Defibrillators have been developed to be used by anybody. They are usually simple to use without any prior training or knowledge. But could a child deploy and use a defibrillator in an emergency?
Yes, defibrillators, and particularly fully automatic defibrillators, have been designed to be used by any member of the general public. They have clear step-by-step instructions which are usually delivered by voice prompts when the AED is switched on. They can sometimes be replaced with or accompanied by visual prompts so the user is not required to read any instructions to operate the AED. The electric shock delivered by the machine and electrode pads is automatic and with a fully automatic defibrillator no human intervention is needed to activate these shocks.
Defibrillators are also lightweight and often durable. Some even have drop resistance and water resistance for maximum protection.
Any worries that the incorrect use of a defibrillator can somehow make the patient's situation worse should be dispelled. Voiced instructions are easy to follow and in the unlikely event that they are not carried out properly, they will not put the person having a cardiac arrest in greater danger. The machine can detect heart rhythms and will not deliver a shock unless it is necessary. Nevertheless, it is important to consider whether children should use a defibrillator and whether they would require training first.
Training in the techniques of basic life support (BLS) has been standard practice for school children in many European countries (e.g. Germany, Denmark and Italy) and in many US states for several years. Norway made the subject a compulsory part of the curriculum in all schools as long ago as 1961.
Several studies have demonstrated that school children learn the techniques readily and retain the skills well. After years of campaigning by key organisations such as the British Heart Foundation and The Resuscitation Council UK, first aid and CPR training were added to the curriculum for secondary schools in England from September 2020. Children over the age of 12 across the UK should now learn life-saving skills as part of their Health Education, such as CPR and defibrillator awareness. In fact, the Resuscitation Council1 recommends that teaching young people skills in CPR and the use of defibrillators is one of the most important factors in improving survival for out of hospital cardiac arrests. A CPR secondary school lesson plan and other school CPR resources are available to support teaching on the subject.
Study 1 – Use of defibrillators by children
A study from Seattle compared the use of defibrillators by untrained 6th grade children (11 - 12 year olds) with ambulance technicians and paramedics in a mock cardiac arrest scenario. The study aimed to improve understanding of defibrillator use in naive users by measuring time-to-shock and appropriateness of pad location.
AED use by 15 children was compared with that of 22 emergency medical technicians or paramedics. The mean time to defibrillation was between 59 and 111 seconds for the children and between 50 to 87 seconds for the ambulance technicians/paramedics. Electrode pad placement was appropriate for all subjects.
During mock cardiac arrest, the speed of AED use by untrained children was only slightly slower than that of professionals. The difference between the groups is surprisingly small, considering the naïveté of the children as untutored first-time users. These findings suggest that widespread use of AEDs will require only modest training.
Study 2 – CPR delivered by children
An observational study took place at four schools in Cardiff amongst 157 children aged 9-14 years in three school year groups (ages 9-10, 11-12, and 13-14). Participants were taught basic life support skills in a single lesson lasting 20 minutes and were then tested for the effectiveness of three minutes continuous chest compression on a manikin.
No year 5 pupil (age 9-10) was able to compress the manikin's chest to the depth recommended in guidelines. 19% of pupils in year 7 (age 11-12) and 45% in year 9 (age 13-14) achieved adequate compression depth. Only the 13-14 year olds performed chest compression as well as adults in other reported studies.
The study concluded that the children's ability to achieve an adequate depth of chest compression depended on their age and weight. The ability to provide the correct rate and to employ the correct hand position was similar across all the age ranges tested. However, young children who are not yet physically able to compress the chest can nonetheless learn the principles of chest compression as well as older children.
Therefore, it would not be inappropriate to teach children as young as 11 to use a defibrillator, even though they may have insufficient strength to use compression techniques.
Reviewed: 21/12/2021 (doc:561 V1.0). Our articles are reviewed regularly. However, any changes made to standards or legislation following the review date will not have been considered. Please note that we provide abridged, easy-to-understand guidance. To make detailed decisions about your fire safety provisions, you might require further advice or need to consult the full standards and legislation.