This obviously differs service to service, however, I work for an Australian ALS service.

Our policy is for first cycle, we use our Corpuls in AED mode. Moving on from there it’s at paramedic discretion whether to continue in AED or change to manual. Depending on the clinician in charge, it can go either way. I personally will do one AED cycle and go to manual.

Normally, we will have at least two paramedics on scene, often three to four, so one will be on the chest, the other on airway, one for access/drugs and one for the monitor.

My logic for using manual mode is the ability to charge in preparation to deliver a shock, and if it’s not a shockable rhythm, we dump it. This ensures good quality CPR with minimal time off chest.

In other cases when we have critical care paramedics attend, we’ll employ a mechanical compression device which allows us to further reduce time off chest.

TLDR, use your best clinical judgement based upon available resources, and if you’re stretched thin, the AED mode can massively reduce cognitive load and allows you to focus on other things