The defibrillator

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Scene 1 · Opening

20.40, the foyer of a council swimming pool. The queue at the desk has stopped dead and opened out into a circle.

A man is on the floor. A woman is already kneeling against him doing compressions, arms straight, without lifting her head.

On the wall, ten metres away, a green box with a heart and a lightning bolt on it.

Scene 2 · The green box

She looks up for two seconds and tells you: “15 has been called.”

She has been doing compressions for a minute and a half. You are the only person in the foyer doing nothing.

What do you do?

• Right move : I run to the green box, open it, and bring the machine back to her.
  What is missing here is the machine : The compressions are already going and the call has been made. The one thing missing is that, and it is measured in seconds of running. A signed cabinet ten metres away is the best possible use of your legs.
• Mistake : I look up the nearest defibrillator on my phone.
  It is ten metres away, and it is signed : Units put at the public's disposal are often housed in wall cabinets marked with an easily recognisable logo: a green box, a heart, a lightning bolt, an arrow on the wall, built to be seen from a distance, by anyone, with nothing to look up. Learn the shape once and you will see it everywhere. The syllabus does advise keeping an app that locates defibrillators on your phone at all times: that is for beforehand, or for when you cannot see one. Not when the box is on the wall across the room.
• Not the best choice : I ask out loud whether anyone in the foyer is a doctor.
  Nobody puts a hand up : The machine on the wall already knows what to do. And it was put there for exactly the evenings when nobody puts a hand up.

Scene 3 · The machine in your hands

The box is lighter than you expected. Inside the lid there is a laminated card and two sealed packets.

She is on her twenty-first compression, counting under her breath.

What do you do with it now?

• Right move : I put it on the floor against him, on the opposite side from her, and I switch it on straight away.
  The moment it is there, you switch it on : And from that second on you no longer have to think it out alone: the machine gives the orders, one at a time, and waits until you have done each one. She carries on with compressions the whole time.
• Mistake : I wait for her to finish her set of thirty compressions so as not to get in her way.
  The machine goes on during the compressions, not between two sets : Nothing you do with the machine forces anybody else's hands to stop. Compressions are interrupted only when the machine itself says to stop touching the casualty.
• Not the best choice : I read the laminated card in the lid first, all of it.
  It is in six languages : And it says one thing: switch me on. The machine has read the card for you, and it knows it by heart.

Scene 4 · The machine speaks

A two-note chime, an amber light, and a very calm synthetic voice in the middle of a swimming pool foyer.

Do what it says, in the order it says it.

Five instructions, one at a time. The machine repeats itself until each one is done, exactly like the real thing. No mistake here is beyond repair, but every one of them costs seconds to somebody who has none.

1. “Press the power button.”
   • Right move : I press the power button.
   • Mistake : I leave it switched off and wait to see whether help arrives.
     A machine that is switched off says nothing and analyses nothing. It is switched on the moment it is available.
2. “Bare the patient's chest. Apply the pads as shown in the picture.”
   • Right move : I pull his shirt up, unwrap the pads and stick them onto bare skin.
   • Mistake : I stick them on over the shirt, it will be quicker.
     The pads go onto bare skin: through clothing the machine measures nothing and delivers nothing.
3. “Analysing rhythm. Do not touch the patient.”
   • Right move : I stop the compressions, lift my hands, and tell everyone to stand back.
   • Mistake : I carry on with compressions during the analysis, you must never stop.
     This is the one interruption the guidance asks for: when the machine says so, you stop compressions and you stop touching the casualty.
   • Mistake : I take his wrist to check his pulse while it analyses.
     Touching the casualty during the analysis corrupts it, and a pulse is not a sign the public guidance asks you to look for.
4. “Shock advised. Stand clear of the patient. Press the orange button.”
   • Right move : I check that nobody is touching him, I say so out loud, and I press the orange button.
   • Mistake : I press the button while keeping my other hand on his chest.
     Before the shock you have to be sure nobody is touching the casualty, yourself included. That is the instruction never to get wrong, for any reason.
5. “Shock delivered. Resume chest compressions.”
   • Right move : My hands go straight back, without waiting.
   • Mistake : I wait a few seconds to see whether he starts breathing again.
     The guidance says to resume compressions immediately once the shock has been delivered. The machine will do the checking again itself, and it will say so.

Challenge held : You followed the five instructions, in order : That is exactly how this machine is meant to be used: it is safe and carries no risk even in the hands of people with little or no training, on one condition, and you have just met it. Following its instructions to the letter saves time and keeps everyone safe.

Challenge missed : Someone else takes the machine : It says one thing at a time, and it moves on only once that thing is done. Following its instructions to the letter lets you get through the steps faster and more safely: that is written into the guidance in those words. Here someone else takes the machine and follows its instructions in your place: the guidance provides for the resuscitation to carry on while the machine is being set up whenever more than one rescuer is present.

Scene 5 · After the shock

Compressions are going again, the pads are still stuck down, and the machine carries on talking to nobody.

It announces another analysis in two minutes.

One decision left, and it is the one people get wrong.

• Right move : I touch nothing: the pads stay where they are and the machine stays on.
  It has not finished its work : There is a period of resuscitation, usually two minutes, before the machine asks for another pause to analyse the rhythm. Compressions resume immediately after the shock, and it is the machine that will say when to stop again.
• Mistake : I switch the machine off: the shock has been given, it is no more use.
  You do not switch a defibrillator off : One shock is not always enough, and the machine is what decides whether a second one is needed. Switched off, it is watching nothing, and it would all have to be done again from the start.
• Mistake : I peel the pads off so they do not get in the way of the compressions.
  The pads are not in the way, they are watching : They stay in place on the casualty's chest. They are what makes the next analysis possible, and they are how the next shock would be delivered.

Scene 6 · The crew

Blue light on the foyer windows, two sirens stopping. A crew comes in, and one of them asks straight away: “Did you shock him?”

You say yes, once, two minutes ago. They plug their own machine into the pads you put on, without peeling them off.

The green box goes back on the wall in the morning. It did its job tonight, because somebody saw it and brought it over.