TempoLife › Features › Defibrillators and cardiac arrest response › pad-placement
Where the pads go, and what gets in the way
Right collarbone and left ribs, or front and back. Chest hair, sweat, snow, a medicine patch, a pacemaker lump, an underwired bra, a tattoo: which of these actually matter and what to do about each.
CPR in sixty seconds
- Unresponsive and not breathing normally? Gasping is not breathing. Treat it as a cardiac arrest.
- Call 112 (113 in Norway). Speaker on, phone on the floor. Stay on the line — the dispatcher will coach you.
- Push hard and fast in the centre of the chest: 5–6 cm in an adult, 100–120 per minute, letting the chest come all the way back up.
- Send somebody else for a defibrillator. Do not go yourself unless it is seconds away. Keep compressing.
- Turn the device on and do what it says. It decides whether to shock. After a shock, go straight back to compressions.
This is a reference written for bystanders, not a diagnosis, a training course or medical advice. It cannot tell you what is wrong with a particular person, and it does not replace the dispatcher on the other end of an emergency call — they can see what is near you and they will talk you through it. If you are worried about your own heart, or about a symptom, that is a conversation with a clinician rather than a page on a website.
The standard position, and the one that also works
Anterolateral placement is the default and it is drawn on the pads: one pad below the right collarbone next to the breastbone, the other on the left side of the chest below and to the outside of the left nipple, roughly in the mid-axillary line — further round the side than most people place it. The alternative is anteroposterior, one pad centred on the breastbone at the front and one between the shoulder blades at the back. Both are accepted for adults; the point of the geometry is that the current must cross the heart rather than skim the surface of the chest.
Skin has to be dry and bare
Pads stick to skin, not to fabric, sweat, water or snow. Cut or tear clothing away rather than trying to work around it. If the chest is wet — from rain, a pool, sweat or melting snow — wipe it dry with a towel, a jumper, anything to hand, in a couple of seconds. Wet skin lets the shock track across the surface instead of through the chest and the pads peel off. Most public cabinets contain a small kit with scissors and a razor for exactly this reason.
Chest hair, and the razor in the kit
A thickly haired chest is the classic pad-adhesion failure: the device announces that it cannot read the rhythm or that the pads are not attached. Press hard first — often that is enough. If not, and the kit has a razor, take one fast pass over each pad site; if it has a spare set of pads, the trick of sticking the first pair on, ripping them off to strip the hair and applying the fresh pair works. None of this is worth more than a few seconds of interrupted compressions.
Implants, patches, jewellery and metal
A pacemaker or implanted defibrillator sits as a hard lump under the skin, usually below the left or right collarbone, often with a scar over it. Move your pad about a hand's width — eight centimetres or so — clear of it and carry on; do not abandon the defibrillation. Medicine patches (glyceryl trinitrate, nicotine, hormone, opioid) must come off the pad site, wipe the skin, because they can arc and burn. Take metal necklaces and long chains out of the way. Body piercings in the pad area come out or get worked around. A tattoo makes no difference at all.
Breasts, underwires and where the left pad really goes
Bystanders defibrillate women less often than men, and reluctance to expose and touch the chest is part of the reason. The chest has to be bare. An underwired bra should be unhooked and pushed clear of the pad sites — it does not need to be removed if that costs time, only moved out of the way. The left pad goes on the ribs to the side of the breast, not on breast tissue; lift the breast up and out of the way and place the pad flat against the chest wall beneath it. Skin contact and correct position beat modesty.
| What you find | Does it matter? | What to do |
|---|---|---|
| Wet or sweaty chest | Yes — pads peel, current tracks | Wipe dry with anything, then apply |
| Thick chest hair | Yes — device reports poor contact | Press hard; shave or hair-strip with a spare pad |
| Medicine patch on the site | Yes — burns and arcing | Peel it off, wipe the skin, place the pad |
| Pacemaker or ICD lump | Yes — position only | Move the pad about 8 cm clear, still shock |
| Underwired bra | Yes — metal and fabric in the way | Unhook and move clear of the pad sites |
| Metal necklace or piercing | Slightly | Move it aside; do not delay for it |
| Tattoo | No | Place the pad normally |
| Lying on metal or a puddle | Yes — for the rescuers | Move the person or dry the surface first |
Sources: European Resuscitation Council Guidelines · Käypä hoito national guideline: Elvytys · checked 2026-09-08
Frequently asked questions
Do the pads have to be exactly where the picture shows?
Close is good enough. The requirement is that the current crosses the heart, so the side pad in particular should sit further round the ribs than instinct suggests. A pad a few centimetres off still defibrillates.
What if the person has a pacemaker?
Place the pad about eight centimetres clear of the lump and shock normally. An implanted device is a reason to move the pad, never a reason to withhold defibrillation.
Can I use adult pads on a child?
If paediatric pads are not available, yes — adult pads and an adult shock are recommended rather than no defibrillation. Keep the pads from touching each other, using front-and-back placement on a small chest.
What to do, right now
Is this a cardiac arrest?
Two checks decide it: not responding, and not breathing normally. The noisy gasping that fools nearly everyone, why a brief seizure at the start is a cardiac sign, and why a heart attack is a different emergency.
Hands-only CPR, in sixty seconds
Centre of the chest, 100 to 120 pushes a minute, 5 to 6 cm deep, let the chest come all the way back up, and do not stop. The rate, the depth, the fatigue problem, and a pacer that keeps you on the beat.
The emergency call, and the address problem
What the dispatcher asks, why the phone goes on speaker on the floor, how dispatcher-guided CPR works, and the single hardest question in a rural arrest: where exactly are you?
Using a defibrillator, step by step
Open it, turn it on, bare the chest, follow the voice. What the machine decides for you, what it will never do, and the one instruction people get wrong — go straight back to compressions after the shock.
"No shock advised" does not mean stop
The most misread sentence in public-access defibrillation. What the machine has actually detected, why roughly two thirds of arrests are not shockable, and why the pads stay on and the compressions continue.
Everything on this subject
Before the emergency, there is a long quiet stretch
Blood pressure, resting heart rate, movement and sleep are the part of this you can act on for years beforehand. TempoLife keeps them in one place, free to start.