AED deployment in metal grandstands at track meet

[berkeman]

I worked a 2-day USATF track meet in NorCal this last weekend, and I had a moderate asthma Pt in the grandstands that had her own inhaler and the situation worked out fine. But as usual afterwards I started running alternate scenarios, and for the first time I thought about how to handle a cardiac arrest of a Pt on a very hot sweaty day in metal grandstands at an event.

My worry is that even after drying off the topside of my trauma-naked Pt laying on the metal grandstands, there is still an alternate electrical path around the heart through their sweaty back and the metal of the grandstands. My thoughts now after thinking the scenario through are to also dry off her back and find a dry towel or extra piece of specator clothing quickly and drag her onto it so it semi-insulates her back from the metal bench. I guess with really sweaty Pts it's also good to try to remove the wet clothing from their back and dry that off before the first shocks?

My AED training has not addressed the Pt's back so far. Thanks for your thoughts.

 

[MMiz]

You should be fine using an AED on a metal surface as long as the electrodes aren't attached to the metal surface and no one is toughing the patient at time of shock.

Source: Zoll AED FAQ

Though not required, I would put a towel, backboard, or other barrier between the patient and the metal.

To your credit, as I researched before responding I found a lot of conflicting information. Good question!

 

[OrthoHypo]

I wasn't there, so I don't know what the location really looked like. Depending on the size/shape/positioning/crowding of the grandstands, it may not be a safe or effective location to work a code, to begin with. Starting compressions and quickly scooping the patient to flat and level ground may be an option, but you have to weigh the risks/benefits. I agree with Miz though, if you were going to work the code in place, throwing an insulator under the patient wouldn't be a bad idea.

 

[johnrsemt]

I have seen patients shocked on wet sides of swimming pools (major no no in every class) with no major problems, so this shouldn't cause a problem. Maybe not kneel on the metal, Squat on it