New Guidance on where the defibrillator pads are applied

Updated Guidance from the Resuscitation Council UK – October 2025

When someone collapses suddenly and becomes unresponsive, every moment counts. Cardiac arrest can happen anywhere, at work, in a classroom, at the gym, or even in the street, and the person’s chances of survival drop rapidly with each minute that passes without help.

That’s why defibrillators, or automated external defibrillators (AEDs), are such an essential part of first aid. But, what are the new Guidance on where the defibrillator pads are applied? They’re designed to be used by anyone, even with no first aid training, and can deliver a life-saving shock to restart the heart.

But while AEDs are simple to operate, one of the most common questions people ask during first aid training is, “Where do the defibrillator pads actually go?” The latest Resuscitation Council UK (RCUK) guidelines, published on 27th October 2025, have clarified and updated their recommendations for pad placement, particularly in adult resuscitation. Understanding and following this guidance ensures that when an emergency happens, the shock delivered by the defibrillator travels effectively through the heart, giving the person the best possible chance of survival.

Let’s look at the new advice and also explore some of the other common questions people ask about using defibrillators; including how to use one, what to do about clothing, hair, pacemakers, and how to adapt when the casualty is a child.

Correct Pad Placement According to the 2025 RCUK Guidelines

The 2025 RCUK update confirms that the antero-lateral pad placement remains the preferred position for adults. This means the pads should be placed so that the electrical current passes directly through the heart muscle from one side of the chest to the other.

Here’s how to position them correctly:

The first pad (often marked with a picture on the AED packaging) goes on the upper right side of the chest, just below the collarbone.
The second pad should be placed on the left side of the chest, directly below the armpit, along the rib cage in what’s known as the mid-axillary line.

This placement is designed to direct the electrical current through the heart in the most efficient way. Both pads must be stuck firmly to bare skin, ensuring there is no gap or clothing underneath that could interfere with contact.

Correct pad placement is more than just a technical detail, it’s a life-saving one. The heart lies deep in the chest cavity, and if pads are placed too high, too low, or too close together, the current may not travel properly through the cardiac muscle. That’s why the 2025 update emphasises the importance of good contact and accurate placement every time an AED is used.

How Do You Use a Defibrillator?

Using an AED might sound intimidating, but these devices are designed to guide you through each step. They’re intended for use by anyone, whether you’re a first-aid-trained employee, a teacher, or a passer-by. Once you switch the AED on, it gives clear, calm voice instructions that tell you exactly what to do.

Here’s what happens when you use one:

Check for responsiveness and breathing. If someone is unresponsive and not breathing normally, ask for help, call 999 (or instruct someone else to), and bring the defibrillator to the scene.
Start CPR. Begin chest compressions immediately while someone retrieves the AED.
Turn on the defibrillator. Most devices have a single “On” button or will power on automatically when you open the lid.
Expose the chest. Quickly remove or cut away clothing so that the chest is bare.
Attach the pads. Follow the pictures on the pads for correct placement, upper right chest and lower left side.
Allow the AED to analyse the heart rhythm. Do not touch the casualty during this time.
Deliver the shock if advised. The AED will either shock automatically or tell you to press the shock button.
Continue CPR. After the shock, resume chest compressions immediately and follow further AED prompts until emergency services arrive.

It’s that simple. AEDs are designed to do all the thinking for you — you just follow the instructions. They will not deliver a shock unless it’s needed, so there’s no risk of using one incorrectly and causing harm.

Do You Remove a Bra to Use a Defibrillator?

This is one of the most frequently asked questions during first aid training, and the answer is yes; if the bra interferes with pad placement, it should be removed.

AED pads must stick directly to bare skin. A bra, particularly one with an underwire or metal components, can interfere with pad contact or even cause burns if metal sits between the pad and the skin. The goal is always to ensure that both pads are fully adhered to the chest in their correct positions, the upper right chest and the lower left rib area.

The 2025 RCUK guidelines reiterate that rescuers should prioritise effective pad contact and correct positioning over modesty concerns. In a real cardiac emergency, saving the person’s life takes priority. If you’re in a public setting, it’s best to use a jacket, towel, or blanket to preserve dignity after pads have been placed and resuscitation has begun.

For women, it’s worth noting that AED pads can often be placed without completely removing the bra if it doesn’t obstruct the area where the pads go. However, if the strap, cup, or underwire covers those zones, quick removal is necessary. AED pads should never be placed on top of clothing or fabric, even thin material, as this can reduce their effectiveness.

Do You Need to Shave the Chest When Using a Defibrillator?

Sometimes, yes, but only if it’s really necessary. AED pads need to stick firmly to the skin to work properly. If someone has a very hairy chest, the pads might not make good contact, and this could prevent the AED from detecting the heart rhythm correctly or delivering an effective shock.

Most public-access defibrillator kits include a small disposable razor for this reason. If the chest is very hairy, you should shave only the small areas where the pads will go. However, it’s crucial not to delay the use of the AED unnecessarily.

If a razor isn’t available or time is critical, another option is to apply one pad firmly and then remove it quickly, this pulls away enough hair to clear the area for good contact. Then apply a fresh pad in the same spot. AED pads are single-use, so you should never reuse a pad that has already been pulled off.

For most people, a small amount of hair won’t interfere, so it’s not something to worry about unless the chest hair is thick enough to prevent proper adhesion. The 2025 RCUK guidance still stresses that the priority is speed; early defibrillation saves lives, and every second counts.

Can You Use a Defibrillator if Someone Has a Pacemaker?

Yes, you can, and you should. A pacemaker or implanted defibrillator (ICD) is designed to help regulate the heart’s rhythm, but during a cardiac arrest, it may not be functioning correctly or may not be enough to restart the heart.

The presence of a pacemaker shouldn’t stop you from using an AED. However, pad placement needs to be adjusted slightly. The pads should not be placed directly over or too close to the device, as this can interfere with the electrical current. The RCUK’s 2025 guidance recommends placing the pads at least 8 centimetres away from the pacemaker site.

You can usually identify a pacemaker or ICD by a small, hard lump under the skin of the upper chest, often on the left side, just below the collarbone. If you see or feel this, move the pad slightly away, for example, place it a little lower or more towards the centre of the chest. The goal is still to maintain an antero-lateral or antero-posterior current path through the heart.

AEDs are safe to use even if the person has a pacemaker, an ICD, or a metal implant in another part of their body. The small adjustment to pad placement ensures the shock is delivered correctly without damaging the implanted device.

Can You Use a Defibrillator on a Child?

Yes, absolutely; AEDs can and should be used on children who are unresponsive and not breathing normally. Cardiac arrest in children is rare, but it can happen, and early use of an AED can be lifesaving.

The RCUK guidelines recommend that AEDs should be available in all public places, schools, and childcare settings. Many AEDs now have paediatric pads or a child mode that reduces the strength of the shock for younger patients.

For children aged 1 to 8 years, you should

If you need to use a defibrillator on a child, you’d place one pad on their front, close to the heart, and you’d place the other on their back, between their shoulder blades. This helps to ensure the shock reaches the heart – to increase the chance of the heart starting to beat normally again. Follow the prompts and pictures on the pads to ensure the correct placement.
If a defibrillator doesn’t have child pads or a child setting, the Resuscitation Council UK suggests using any defibrillator available.

Some defibrillators have different pads for adults and children. You’d usually use child defibrillator pads for children up to the age of 8 years old. Adult pads are used for anyone over this age. Child defibrillator pads usually provide a smaller amount of energy than adult pads.

Some defibrillators use the same pads for both adults and children. In this case, these pads have pictures to show you where to put those pads on an adult and where to put them on a child up to 8 years old. If the same pads are used on adults and children, the defibrillator usually has a switch to choose either ‘adult’ or ‘child’. Selecting ‘child’ will usually reduce the energy level.

How much energy is delivered by a defibrillator?
Most modern defibrillators deliver a shock between 120 and 360 joules for an adult and 50-75 joules for a child. The defibrillator determines whether to deliver the adult amount or the child amount based on which pads are used or whether the user has selected the adult or child setting on the defibrillator. If your AED doesn’t have paediatric pads, you can still use adult pads; it’s far better to use them than to delay defibrillation. Just make sure the pads don’t touch each other. If necessary, you can use an antero-posterior placement, one pad on the front of the chest, one on the back.

For infants under 1 year old, defibrillation may be considered by trained healthcare professionals using a manual defibrillator, but if no manual defibrillator is available, an AED can be used as a last resort with caution.

It’s important that schools, nurseries, and community organisations know whether their defibrillator has a child mode and where it’s located. In training sessions, staff should be shown how to switch between adult and child settings or where to find the paediatric pads.

Why Correct Pad Placement Matters

It’s easy to underestimate how much difference correct pad placement makes. The heart is not centred in the chest; it sits slightly to the left, deep behind the breastbone. To deliver a successful shock, the AED needs to send a controlled electrical current through the heart muscle. If the pads are too close together, placed over bone, or separated by clothing, the current may not flow properly, and the shock may not be effective.

Research continues to show that good pad placement improves defibrillation success and survival rates. The 2025 RCUK guidelines place renewed emphasis on training people not only to start CPR quickly but also to place AED pads correctly and confidently.

During a cardiac arrest, the body’s normal electrical system fails, and the heart can go into a chaotic rhythm called ventricular fibrillation. The AED’s shock helps reset this system, allowing the heart to resume a normal rhythm. Proper pad placement ensures that this reset actually reaches the heart muscle rather than dispersing through other tissues.

In short, where the pads go really does matter, it’s a small step that has a huge impact.

How the 2025 Update Helps Workplaces and Schools

The Resuscitation Council UK’s 2025 update encourages all organisations to review their first aid and AED procedures. For schools, nurseries, and workplaces, this means ensuring that staff know:

How to locate and use the AED.
Where to place the pads and how to recognise when a vector change (front–back positioning) is needed.
That pads must always go on bare skin.
That it’s safe to use an AED on someone with a pacemaker or on a child, as long as placement is adjusted correctly.

It’s also a good opportunity to check that your AED equipment is well maintained, batteries charged, pads in date, and signage clearly visible. Training sessions and refresher courses should now include the updated 2025 recommendations so everyone feels confident in using the equipment correctly.

AEDs save lives, but only when they are used quickly and effectively. Encouraging staff and community members to practise pad placement during training helps remove hesitation in a real emergency.

Conclusion – New Guidance on where the defibrillator pads are applied

When cardiac arrest strikes, there’s no time to second-guess what to do. Having an AED nearby, and knowing exactly where to place the pads, can make the difference between life and death. The Resuscitation Council UK’s 2025 guidance, released on 27th October, reinforces that effective pad placement, good contact with the skin, and confidence in using the device are key to saving lives.

Remember: one pad goes on the upper right chest, just below the collarbone, and the other goes on the left side of the chest, under the armpit. If needed, switch to the front-and-back (antero-posterior) position after three unsuccessful shocks or when working around a pacemaker. Always apply the pads to bare skin, remove any clothing that interferes, and don’t let embarrassment or uncertainty delay you; because every second matters.

Whether you’re a teacher, manager, or first aider, take this as a prompt to refresh your AED knowledge and make sure everyone around you knows where your nearest defibrillator is located. Together, with a little preparation and confidence, we can all help save more lives.

Our current first aid courses;

Our Emergency and First Aid at Work courses are for those working in an office, factory, warehouse, manufacturing or on a building site. These courses will set you up to know exactly what to do in an emergency. Completing our courses will help you understand the hazards and risks in your workplace to therefore prevent accidents.

Apprentices, staff who are unlikely to be left alone with children, and lunchtime supervisors are all candidates for our Emergency Paediatric First Aid Training. Our one-day course includes roles and responsibilities of a first aider, first aid kits, accident reporting, reasons of a life-threatening condition, CPR, defibrillator, causes of unconsciousness and recovery position, choking, bleeding, burns, and minor injuries.

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This course is ideal for those working alone with children, whether you are a Teacher or Teaching Assistant working in the Early Years or a childminder. Our Paediatric courses are fully accredited. We have open courses running at our Brownhills Centre or we can come to your setting.

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Our courses provide you with the peace of mind that you’ll know what to do in the event of an emergency, such as illnesses like asthma. Furthermore, getting first aid training will give you the skill set of knowing exactly what to do if your child, friend, or work colleague suffers from an injury or life threatening condition. Never put yourself in a situation where you’re thinking, “What if I knew what to do?” Get First Aid Trained Today!

If you have any questions with this blog we are happy to help. New Guidance on where the defibrillator pads are applied. If you want to know how, our Emergency First Aid at Work Course, is the course for you. Here is the link to our upcoming courses. https://www.hmbtrainingservices.co.uk/courses

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