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Let Us Know You've Used an AED, So We Can Help Ensure it's Properly Maintained
AED-Use Notification Form
First Name
Last Name
Email
Phone
Does the AED have a card attached to it with a Heart of the Nation logo on it?
Choose an option
Enter the name of the locaton or approximate address of where the AED was taken from to be used - if known.
AED Name
Where is the AED located now?
Was the patient somebody known to you?
Choose an option
Was the AED used to shock the patient?
Choose an option
After approximately how many minutes was the first shock delivered by the AED?
Choose an option
Were the pads peeled from the pack?
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How many shocks were provided by the AED?
Select number
Was CPR provided to the patient by a bystander?
Choose an option
For approximately how many minutes was CPR provided by bystanders before paramedics arrived and took over at the scene?
Choose an option
Was the patient breathing when the paramedics escorted them to hospital?
Choose an option
Submit
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