Quick Answer
Yes. Use the AED if the person is unconscious and not breathing normally, even if they have a pacemaker or implanted defibrillator. At that point, you are not treating a stable person with a heart device. You are treating a cardiac arrest. If their own heart rhythm and implanted device have not kept them breathing normally, the outside chain of survival has to take over: call Triple Zero (000), start CPR, attach the AED and follow its prompts. The only pad-placement adjustment is simple: if you can see or feel the implanted device under the skin, do not stick an AED pad directly on top of it.
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What Changes If Someone Has a Pacemaker or ICD?
A pacemaker or implantable cardioverter defibrillator, often called an ICD, may sit under the skin of the upper chest. It can look or feel like a small firm lump. A first aider might notice it while exposing the chest for AED pads.
That discovery can make people hesitate, so here is the plain first aid logic. A pacemaker is there to support the person’s heart rhythm day to day. An ICD may also deliver shocks internally if it detects certain dangerous rhythms. But if the person is now unconscious and not breathing normally, whatever protection they normally have has not solved the emergency in front of you. You should assume cardiac arrest until emergency services or the AED tells you otherwise.
So the implant changes pad placement, not the decision to act. You still call Triple Zero (000), start CPR, send for the AED, expose the chest, attach pads and follow prompts. If the lump is where a pad would normally sit, place the pad a little away from it while keeping the pad on the chest in the general position shown by the AED diagram. Australian resuscitation guidance supports keeping pads away from implanted devices where practical, but it is just as clear that pad concerns should not delay defibrillation.
Where Do AED Pads Go If There Is an Implanted Device?
Use the pad diagram on the AED pads as your main guide. The usual adult placement is one pad on the upper right chest and the other on the lower left side of the chest. If you can see or feel an implanted device under the skin where a pad would normally go, move the pad slightly so it is not directly over the device. Think of it as steering around a bump in the road, not changing destination.
Do not spend precious time trying to identify the exact model, type or medical history. You are not troubleshooting the implant. You are treating a person who is unresponsive and not breathing normally.
The rule to remember
The pacemaker is not a stop sign. It is a pad-placement landmark. Avoid the lump if you can do that quickly. Do not delay CPR or AED use while trying to solve the person’s medical history.
What If You Are Not Sure It Is a Pacemaker?
You may not know. It could be a pacemaker, ICD, medication port, scar tissue or something else. In a real cardiac arrest, uncertainty should not stop the chain of survival. If the person is not responding and not breathing normally, send someone to call Triple Zero (000), start CPR and use the AED as soon as it is available.
If the pad is already on and you then notice an implanted device nearby, do not peel everything off and restart unless the pad is clearly sitting directly over the lump and can be moved quickly. Keep interruptions short. Long pauses in CPR are not your friend.
Step-by-Step for First Aiders
- Check response and breathing. If the person is unresponsive and not breathing normally, treat it as cardiac arrest. A pacemaker or ICD does not change that first aid decision.
- Call Triple Zero (000). Put the phone on speaker if possible so the call taker can guide you.
- Start CPR. Push hard and fast in the centre of the chest. Swap rescuers if someone else can help.
- Send for the AED. Turn it on as soon as it arrives.
- Expose and prepare the chest. Dry wet skin, remove medication patches if they are in the pad area, and shave only if thick hair stops pads sticking.
- Place pads away from the implant if practical. Keep to the pad diagram, but do not place a pad directly over a visible or felt pacemaker/ICD. If moving the pad slightly avoids the lump, do that. If you cannot confidently identify anything, get the pads on and follow the AED.
- Follow the prompts. Stand clear when the AED analyses or advises a shock. Resume CPR immediately when told.
Training Points for Workplaces
This is exactly the kind of question that makes people freeze if they have only read about AEDs. A short practical session removes the awkwardness. People get to see the pads, handle a trainer unit, practise exposing the chest respectfully, and ask what to do when something looks unusual.
If your workplace has an AED, the training conversation should include implanted devices, pregnancy, wet areas, medication patches, jewellery, children and handover to paramedics. These details are not there to scare people. They make the actual emergency less confusing.
A good baseline is HLTAID009 Provide Cardiopulmonary Resuscitation. For broader workplace responders, pair it with HLTAID011 Provide First Aid.
Make AED Use Feel Less Awkward
If your workplace has an AED, make sure the people around it are confident with CPR, pads, prompts and handover to paramedics.
FAQs
Can an AED damage a pacemaker?
The bigger risk is delaying CPR and defibrillation. If the person is unconscious and not breathing normally, the pacemaker or ICD has not prevented the emergency you are seeing. Place pads away from the implanted device if practical, then let the AED analyse the rhythm and guide you.
How far away should AED pads be from a pacemaker?
For a first aider, the practical rule is: do not put the pad directly over the lump if you can avoid it quickly. A small shift away from the implanted device is usually enough. Keep the pad on the chest, keep interruptions short, and keep following the AED prompts.
What if the person has an implanted defibrillator instead of a pacemaker?
The first aid response is the same. If they are unconscious and not breathing normally, call Triple Zero (000), start CPR, use the AED, follow prompts, and avoid putting pads directly over the implanted device if practical.
Should I wait for paramedics if I see a pacemaker scar?
No. A scar or lump might tell you where not to put a pad, but it does not tell you to wait. If the person is unresponsive and not breathing normally, start CPR and use the AED. Waiting removes the person's best chance of early defibrillation.
Sources Checked
This draft was written against current Australian guidance and uses non-competing source links for factual claims. Always follow your workplace procedures and call Triple Zero (000) in an emergency.
