Manual Mode on ALS Defibrillator

Defibrillator Functions
(Part 4 - Manual Mode Defibrillation)

ALS Defibrillator = Advanced Life Support Defibrillator
Defibrillators used by medical providers. Typically by EMS and in advanced care settings Hospitals, Free standing ER's, etc.

A lot of medical providers are uncomfortable using the ALS Defibrillator in their medical care settings. This can be due to the lack of training, not enough hands on practice, and the numerous brands and models on the market. This often leads to intimidation and delay in treatment.

Therefore, this series highlights the main features of the ALS Defibrillator. We want to get you thinking about and looking at your facilities defibrillator……NOW……and not during an emergency. Hopefully, this helps boost your confidence!

This education is NOT for the lay rescuer using an AED (Automated External Defibrillator) in a community setting. 

4 Part series will include:

Part 1: Using AED Mode for Defibrillation

Part 2: Using Pacing Mode for Transcutaneous Pacing (TCP)

Part 3: Synchronized Cardioversion

Part 4: Manual Mode for Defibrillation

Manual Mode versus AED Mode

Did you know that All Brands of ALS Defibrillators can defibrillate a patient in AED mode or manual mode???
AED Mode for defibrillation

The AED function can be used by any certified:  BLS Provider, ACLS Provider, or PALS Provider. 

Some are under the impression it can only be used by an ACLS or PALS Provider; However, the AED function is so a BLS Only Provider can use it as well. 

Our goal is to deliver a shock to a patient in under 5 minutes if they are in a shockable rhythm. Therefore, we want to use the defibrillator as soon as possible.

manual Mode for defibrillation

Manual Mode can be used by any certified:  ACLS Provider or PALS Provider.

As an ACLS/PALS provider you will determine which rhythms to defibrillate or not based on what EKG you see and the presence of a pulse. This requires additional training that a BLS only provider does not have. 

would AED mode as an ACLS or PALS provider be helpful???

Yes, It can be. Here are just a few of the reasons why:

  1. Takes the pressure off the team lead and can result in a quicker shock to the patient. Especially on units where codes are rare! 
  2. It provides you a 2 minute timer.
  3. Great for codes with fewer resources or staff.
  4. Great for units that are BLS trained only (versus waiting for ACLS/ALS code team arrive)
If you want to learn more about how to use the AED function visit our earlier blog: Using AED Mode for Defibrillation

Steps for using the Defibrillator

General steps:  

CPR is in progress……

  • Apply pads
  • Check the rhythm (don’t pause CPR longer than 5-10 sec)

If shockable rhythm then:

  • Adjust the number of Joules (energy select)
  • Charge the defibrillator
  • Clear the patient
  • Press shock

Where to find the energy select, charge, and shock buttons.

Pictures of some of the most common ALS defibrillators: ZOLL, LIFEPAK, and PHILLIPS with guidance on where to locate the cardioversion functions. 

Blue will show you where to turn on the defibrillator.

Yellow will show you where to adjust the number of Joules.

Pink will show you where to find the charge button.

Red will show you where to find the shock button.


While several models of ZOLL Defibrillators are on the market they have similar visual features. 


These pictured Phillips Defibrillators were commonly seen in the hospital setting. They have been discontinued and no longer being supported by PHILLIPS. They are included in this blog as some hospitals still have them for use. 

My understanding, is the only ALS defibrillator that they will be making is the prehospital care Tempus ALS.

They will still be manufacturing AED’s for the community setting. 


Hope you enjoyed the post and found it helpful.
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