From NASEMSO:

Situation:
The NASEMSO Pediatric Emergency Care (PEC) Council recently learned of several issues
regarding automatic external defibrillator (AED) pad incompatibility, with multi-function
defibrillator and AED pads not being used in accordance with manufacturer’s
recommendations, particularly in pediatric applications.

Background:
In recent inspections, it was identified that some EMS services and/or their personnel are
utilizing incorrect pediatric defibrillator pads with various manual monitor/defibrillators and
AEDs. This results in the inability to deliver therapy across all age and weight ranges. On
November 29, 2021, the Massachusetts Office of EMS issued a statewide memorandum
regarding this issue and shared it with the NASEMSO PEC Council. Subsequently, this has been
found to be occurring in several other states as well.

Assessment:
Examples include:

• Zoll Pedi-padz: These defibrillator pads, although manufactured by Zoll, are not compatible with the Zoll AED Plus units and will not plug into the unit. The pediatric pads required for the Zoll AED Plus units are the Pedi-padz II. The Zoll AED Plus Administrators Guide, page 30, states to use “ZOLL Stat-padz II, CPR-D-padz or Pedi-padz II” and to “Only use electrodes labeled “Infant/Child” on children less than 8 years old or weighing less than 55 lbs. (25 kg). Use CPR-D-padz® if patient is older than 8 years or weighs more than 55 lbs. (25 kg).”
• Physio-Control Lifepak-15: Use of non-manufacturer recommended pads for LP-15 units, with the intent of using them for pediatric patients. These pads have therapy limitations for both age and weight ranges for infants and children in both the manual and AED mode on the LP-15. The pads’ packaging states that in manual defibrillator mode, these pads cannot be used for patients weighing under 22 pounds, and in AED mode, are not to be used for patients under age 8. As a reminder, providers cannot use an LP15 in the AED mode for pediatrics, regardless of pad type. The LP15 operator’s manual, in section 5 pages 5-7, under “Automated External Defibrillation (AED)” states, “In AED mode, the LIFEPAK 15 monitor/defibrillator is not intended for use on pediatric patients less than 8 years old.”
• General: Some AEDs have been identified that were accompanied by pediatric pads with packaging that had red writing and a circle with a line through it around an AED symbol that stated, “not for AED use.”

Recommendation:
Although pediatric defibrillation is an uncommon event, ensuring that properly compatible
equipment is available is one of the keys to this life-saving intervention. We are recommending
that state and regional EMS leadership share this information and remind all EMS, Fire, and
other public safety agencies to double-check all monitors and AED units to ensure they have the
correct manufacturer recommended pads stocked in all units. For questions, please refer to the
manufacturer instructions for the device, contact the manufacturer, and/or contact state or
regional EMS leadership.

References

1. Lifepak-15 Operators Manual https://www.physiocontrol.com/uploadedFiles/Physio85/Contents/Emergency_Medical_Care/Products/Operating_Instructions/LIFEPAK15_OperatingInstructions_3306222-002.pdf
2. Zoll AED Plus Administrator’s Guide https://www.zoll.com/-/media/product-manuals/aed-plus/01-
   english/9650-0301-01-sf_yd.ashx
3. Massachusetts Office of EMS Memorandum
   https://www.cmemsc.org/images/Announcements/Memorandum_Ensuring_Defibrillator_Pad_Compatibility_to_Provide_Effectivepdf.pdf