# AI instructs to use AED pads or defibrillator paddles without conductive gel or with improper placement on hairy chest, causing no shock delivery

- **ID:** `medical/aed-pad-placement-chest-hair`
- **Domain:** medical
- **Category:** protocol_error
- **Error Code:** `AED-PAD-ERR-05`
- **Verification:** ai_generated
- **Fix Rate:** 85%

## Root Cause

The AI omitted the critical step of removing chest hair and applying conductive gel before AED pad placement; without proper skin contact, impedance is too high, preventing the AED from analyzing rhythm or delivering shock.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| AHA ACLS Guidelines 2020 | active | — | — |
| Philips HeartStart FRx v3.0 | active | — | — |
| Zoll AED Plus v4.5 | active | — | — |

## Workarounds

1. **Rapidly shave the chest hair at the pad placement sites using the AED kit's disposable razor or a scalpel. Apply conductive gel pads (if available) or use self-adhesive pads with gel. Place pads: one on upper right chest (sternum), one on left lower chest (apex).** (95% success)
   ```
   Rapidly shave the chest hair at the pad placement sites using the AED kit's disposable razor or a scalpel. Apply conductive gel pads (if available) or use self-adhesive pads with gel. Place pads: one on upper right chest (sternum), one on left lower chest (apex).
   ```
2. **If no razor is available, use a second set of AED pads to 'wax' the hair: press the first pad firmly onto the hair, then quickly pull it off to remove hair. Then apply fresh pads to the cleared skin.** (80% success)
   ```
   If no razor is available, use a second set of AED pads to 'wax' the hair: press the first pad firmly onto the hair, then quickly pull it off to remove hair. Then apply fresh pads to the cleared skin.
   ```
3. **Train all staff on 'AED Pad Placement Protocol': 1) Expose chest, 2) Shave or remove hair if present, 3) Dry skin if wet, 4) Apply pads per diagram, 5) Ensure 'Pad to Skin' contact indicator shows green. Include in annual ACLS recertification.** (90% success)
   ```
   Train all staff on 'AED Pad Placement Protocol': 1) Expose chest, 2) Shave or remove hair if present, 3) Dry skin if wet, 4) Apply pads per diagram, 5) Ensure 'Pad to Skin' contact indicator shows green. Include in annual ACLS recertification.
   ```

## Dead Ends

- **** — Chest hair creates an air gap that increases transthoracic impedance; the AED may fail to detect shockable rhythm or deliver inadequate energy. (90% fail)
- **** — Alcohol wipes clean the skin but do not remove hair; impedance remains high if hair is present. (85% fail)
- **** — While AP placement is an alternative, it still requires good skin contact; hair on the chest or back still causes high impedance. (70% fail)