Early Access

Ease of Access to Stored AEDs

Last Full Review: ILCOR 2025

Automated external defibrillators (AEDs) used for public access are typically stored in highly visible and accessible locations to ensure quick access during emergencies. In public places, they are stored in wall-mounted cases or cabinets. However, in settings prone to theft or vandalism, organizations may choose to secure AEDs in cabinets locked with a key or code to prevent damage or to prevent discovering an AED is missing when it is needed. In some facilities, AEDs are stored in an area where access is restricted or controlled and thus not freely accessible to the public. This topic was reviewed by the International Liaison Committee on Resuscitation (ILCOR) to evaluate the benefits and harms of placing an AED in a locked versus unlocked cabinet.

 

Evidence Summary

A 2025 ILCOR scoping review (Oonyu et al. 2024, 100791; Bray et al. 2025, S34) on the topic of locked AED cabinets included simulation studies and several relevant observational studies, none of which reported on patient outcomes. Theft and vandalism were reported in less than 2% of the cases with one study (Cheema et al. 2022, 175[1]) reporting an AED theft rate of 0.1% for locked cabinets and 0.3% for unlocked cabinets. The simulation studies (Uhm and Kim 2018, 534; Tele et al. 2018, 181) reported slower AED retrieval times with locked cabinets and other security measures. Injuries to first responders were reported when it was necessary to break the glass to access an AED from a locked cabinet (Ng et al. 2022, 266). The ILCOR scoping review noted that rapid defibrillation is critical to improving patient outcomes, and defibrillation by bystanders gives patients the greatest chance of survival (Oonyu et al. 2024, 100791; Bray et al. 2025, S34). Security measures combined with locked cabinets increase the time to access an AED, and locked cabinets can create a delay to access. A good practice statement by ILCOR advises against using locked cabinets. If locked cabinets are used, instructions for unlocking them must be clear and ensure minimal delays in access. Emergency medical services should devise strategies to return public access defibrillators after they are used (Oonyu et al. 2024, 100791; Bray et al. 2025, S34).

Insights and Implications

Storing public access AEDs in locked cabinets may seem counterintuitive when rapid access is essential for emergencies. Yet, leaving them unlocked poses risks, such as theft or device malfunction, while locked storage introduces the possibility of responders being injured if they must force the cabinet open. To achieve a balance between security needs and accessibility, some facilities will install AEDs in alarmed cabinets that can reduce the risk of theft or tampering while maintaining device accessibility. The audible alarm also alerts nearby personnel to the AED’s use, which can improve rapid response to an event. Strategic placement of AEDs in high-traffic, monitored areas can also reduce the risk of misuse and ensure the devices are quickly accessible during emergencies. Comprehensive training of staff and building occupants about the location and use of AEDs also ensures that even if an AED is secured, authorized users can access them promptly when needed. Finally, if an AED is used, it is critical to have it returned or replaced as soon as possible. In some of the studies evaluated by ILCOR, it was not clear if an AED was missing due to theft or if the AED had been recently used and not returned.

Public Access Defibrillation Programs for Adults

Last Full Review: ILCOR 2020
Last Update: 2024

Bystander use of automated external defibrillators (AEDs) has been shown to improve the odds of survival to hospital discharge and favorable neurological outcome following out-of-hospital cardiac arrest (Holmberg et al. 2017, 120). Despite this, public access defibrillators (PADs) are used in less than 3% of out-of-hospital cardiac arrests prior to the arrival of emergency medical services (EMS) (Brooks et al. 2022, 204). Identifying barriers to the use of PADs can help generate novel strategies for public access to AEDs and for their deployment, thus allowing for earlier defibrillation and improved survival from out-of-hospital cardiac arrest.

 

Evidence Summary

A 2017 American Red Cross Scientific Advisory Council literature scientific review (American Red Cross Scientific Advisory Council: Resuscitation 2017a) identified observational studies showing improved survival outcomes following use of PAD programs for out-of-hospital cardiac arrest. Other studies were identified evaluating strategies for placement of, and novel deployment of, public AEDs. A 2022 International Liaison Committee on Resuscitation (ILCOR) evidence update (Wyckoff et al. 2022a) identified one new randomized controlled trial  (Shibahashi et al. 2021, 4) showing an improved odds of favorable neurological outcomes following bystander defibrillation for witnessed out-of-hospital cardiac arrest at metropolitan railroad stations, compared with patients who received defibrillation by EMS, supporting previous recommendations for implementation of public access defibrillation programs for patients with out-of-hospital cardiac arrest. Recently, a scientific statement from ILCOR sought to identify known barriers to PAD use and early defibrillation, to review current and new strategies to address barriers and to identify knowledge gaps to guide future research (Brooks et al. 2022, 204). Suggestions made to improve PAD implementation centered on:

• Improving public awareness and willingness to use.
• Optimizing AED availability, reliability and usability.
• Automated external defibrillator signage, including design, visibility, location information and maintenance.
• Mobile device application use for crowdsourcing cardiopulmonary resuscitation (CPR) and early AED use.
• Use of mobile community health, fire and police personnel for early community AED deployment and defibrillation.

Insights and Implications

Survival to hospital discharge with a favorable neurologic outcome following out-of-hospital cardiac arrest remains low, at about 10% internationally (Dyson et al. 2019, 168). Immediate CPR and AED use can greatly improve the odds of neurologically favorable survival. Public access defibrillator use bridges the temporal gap between out-of-hospital cardiac arrest and EMS arrival but continues to be underutilized. While AED proximity to out-of-hospital cardiac arrests is key to bystander defibrillation, many other known and potential barriers exist. The ILCOR scientific statement can serve as a blueprint for future research and consideration in PAD program development (Brooks et al. 2022, 204).

Public Access Defibrillation Programs for Infants, Children and Adolescents

Last Full Review: ILCOR 2022; American Red Cross Scientific Advisory Council 2010 (Infant)
Last Update: 2024

Out-of-hospital cardiac arrest is rare in infants and children, and unlike adults, is less likely to be due to a primary cardiac event and more likely to be the result of a respiratory issue or trauma. Is there evidence to support the use of public access automated external defibrillators (AEDs) in pediatric out-of-hospital cardiac arrest?

 

Evidence Summary

A 2022 systematic review (Atkins et al. 2022b, 100283) and Consensus on Science with Treatment Recommendations (Wyckoff et al. 2022; Atkins et al. 2022a) by International Liaison Committee on Resuscitation (ILCOR) evaluated the evidence for the application of, or shock delivery from, an AED by lay rescuers to infants, children and adolescents with nontraumatic out-of-hospital cardiac arrest compared with standard care without AED application and use. Four observational studies were identified, including three from the Cardiac Arrest Registry to Enhance Survival (CARES) database (Naim et al. 2019, e012637; Naim et al. 2017, 133; Griffis et al. 2020, 126). Data from the CARES studies was used to calculate the relative risk of survival if an AED was applied and analyzed by age group for infants less than 1 year of age, children from 1 to 12 years of age and adolescents from 13 to 18 years of age. The relative risk of survival to hospital discharge with a Cerebral Performance Category score of 1 to 2 was found to be significantly improved with AED application in all age groups except for the under 1 year age group (Atkins et al. 2022a). A weak recommendation was made by ILCOR suggesting the use of an AED by lay rescuers for all children over 1 year of age who have a nontraumatic out-of-hospital cardiac arrest. No recommendation was made for or against the use of an AED by lay rescuers for infants under 1 year of age with a nontraumatic out-of-hospital cardiac arrest. The authors noted the limited evidence available, including a small percentage of children (1.5%) from the CARES database who had an AED applied and a small percentage of children (3.7%) in the fourth observational study (Kiyohara et al. 2018, 890) who had a shock delivered. Only 12 patients in the under 1 year of age group had an AED applied, with 1 survival. Because this may result in a false negative result, a recommendation was not made by ILCOR for this age group (Atkins et al. 2022a).

Insights and Implications

Cardiac arrest in children is commonly preceded by a respiratory event and hypoxemia. As would be expected, ventilations with compressions have been shown to be vitally important for successful resuscitation (Tobin et al. 2017, 39). The application of an AED may delay starting cardiopulmonary resuscitation (CPR) or increase pauses in CPR, which could be potentially detrimental. The review authors acknowledge this but note the relative risk was still significantly in favor of AED application (Wyckoff et al. 2022; Atkins et al. 2022a). While out-of-hospital cardiac arrest is less common in infants and children than in adults, shockable rhythms do occur in this population. Despite the lack of evidence in the ILCOR review to support the public use of AEDs for infants with out-of-hospital cardiac arrest, there is no evidence to suggest harm from their use. Although the application of an AED may cause a slight pause in CPR, that determinant is outweighed by the lifesaving benefit in both infants and children with shockable rhythms.

Drone Delivery of Automated External Defibrillators

Last Full Review: ILCOR 2023  

Early provision of cardiopulmonary resuscitation combined with early defibrillation is key to successful resuscitation from cardiac arrest. Most cardiac arrests occur at home, where automated external defibrillators (AEDs) are not readily available. This has led to the consideration of alternative means to access AEDs, including the delivery of AEDs using drones.

 

Evidence Summary

A 2023 scoping review (Kollander et al. 2023; Berg et al. 2023) by the International Liaison Committee on Resuscitation aimed to identify and summarize evidence related to the delivery of AEDs by drones to adults and children with out-of-hospital cardiac arrest, as compared with standard delivery of AEDs by bystanders, activated volunteer responders and emergency medical services. The studies included computer and prediction models (17 studies) to localize optimal sites for the location of AED drone bases; test flights and simulation studies and qualitative analysis (nine studies); and one real-life AED-drone delivery feasibility study in 14 suspected out-of-hospital cardiac arrests. Drone delivery of AEDs was found to be feasible in all included studies. The real-life feasibility study included 12 drone flights with successful delivery of an AED in 11 of 12 incidents; AED-drone delivery occurred before ambulance delivery in 64% of cases (Schierbeck et al. 2022,1478). Other studies predicted the cost effectiveness of an AED-drone delivery system as a supplement to existing AED delivery models, and participant feedback regarding the use of drones in out-of-hospital cardiac arrest.

Insights and Implications

Although studies find that drone delivery of AEDs is feasible, there are no studies demonstrating an impact on patient outcomes, and there are significant challenges to the implementation of an AED-drone delivery network. Concerns about privacy intrusion, safety, battery life and expense need to be addressed. Air Traffic Control and regulatory restrictions that limit flying a drone beyond the visual sight line of an operator make it difficult to fly drones over most of the terrain in the United States or in urban areas where line of sight is blocked by buildings. Future development of unmanned traffic management systems for commercial drones will hopefully enable automated management of AED-drone delivery flights.