physician reported feeling a minor tingling sensation, likening it to "maybe 1/5 of an electric fence." This incident dispels the myth of severe injury occurring due to accidental contact with a defibrillated patient. It demonstrates that the sensation is generally mild and poses no significant risk to EMS personnel.

Understanding the Electrical Pathway

Defibrillation is simply the application of electrical current to the heart, aiming to restore normal rhythm. The voltage is applied between two pads, and the current travels between these points. If a rescuer makes contact with the patient, especially if their heart is part of the conductive pathway, the risk of injury increases. However, the pathway of least resistance is typically the direct path between the pads, bypassing the rescuer.

Rescuers sometimes encounter issues when placing the left side electrode too "frontward," causing the current to bypass the heart and travel through the chest wall instead. Proper electrode placement, such as the anterior-posterior (chest and back) position, is often recommended to ensure the current travels through the heart more effectively, reducing the risk of injury to the rescuer.

Risk Assessment for High-Risk Patients

High-risk patients, such as those with unstable conditions or those who are high from anesthesia without proper sedation, can present a challenge. While it would be ideal for such patients to be sedated and unconscious, this is not always feasible. These patients may have irregular heart rhythms, such as atrial fibrillation, supraventricular tachycardia, or ventricular tachycardia, which necessitate defibrillation.

In such cases, the pain experienced by patients during defibrillation can range from mild to severe. Patients reported the sensation of being punched by Mike Tyson, kicked by a mule, or even a horse, depending on the energy level of the shock. However, the shocks are synchronized with the patient's heart rhythm to avoid the vulnerable moments during the cardiac cycle, significantly minimizing the risk of injury.

Conclusion

The risks associated with EMS personnel making contact with a patient during defibrillation are overstated and often stem from misunderstandings and folklore. Real-world incidents demonstrate that the sensation experienced is generally minor and poses little to no significant risk to the rescuer. Proper training, electrode placement, and thoughtful application of shocks can further mitigate any potential risks. It is crucial for EMS professionals to understand the scientific principles behind defibrillation to ensure both patient and rescuer safety.

Keywords: Defibrillator, EMS Personnel, Patient Safety, Electrical Current