Public access defibrillation: utilisation and missed opportunities


public access defibrillation programs
emergency medical services

How to Cite

Cunningham C, Lowe JR, Johnson A, Carter W, Whited WM, Shofer F, Brice JH, Williams JG. Public access defibrillation: utilisation and missed opportunities. Australasian Journal of Paramedicine [Internet]. 2019Jul.19 [cited 2021Sep.22];160. Available from:



Automated external defibrillators (AEDs) for public use are becoming increasingly prevalent, but little is known about utilisation. The purpose of this study was to compare the locations of out-of-hospital cardiac arrests (OHCAs) to the locations of AEDs to determine whether missed opportunities exist.


A retrospective study was performed of all OHCAs in which resuscitation was attempted between 1 January 2005 and 31 December 2010 in Orange County, North Carolina, United States of America, a mixed suburban/rural emergency medical services (EMS) system. Emergency medical services records were used to determine public AED utilisation and OHCA location. The locations were plotted on a map using ArcGIS. Businesses, public buildings and facilities located within a 100 metre radius of each OHCA were surveyed to determine AED availability. Data were analysed using standard descriptive statistics.


During the study period, 307 OHCAs occurred at 282 locations. Of these, 219 (71%) occurred in private homes, 26 (9%) in nursing or assisted living facilities, and 62 (20%) in public locations. An AED location was within 100 metres of an OHCA location in 22 cases. Five cases were excluded due to the arrest being witnessed by EMS, and late or unknown AED installation time. Of the remaining 17 OHCAs, seven (41%) had a nearby AED that was not used, constituting a missed opportunity for deployment.


In nearly half of OHCAs that have a nearby public AED, the AED was not utilised. This suggests that public awareness and accessibility of AED locations should be improved.


Mozaffarian D, Benjamin EJ, Go AS, et al, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2015 update: a report from the American Heart Association. Circulation 2015;131:e128-32.

Centers for Disease Control and Prevention. 2017 Cardiac Arrest Registry to Enhance Survival (CARES) National Summary Report. 2017. Available at: [Accessed 31 July 2017].

Daya MR, Schmicker RH, Zive DM, et al. Resuscitation Outcomes Consortium Investigators. Out-of-hospital cardiac arrest survival improving over time: results from the Resuscitation Outcomes Consortium (ROC). Resuscitation 2015;91:108-15.

Neumar RW, Shuster M, Callaway CW, et al. Part 1: executive summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132(Suppl 2):S315-67.

Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professions from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. ibid. 1991;83:1832-47.

Stiell IG, Wells GA, De Maio VJ, et al. Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ann Emerg Med 1999;33:44-50.

Stiell IG, Wells GA, Field BJ, et al. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. JAMA 1999;281:1175-81.

Stiell IG, Wells GA, Field BJ, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004;351:647-56.

Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation 1997;96:3308-13.

Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993;22:1652-8.

Waalewijn RA, de Vos R, Tijssen JG Koster RW. Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder, and the paramedic. Resuscitation 2001;51:113-22.

Schober P, van Dehn FB, Bierens JJLM, Loer SA, Schwarte LA. Public access defibrillation: time to access the public. Ann Emerg Med 2011;58:241-7.

Winkle RA. The effectiveness and cost effectiveness of public-access defibrillation. Clin Cardiol 2010;33:396-9.

Caffrey SL, Willoughby PJ, Pepe PE, Becker LB. Public use of automated external defibrillators. N Engl J Med 2002;347:1242-7.

Gratton M, Lindholm DJ, Cambell JP. Public-access defibrillation: where do we place the AEDs? Prehosp Emerg Care 1999;3:303-5.

Reed DB, Birnbaum A, Brown LH, et al. Location of cardiac arrests in the public access defibrillation trial. ibid. 2006;10:61-7.

Mell HK, Sayre MR. Public access defibrillations and fire extinguishers: are comparisons reasonable? Prog Cardiovasc Dis 2008;51:204-12.

Weisfeldt ML, Kerber RE, McGoldrick RP, et al. Public access defibrillation. A statement for healthcare professions from the American Heart Association Task Force on automatic external defibrillation. Circulation 1995;92:2763.

Nichol G, Hallstrom AP, Kerber R, et al. American Heart Association Report on the Second Public Access Defibrillation Conference, April 17-19, 1997. ibid. 1998;97:1309-14.

Hallstrom A, Ornato JP, Weisfeldt ML, et al, Public Access Defibrillation Trial Investigators. Public access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004;351:637-46.

Weisfeldt ML, Everson-Stewart S, Sitlani C, et al. ibid. 2011;364:313-21.

Weisfeldt ML, Sitlani CM, Ornato JP, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system. J Am Coll Cardiol 2010;55:1713-20.

Nichol G, Huszti E, Birnbaum A, et al. Cost-effectiveness of lay responder defibrillation for our-of-hospital cardiac arrest. Ann Emerg Med 2009;54:226-35.

Cram P, Vijan S, Fendrick M. Cost-effectiveness of automated external defibrillator deployment in selected public locations. J Gen Intern Med 2003;18;745-54.

Hansen CM, Wissenberg M, Weeke P, et al. Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime and weekends. Circulation 2013;128:2224-31.

Myers JB, French D, Webb W. Lack of integration of automated external defibrillators with EMS response may reduce lifesaving potential of public-access defibrillation. Prehosp Emerg Care 2005;9:339-43.

Rea TD, Blackwood J, Damon S, Phelps R, Eisenberg M. A link between emergency dispatch and public access AEDs: potential implications for early defibrillation. Resuscitation 2011;82:995-8.

De Maio VJ, Stiell IG, Wells GA, Spaite DW. Optimal defibrillation response intervals for maximum out-of-hospital cardiac arrest survival rates. Ann Emerg Med 2003;42:242-50.

Frank RL, Rausch MA, Menegazzi JJ, Rickens M. The locations of nonresidential out-of-hospital cardiac arrests in the city of Pittsburgh over a three-year period: implications for automated external defibrillator placement. Prehosp Emerg Care 2001;5:247-351.

Lerner EB, Billittier AJ, Newman MM, Groh WJ. Automated external defibrillator (AED) utilization rates and reasons fire and police first responders did not apply AEDs. ibid. 2002;6:378-82.

Sun C, Demirtas D, Brooks SC, Morrison LJ, Chan T. Overcoming spatial and temporal barriers to public access defibrillators via optimization. J Am Coll Cardiol 2016;68:836-45.

Folke F, Lippert FK, Nielsen SL, et al. Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations. Circulation 2009;120:510-7.

Bartimus HA, Rea TD, Eisenberg MS. Prevalence of automated external defibrillators at cardiac arrest high-risk sites. Prehosp Emerg Care 2004;8:280-3.

Rea TD, Olsufka M, Bemis B, et al. A population-based investigation of public access defibrillation: role of emergency medical services care. Resuscitation 2010;81:163-7.

Lerner EB, Fairbanks RJ, Shah MN. Identification of out-of-hospital cardiac arrest clusters using a geographic information system. Acad Emerg Med 2005;12:81-4.

Aufderheide T, Hazinski MF, Nichol G, et al. Community lay rescuer automated external defibrillation programs: key state legislative components and implementation strategies: a summary of a decade of experience for healthcare providers, policymakers, legislators, employers, and community leaders from the American Heart Association Emergency Cardiovascular Care Committee, Council on Clinical Cardiology, and Office of State Advocacy. Circulation 2006;113:1260-70.

The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Part 4: the automated external defibrillator: key link in the chain of survival. In: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. ibid. 2000;102(Suppl 8):I-60-76.

Becker L, Eisenberg M, Fahrenbruch C, Cobb L. Public locations of cardiac arrest: implications for public access defibrillation. ibid. 1998;97:2106-9.

Engdahl J, Herlitz J. Localization of out-of-hospital cardiac arrest in Goteborg 1994 – 2002 and implications for public access defibrillation. Resuscitation 2005;64;171-5.

Neumar RW, Barnhart JM, Berg RA, ibid. Implementation strategies for improving survival after out-of-hospital cardiac arrest in the United States: consensus recommendations from the 2009 American Heart Association Cardiac Arrest Survival Summit. Circulation 2011;123;2898-910.

Litwin PE, Eisenberg MS, Hallstrom AP, Cummins RO. The location of collapse and its effect on survival from cardiac arrest. Ann Emerg Med 1987;16:787-91.

Contra Costa County fire departments launch life-saving cell phone app. ABC7 San Francisco. Available at: [Accessed 23 July 2018]. | Allegheny County, Pittsburgh Announce Launch of Lifesaving Smartphone Application. Available at: [Accessed 23 July 2018].

Richmond (Va.) Implements PulsePoint Respond and PulsePoint AED. Public Safety Communications. 1460592000. Available at: [Accessed 23 July 2018].

Ringh M, Rosenqvist M, Hollenberg J, et al. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med 2015;372:2316-25.

Atkins DL. Realistic expectations for public access defibrillation programs. Curr Opin Crit Care 2010;16:191-5.

Deakin CD, Shewry E, Gray HH. Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest. Heart 2014;100:619-23.

Portner ME, Pollack ML, Schirk SK, Schlenker MK. Out-of-hospital cardiac arrest locations in a rural community: where should we place AEDs? Prehosp Disaster Med 2004;19:352-5.

Mosesso VN, Newman MM, Ornato JP, et al. Law Enforcement Agency Defibrillation (LEA-D): proceedings of the National Center for Early Defibrillation Police AED Issues Forum. Prehosp Emerg Care 2002;6:273-82.

Nelson RD, Bozeman W, Collins G, et al. Mobile versus fixed deployment of automated external defibrillators in rural EMS. Prehosp Disaster Med 2015;30:152-4.

Van de Voorde P, Guatama S, Momont A, et al. The drone ambulance [A-UAS]: golden bullet or just a blank? Resuscitation 2017;116:46-8.

Pulver A, Wei R, Mann C. Locating AED enabled medical drones to enhance cardiac arrest response times. Prehosp Emerg Care 2016;20378-89.

Boutilier JJ, Brooks SC, Janmohamed A, et al. Optimizing a drone network to deliver automated external defibrillators. Circulation 2017;135:2454-65.