AEDs and Oxygen in the Aquatic Environment

AEDs and emergency oxygen have been demonstrated to be effective lifesaving tools in public facilities. Within the aquatic environment, the use of supplemental oxygen or an AED can contribute to a successful resuscitation during an aquatic incident. While such equipment has not yet become mandatory, its availability and use is recommended.

AED Recommendations & Considerations
In a wet environment, the most common concern involving AEDs is the potential electrical hazard to those in the general proximity. Numerous tests have been performed using both one- and two-phase devices on simulated victims in both fresh and salt water. These tests demonstrated that the defibrillation of a patient in a wet environment produced insignificant electrical potential that posed a negligible risk to the patient, operator or bystanders. Because most AEDs are self-grounded they are shown to be safe to use in wet environments. Below are additional protocols that you can implement when using AEDs in a wet environment:

• The patient should be placed on a backboard and moved at least six feet from the water’s edge.
• The patient’s chest should be dried before attaching the AED electrode pads. This will help ensure that the pads can be properly applied and will avoid stray electrical currents.
• The AED operator and others should never be in contact with the patient during rhythm analysis or defibrillation.
• The attached AED cable should be extended away from the patient as far as possible before the defibrillation button on the AED is pressed.

Another concern people often have when operating an AED is that no one should be touching the patient when the defibrillator is discharged. But, as long as the electrode pads are properly placed and there is no contact between the operator or bystanders and the patient, there is no direct current path that would cause a shock to those other than the patient. When administering oxygen in combination with an AED, be sure that the oxygen is removed from the victim and placed several feet away or that the oxygen flow is shut off when a shock is delivered. This is to reduce the possibility that the electrical charge from the AED ignites the oxygen-enriched space surrounding the victim.

Oxygen Recommendations & Considerations
Any victim of a potentially life-threatening emergency should receive emergency oxygen. In a drowning or any other hypoxic emergency, the vital organs and tissues of the victim will suffer from low oxygen levels, that, if sustained, will lead to brain damage and cardiac arrest. It is important to restore as much oxygen to the victim as possible through the use of emergency oxygen. Oxygen should be administered to both breathing victims, via a mask, and non-breathing victims through rescue breaths. It is best practice that the oxygen regulator is set to 15 flow liters per minute. Oxygen use should be maintained until EMS arrives, even if the victim appears to recover.

Training Tip
Ensure that all staff who would be responding in an actual emergency are trained in AED and oxygen use, and keep these certifications up to date. When training, use real emergency equipment or training devices that are replicas of the real equipment. This will familiarize staff with the equipment should they need to use it in an emergency.

We also recommend that you regularly check with the American Heart Association (AHA) and your AED and oxygen suppliers for any changes to codes or best practices.