Using an AED in Special Situations: Wet Skin, Jewelry & More

Training gives you a clean scenario: a person on a gym floor, dry skin, clear chest, nothing in the way. Emergencies are messier. In Jacksonville, a collapse may happen on a pool deck, at a beach access point, inside a warehouse, or at a construction site. The patient may also have a pacemaker, medication patch, jewelry, or dense chest hair between the pads and the skin. Most of those problems have a fast solution. They call for a few seconds of preparation, not hesitation.

Automated external defibrillators are designed to be usable by ordinary people without medical training. The voice prompts walk you through every step. But the device assumes some baseline conditions: that the pads can make good direct contact with bare skin, that no nearby conductor is going to interfere with the shock, and that bystanders have stepped away. When those conditions need adjustment, the adjustment is usually small and fast. Knowing what to do before you face it is what makes the difference.

The most common complications are wet skin, jewelry, chest hair, metal surfaces, and implanted devices. Each one has a solution. None is a reason to withhold defibrillation when someone is in cardiac arrest.

Educational note: use this information for general awareness only. It is not a substitute for calling 911, hands-on training, or professional medical judgment during an emergency.

Using an AED on Wet Skin

The issue with wet skin is not electricity arcing through water the way a movie would have you imagine. The practical problem is contact. AED pads need firm, consistent contact with bare skin. Wet skin weakens the adhesive, creates air gaps, and can compromise both rhythm analysis and shock delivery.

If the person is lying on a wet surface or has come out of a pool, move them to dry ground before using the AED if you can do it quickly. Then dry the chest where the pads will go. A quick wipe is enough. You do not need to dry the person completely. The pad placement zones just need to be dry enough for solid adhesion.

Many AED kits include a towel or cloth for exactly this reason. If yours does not, use whatever is available. The extra seconds spent making sure the pads are on dry skin are not wasted. They are what make the shock count.

AED Use with Jewelry and Piercings

Jewelry worn on the torso, such as a necklace resting on the chest, can interfere with AED pad placement if the metal sits directly in the pad zone. AED pads should not be placed on top of metal. If a necklace or pendant is sitting where the pad needs to go, move it aside or remove it before placing the pad.

Piercings are less of an issue unless they are directly under a pad placement site. The standard AED pad positions are upper right chest below the collarbone and lower left side below the armpit. If a piercing falls directly under one of those zones, shift the pad slightly to avoid contact with the metal. A small positional adjustment does not meaningfully reduce effectiveness, and it is safer than placing the electrode pad in direct contact with the conductive surface of a piercing.

Do not delay the response to search for and remove every piece of jewelry on the person. Focus on what is directly in the pad placement area. Everything else can stay where it is.

AED Use with Chest Hair

Excessive chest hair is a common AED problem because the pads need direct contact with skin. A layer of hair between the adhesive and the chest wall can keep the pads from sticking firmly enough to read the rhythm or deliver the shock effectively. If the pad peels back as soon as you press it down, hair is blocking adhesion.

If the AED kit includes a razor, use it. A few quick shaving strokes across the upper right chest and lower left side is all it takes. You are not shaving the person’s chest for cosmetic reasons. You are clearing the small areas where the pads need to stick.

If there is no razor available, press the first set of pads firmly onto the hairy chest, then peel them off quickly. The adhesive picks up a significant amount of hair and leaves the skin clearer. Then apply the spare pads to the cleared areas. The second set usually gets much better contact.

Using an AED on Metal Surfaces

Metal surfaces conduct electricity. If someone collapses on a metal bleacher, a steel grating, or a metal-framed cot, placing the AED pads on their chest while they remain in contact with that metal surface creates a path for the current to travel somewhere other than directly through the heart. It also creates a risk of the shock affecting bystanders who are touching the metal.

The right move is to move the person off the metal surface before using the AED if you can do it quickly. Even a few inches of dry non-conductive ground between the person and the metal changes the equation. Once they are clear of the conductive surface, proceed normally: place the pads on bare dry skin, warn others to stand clear, and follow the AED’s prompts.

If moving the person is not possible because they are wedged in position or cannot be safely moved, keep the electrodes from touching the metal surface directly, keep bystanders from touching connected metal, and deliver the shock as quickly as you can. An imperfect setup is still better than no defibrillation at all.

AED Use with Pacemakers and Implants

A pacemaker or implantable cardioverter-defibrillator creates a hard rectangular or oval-shaped lump under the skin, usually just below the collarbone on the upper chest. Placement varies, so look and feel before placing the pad. Do not put an AED pad directly over the device. Place the pad at least an inch away from the visible or felt lump.

The fix is simple: move the pad at least an inch away from the device. The standard upper-right pad position shifts slightly lower or to the side to clear the implant. This positional adjustment does not significantly reduce the effectiveness of the shock. Defibrillators have enough tolerance in pad placement to work well even with modest positional changes.

A person with a pacemaker or ICD can still go into a shockable rhythm. The implanted device may not have fired, may not be functioning, or may not be addressing the rhythm that caused the arrest. If someone with an implant is unresponsive and not breathing normally, treat them like any other cardiac arrest patient: adjust pad placement around the device and use the AED.

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