When using a defibrillator, especially an automated external defibrillator (AED), there are several special considerations beyond just “pressing the shock button.” These help keep both the patient and rescuer safe and improve the chance that the shock works when it is needed.

When to (and not to) use a defibrillator

A defibrillator is meant for sudden cardiac arrest —when someone is unresponsive, not breathing normally (or not breathing at all), and has no pulse.

It is not appropriate for someone who is conscious, has a pulse, or is only having chest pain from a heart attack without cardiac arrest.

Chest hair and skin contact

Chest hair can interfere with the pads’ contact and may reduce conduction of the shock.

If possible, quickly clip or shave the area under the pads, or use a pre‑shave kit if available, then re‑apply the pads firmly to ensure good adhesion.

Wet or submerged patients

Defibrillation should not be done if the patient is lying in water or the chest is soaking wet, because water can conduct electricity and make the shock unpredictable or dangerous.

If the patient is on a wet surface , move them to a dry area if safe, then dry the chest thoroughly before attaching pads and shocking.

Patients with implants and patches

Pads should not be placed directly over implanted devices such as pacemakers or implantable cardioverter‑defibrillators (ICDs); these are usually visible or palpable under the skin near the upper chest.

Place the pads several inches away from the device and avoid placing them over transdermal medication patches (e.g., nicotine, nitroglycerin, fentanyl), removing and wiping the area if needed.

Pediatric and infant patients

For children and infants, use pediatric pads or pediatric mode on the AED if available, which deliver a lower‑energy shock suitable for smaller bodies.

If pediatric pads are not available, many guidelines still allow using adult pads on children older than 8 (or about 25 kg), but not on infants under about 1 year, where a manual defibrillator is preferred.

Environmental and safety factors

Make sure the patient and rescuer are on a non‑conductive surface and that no one is touching the patient during the shock; follow the AED’s voice prompts (“stand clear”).

Avoid using metal‑bed rails or placing paddles over jewelry or metal objects, and confirm that the AED is functioning (battery charged, leads connected, no alarm messages).

Quick‑view: Key special considerations

Situation or factor| Special consideration when using a defibrillator
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Excessive chest hair| Clip or shave under pads; ensure good skin contact. 14
Wet chest or surroundings| Move to dry area, dry chest before applying pads. 17
Pacemaker or ICD| Do not place pads directly over the device; shift slightly away. 35
Medication patches| Remove patch and wipe skin before placing pads. 45
Pediatric or infant patient| Use pediatric pads or settings; avoid adult pads on very young infants. 13
Conscious or breathing| Do not shock; use AED only in confirmed sudden cardiac arrest. 37

Information gathered from public forums or data available on the internet and portrayed here.