Why does defibrillator pad placement matter? Each day in the UK, around 200 people experience an out of hospital cardiac arrest. Cardiac arrest occurs when the heart stops beating normally and the brain stops getting oxygenated blood. Sadly less than 10% of people who experience an out of hospital cardiac arrest survive.

If someone goes into cardiac arrest, they need immediate good quality CPR to pump some oxygenated blood around the body to keep the brain alive whilst awaiting the arrival of a defibrillator – which can shock the heart back into a normal rhythm.  

According to the Resuscitation Council UK, a person’s chance of survival decreases by around 10% for every minute that passes whilst waiting for a defibrillator. Anyone can use a defibrillator – but to give the person the best chance of survival, you need to use it properly, and place the defibrillator pads correctly.

Studies have found that minor variations in defibrillator pad placement can reduce first shock efficacy. (Minor Variations in Electrode Pad Placement Impact Defibrillation Success, 2016).

Let’s chat about proper defibrillator pad placement.

How do you use a defibrillator?

Switch the defibrillator on and follow the instructions. Defibrillators are designed to be easy to use and will talk you through each step. Try to stay calm and follow the prompts to give yourself the best chance of making a positive difference in a real life, high pressure First Aid situation.

Where do Defibrillator pads go?

The simplest way to put the pads in the right place is to switch on the defibrillator and listen to the instructions. Look at the pads. The pads have pictures of where to put them. You should put the pads on the person’s bare chest exactly as shown in the pictures.

Place the first pad on the upper right side of the patient’s chest, just below the collarbone. The second pad goes on the left of the rib cage, just beneath the armpit.

Evidence shows that correct defibrillator pad placement is important. Taking a moment to get it right gives the person the best chance of survival.

Do you remove a bra to use a defibrillator?

Don’t waste time removing jewellery – but we need to remove all clothing from the chest. So that we can put the pads in the correct place – we need to remove a person’s bra too. Use the tuff cut scissors included with the defibrillator to do this.

Do you need to shave the chest when using a defibrillator?

The pads also need to make solid contact with the skin. Remove chest hair using the razor provided with the defibrillator. You don’t need to shave the whole chest – just the parts where the pads will need to stick to the skin. If the person is wet or clammy – dry the parts where you need to stick the pads so that they have the best chance of sticking. If the person is wet, dry the chest area between the pads too. When putting the pads on, smooth the pads down to avoid any creases or air bubbles.

Can you use a defibrillator if someone has a pacemaker?

Yes. A pacemaker is a small device about the size of a matchbox or smaller. It is usually implanted on the upper left side of the chest. Defibrillator pads are usually placed on the upper right side of the patient’s chest, just below the collarbone. The second pad goes on the left of the rib cage, just beneath the armpit – so pacemakers shouldn’t get in the way of the pads. If the pacemaker is on the upper right side, place the upper pad 8 centimetres away from the pacemaker.

Can you use a defibrillator on a child?

Yes. Some defibrillators have different pads for adults and children. You’d usually use child defibrillator pads for children up to the age of 8 years old. Adult pads are used for anyone over this age. Child defibrillator pads usually provide a smaller amount of energy than adult pads. 

Some defibrillators use the same pads for both adults and children. In this case, these pads have pictures to show you where to put those pads on an adult and where to put them on a child up to 8 years old. If the same pads are used on adults and children, the defibrillator usually has a switch to choose either ‘adult’ or ‘child’. Selecting ‘child’ will usually reduce the energy level. 

If you need to use a defibrillator on a child, you’d place one pad on their front, close to the heart, and you’d place the other on their back, between their shoulder blades. This helps to ensure the shock reaches the heart – to increase the chance of the heart starting to beat normally again. Follow the prompts and pictures on the pads to ensure the correct placement.

If a defibrillator doesn’t have child pads or a child setting, the Resuscitation Council UK suggests using any defibrillator available.

How much energy is delivered by a defibrillator?

Most modern defibrillators deliver a shock between 120 and 360 joules for an adult and 50-75 joules for a child. The defibrillator determines whether to deliver the adult amount or child amount based on which pads are used or whether the user has selected the adult or child setting on the defibrillator.

Can you shock someone who doesn’t need a shock from a defibrillator?

No. A defibrillator will only allow you to shock someone who needs a shock. A defibrillator will not allow you to shock someone who doesn’t need shock. Listen to the voice prompts and ensure no-one is touching the person when the defibrillator is analysing or when a shock is delivered.

Which is the best defibrillator?

The best defibrillator for one organisation may not be the best for another. Check out our advice on how to choose a defibrillator here. Some of the most popular models are here. Feel free to get in touch if you’d like some advice.

How can I learn to use a defibrillator?

Everyone on all of our courses gets to use a defibrillator. We train people to recognise when someone needs CPR, how to do the best quality CPR and how to use a defibrillator with the minimum disruption to CPR. On our Advanced First Aid and Prehospital Care courses we introduce airway adjuncts, oxygen administration and other considerations to give people the best chance of survival. 

First Aid is a practical skill. Getting good at delivering good quality CPR and using a defibrillator whilst minimising disruptions to CPR takes practice. We use technology including QCPR to provide real time feedback to help people become the best First Aiders and First Responders possible. Get in touch to find out more!