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I teach AED use and both my curriculum and trainer AEDs have one pad on the right chest and one on the left side. Is this the “two on the chest” method? If so, why have organizations not updated their curriculum and tooling?

Should I assume that irrespective of this finding, pads should be placed where the AED indicates so that rhythm detection works correctly?

[_r2h]

A lot of places have updated their curriculum or clinical guidance documents. Medicine is a slow moving beast, however, so change takes forever. A lot of AHA recommendations are woefully outdated. But everyone keeps doing the same thing because they are scared to not do what AHA recommends. I have 15 years as a medic, with 5 being as a training officer for a large capital city metro EMS system. Our clinical guidelines were probably updated 2017-18 with new placement guidance to start placing pads anterior-posterior. At first it was to facilitate automated CPR devices (Lucas) and CPR feedback puck placement. We noticed better resuscitation results, even when considering the CPR devices. Our medical director is extremely progressive and some short research later and consulting with Zoll, we moved to anterior posterior.

If you think of the traveling electrical power as a vector (pointing arrow), consider Anterior-Anterior vs Anterior-Posterior and draw a vector (arrow) between the pads. Which placement directs most of the power to the tissue of the heart? Anterior-Posterior does as the arrow goes directly through the ventricles, the area responsible for the VF/VT rhythm generation.

Once I learned how monitors, specifically Zoll, do rhythm analysis, and especially Zoll's Shock Conversion Estimator, I moved on and went back to school for engineering to help design products like these. It is all really cool stuff.