ScR

AED accessibility (benefits and harms of locked AED cabinets): Scoping Review (BLS 2123; TF ScR)

profile avatar

ILCOR staff

Created: · Updated:

Commenting on this CoSTR is no longer possible

To read and leave comments, please scroll to the bottom of this page.

This CoSTR is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final COSTR will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: None. The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: Janet Bray, Gavin Perkins

Task Force Synthesis Citation

Bray J, Oonyu L, Perkins GD, Smith CM, Vaillancourt C, Olasveengen T on behalf of the International Liaison Committee on Resuscitation BLS Life Support Task Force. Accessibility of AEDs in locked cabinets Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Basic Life Support Task Force, 2024 July 25. Available from: http://ilcor.org

Methodological Preamble and Link to Published Scoping Review

The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a scoping review of basic life support (Oonyu, 2023 Resuscitation Plus) conducted by the members of the BLS Task Force. Evidence for adult and pediatric literature was sought and considered by the Basic Life Support Task Force. These data were taken into account when formulating the Treatment Recommendations.

Scoping Review

Oonyu L, Perkins GD, Smith CM, Vaillancourt C, Olasveengen T, Bray JE on behalf of the International Liaison Committee on Resuscitation BLS Life Support Task Force. The Impact of Locked Cabinets for Automated External Defibrillators (AEDs) on Cardiac Arrest and AED Outcomes: A Scoping Review. Resuscitation Plus 2024;20:100791.

PICOST

Population: Adults and children in out-of-hospital settings

Concept: The benefits and harms of placing automatic external defibrillators (AEDs) in locked cabinets versus unlocked cabinets

Context: Any locations where an AED is placed with the intention of the AED being publicly accessible for use

Outcomes: Any outcome, including AED outcomes (e.g. AED use, time to AED use, AED vandalism or theft)

Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies), case series, and case reports were eligible for inclusion. Grey literature (Google Scholar search -first 20 pages), letters to the Editor and conference abstracts were also eligible for inclusion.

Timeframe: All years and all languages were included as long as there was an English abstract; unpublished studies (e.g., conference abstracts, trial protocols) were excluded. Literature searched to June 25, 2024.

Search Strategies

Articles for review were obtained by searching Medline, Embase, Cochrane and Google Scholar for all entries from database inception to May 2024 (last searched on May 21, 2024).

Articles are using key terms “Cardiac arrest”, “Automated External Defibrillator", "AED", "Locked cabinet", "Public access defibrillation”; including their MESH terms, and Embase exploded terms.

Inclusion and Exclusion criteria

Studies of any type or design (e.g., experimental, observational, qualitative, conference abstracts, letters to the Editor) that were published with an English abstract and examined the impact of locked AED cabinets were included. Studies examining the accessibility of AEDs in buildings were not included, unless they mentioned locked cabinets. Any outcome, including AED outcomes (e.g. AED use before EMS arrival, time to AED use, AED vandalism or theft) were accepted. Systematic reviews were initially included to review reference lists for missed studies. Authors of conference abstracts were contacted where possible to ascertain whether full results were published. We also contacted the authors of studies that reported rates of theft or vandalism without details of security measures, and these studies were included if any of the AEDs studied were contained in locked cabinets.

Reports were excluded if they reported 1) on the general accessibility of AEDs without rates of theft or vandalism or 2) other outcomes (e.g. the results of surveys of what was considered in the placement of an AED).

Data tables:BLS 2123 Data table AED locked cabinets

Task Force Insights

Please insert your task force insights here. They should comprise 3 sections.

1. Why this topic was reviewed.

  • The BLS Task Force prioritized this topic, which has not been reviewed before, to address community concerns about the need for additional security measures to prevent AED theft, vandalism, and misuse.13-15

2. Narrative summary of evidence identified

  • We screened 2,096 titles and found 10 relevant studies: 8 observational (4 published as conference abstracts and 2 as letters to the Editor) and 2 simulation studies.1-10
  • No study reported on patient outcomes.
  • Data were reported on varying numbers of AEDs (range: 39 to 31,938).
  • The majority of studies reported low rates of theft and vandalism (<2.0%), including studies with 24-hour access.3-9 The only study comparing unlocked and locked AED cabinets showed low rates of theft in both cabinet types, with the lowest rates seen in locked cabinets (0.3% vs. 0.1%).8
  • Two simulation studies showed significantly slower AED retrieval when additional security measures were used, including locked cabinets.1,2
  • One survey of first responders reported half (24/45) were injured, most (62.5%) injuries occurred by using body parts to break the glass necessary to access a key to unlock the AED.10

3. Narrative Reporting of the task force discussions

  • Rapid defibrillation is critical to improving patient outcomes, and patients who receive defibrillation from bystanders have the greatest chance of survival.16
  • AEDs cabinets are typically locked with a code or key. Additional security may also be present (e.g. locked in a room in a locked cabinet).
  • While acknowledging that most of the data identified has not undergone peer review and may be publication bias, reported rates of AED theft and vandalism were low across all studies, and thefts occurred in both locked and unlocked cabinets.4,8 It was not reported if AEDs reported as stolen could potentially have been used in an emergency and not returned.
  • AED mapping studies show additional security measures, such as locking AEDs within buildings, reduces accessibility17 and simulation studies show when combined with locked cabinets increases the time to access the device.1,2
  • One study suggests issues with rescuer’s ability to follow the instructions on cabinets to retrieve keys to unlock cabinets.
  • The cost to replace stolen or vandalized AEDs may be an issue in low-resource settings (e.g. community groups with limited funding).
  • Some regions have opted to lock their public access defibrillators with a code that can be retrieved by calling the emergency number to encourage rescuers to call an ambulance as a first action.
  • Tracking devices may be useful to retrieve missing or stolen AEDs.
  • AED cabinet design should not result in harm to rescuers.
  • We agree with the 2022 ILCOR Scientific Statement which, focuses on optimizing public access defibrillation, and advises against using locked cabinets. If locked cabinets are used, instructions for unlocking them need to be clear and ensure no delays in access.11,12

4. Good practice statements

We advise against using locked cabinets (Good Practice Statement).

If locked cabinets are used, instructions for unlocking them must be clear and ensure minimal delays in access (Good Practice Statement).

Emergency Medical Services should devise strategies to return public access defibrillators when used (Good Practice Statement).

Knowledge Gaps

Peer-reviewed research and human studies are needed on this topic, particularly studies focusing on real-life retrieval and the impact of security strategies on delivery times and patient outcomes.

EtD: BLS 2123 AED Accessibility locked cabinets ETD

References

1. Uhm TH and Kim JH. Factors affecting delivery time of public access defibrillator in apartment houses. Indian Journal of Public Health Research and Development. 2018;9(9):534-40.

2. Telec W, Baszko A, Dabrowski M, Dabrowska A, Sip M, Puslecki M, Klosiewicz T, Potyrala P, Jurczyk W, Maciejewski A, Zalewski R, Witt M, Ladny JR and Szarpak L. Automated external defibrillator use in public places: a study of acquisition time. Kardiologia polska. 2018;76:181-5.

3. Salerno J, Willson C, Weiss L and Salcido D. Myth of the stolen AED. Resuscitation. 2019;140:1.

4. Peberdy MA, Ottingham LV, Groh WJ, Hedges J, Terndrup TE, Pirrallo RG, Mann NC and Sehra R. Adverse events associated with lay emergency response programs: the public access defibrillation trial experience. Resuscitation. 2006;70:59-65.

5. Page G and Bray J. Unlocking the key to increasing survival from out-of-hospital cardiac arrest - 24/7 accessible AEDs. Resuscitation. 2024:110227.

6. Ludgate MB, Kern KB, Bobrow BJ and Ewy GA. Donating automated external defibrillators may not be enough. Circulation Conference: American Heart Association. 2012;126.

7. Benvenuti C, Burkart R and Mauri R. Public defibrillators and vandalism: Myth or reality? Resuscitation. 2013;1):S69.

8. Cheema K, O'Connell D, Herz N, Adebayo A, Thorpe J, Benson-Clarke A and Perkins G. The influence of locked automated external defibrillators (AEDs) cabinets on the rates of vandalism and theft. Resuscitation. 2022;175(Supplement 1):S80.

9. Brugada R, Morales A, Ramos R, Heredia J, De Morales ER and Batlle P. Girona, cardio-protected territory. Resuscitation. 2014;1):S57.

10. NG JSY, HO, R.J.S., YU, J. ., NG, Y.Y. Factors Influencing Success and Safety of AED Retrieval in out of Hospital Cardiac Arrests in Singapore. The Korean Journal of Emergency Medical Services 2022;26:97-111.

11. Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang T-L, Koster RW and Ong MEH. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation. 2022;172:204-28.

12. Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH and International Liaison Committee on R. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation. 2022;172:204-28.

13. O'Callaghan PA, Swampillai J and Stiles MK. Availability of automated external defibrillators in Hamilton, New Zealand. N Z Med J. 2019;132:75-82.

14. Lac D, Wolters MK, Leung KHB, MacInnes L and Clegg GR. Factors affecting public access defibrillator placement decisions in the United Kingdom: A survey study. Resusc Plus. 2023;13:100348.

15. Fortington LV, Bekker S and Finch CF. Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study. Emerg Med J. 2020;37:617-22.

16. Nehme Z, Andrew E, Bernard S, Haskins B and Smith K. Trends in survival from out-of-hospital cardiac arrests defibrillated by paramedics, first responders and bystanders. Resuscitation. 2019;143:85-91.

17. Ball S, Morgan A, Simmonds S, Bray J, Bailey P and Finn J. Strategic placement of automated external defibrillators (AEDs) for cardiac arrests in public locations and private residences. Resusc Plus. 2022;10:100237.

Basic Life Support
Defibrillation and Electrical Therapy

Discussion

GUEST
Richard Reynolds

(modified: )

Unlocked cabinets could very result in an AED not be available at all if it’s been stolen or vandalised. lock cabinets already get vandalised and if they can get free access to the AED it’s going to be take.

Reply
GUEST
Rob Martin

(modified: )

Makes sense. The areas I know of AED's, they are not locked up

Reply
GUEST
Crystal Girard

(modified: )

In response to having AED devices in a locked vs unlocked cabinet I feel tbey should be kept in an unlocked cabinet.

We have been stating that seconds count when saving lives and an AED is a main component in the chain on survival so why not have them easily accessible. Although some bystanders Risk injury by breaking open cabinets others will take time finding someone to open it, both use up valuable time that the victim does not have.

fire alarms are left unlocked and easily pulled and yet we leave them in the open so why should an AED be any different the public with proper education will for The most part leave them as is.

Reply
GUEST
LINO MASOTTI

(modified: )

Locked vs Unlocked AEDs for Public - LINO MASOTTI. (Heart and Stroke Foundation (CANADA) Experienced Instructor/Instructor Trainer - 23 years)

AEDs have proven to save lives and there have been many success stories with PROMPT public AED intervention in a CA. The PROS of having AED CABINETS “unlocked” in the General Public - ready for use especially in areas of increased pedestrian traffic areas (malls, plazas/piazza, convention areas, arenas/stadiums… ) greatly out weighs the disadvantages in when emergency medical services are immediately called.

From personal experience, a major concern is that a significant number of AEDs in my community are improperly maintained, lacking a maintenance plan. When I teach out-of hospital resuscitation programs; as part of training, I ask students to locate their in house AED and on several occasions find low batteries, expired pads…

On one occasion, while I was teaching, a student became severely ill and after assessing the student, called 911, had a staff member go and retrieve AED “just in case of cardiac event ” - after EMS had taken the patient to hospital, I checked the unit with the staff - low batteries and expired AED pads. I think this is an issue that needs to be addressed with certain workplaces as I do my best to make sure that they are informed about the proper maintenance and offer them solutions on updating their AEDs - this isn’t my job, but I care about healthcare making our community safer.

PROS UNLOCKED

  • Effortless public access
  • Immediate bystander CPR/AED -improving overall survivor stats.

CONS UNLOCKED

  • Theft
  • Lack of maintenance plan/control
  • Environment conditions
  • Vandalism

LOCKED AED CABINETS

Recommendation in environments controlled by a specialized emergency response team trained in a variety of emergencies with a duty to respond.

Facilities may also have oxygen, trauma kits, emergency medicine.

My input on where I would have a locked access AED cabinet:

PROS LOCKED

CONTROLLED ACCESS, BETTER MAINTENANCE, OTHER EMERGENCY EQUIPMENT

  • Civil/Commercial aircraft
  • Public transportation
  • Medical/Dental Offices
  • Event First Aid Stations

CONS LOCKED

  • AEDs are inaccessible
  • Alarms scare individuals
  • Delays: If a key is required, retrieving the AED takes valuable time.

In conclusion locked/unlocked AEDs involves weighing accessibility against security/maintenance concerns. Balancing these approaches optimizes both public access and readiness which they were ultimately meant for.

Reply
GUEST
Lino Masotti

(modified: )

Locked vs Unlocked AEDs for Public - LINO MASOTTI. (Heart and Stroke Foundation (CANADA) Experienced Instructor/Instructor Trainer - 23 years)

AEDs have proven to save lives and there have been many success stories with PROMPT public AED intervention in a CA. The PROS of having AED CABINETS “unlocked” in the General Public - ready for use especially in areas of increased pedestrian traffic areas (malls, plazas/piazza, convention areas, arenas/stadiums… ) greatly out weighs the disadvantages in when emergency medical services are immediately called.

From personal experience, a major concern is that a significant number of AEDs in my community are improperly maintained, lacking a maintenance plan. When I teach out-of hospital resuscitation programs; as part of training, I ask students to locate their in house AED and on several occasions find low batteries, expired pads…

On one occasion, while I was teaching, a student became severely ill and after assessing the student, called 911, had a staff member go and retrieve AED “just in case of cardiac event ” - after EMS had taken the patient to hospital, I checked the unit with the staff - low batteries and expired AED pads. I think this is an issue that needs to be addressed with certain workplaces as I do my best to make sure that they are informed about the proper maintenance and offer them solutions on updating their AEDs - this isn’t my job, but I care about healthcare making our community safer.

PROS UNLOCKED

  • Effortless public access
  • Immediate bystander CPR/AED -improving overall survivor stats.

CONS UNLOCKED

  • Theft
  • Lack of maintenance plan/control
  • Environment conditions
  • Vandalism

LOCKED AED CABINETS

Recommendation in environments controlled by a specialized emergency response team trained in a variety of emergencies with a duty to respond.

Facilities may also have oxygen, trauma kits, emergency medicine.

My input on where I would have a locked access AED cabinet:

PROS LOCKED

CONTROLLED ACCESS, BETTER MAINTENANCE, OTHER EMERGENCY EQUIPMENT

  • Civil/Commercial aircraft
  • Public transportation
  • Medical/Dental Offices
  • Event First Aid Stations

CONS LOCKED

  • AEDs are inaccessible
  • Alarms scare individuals
  • Delays: If a key is required, retrieving the AED takes valuable time.

In conclusion locked/unlocked AEDs involves weighing accessibility against security/maintenance concerns. Balancing these approaches optimizes both public access and readiness which they were ultimately meant for.

Reply
GUEST
Thomas Webber

(modified: )

The debate around AED (Automated External Defibrillator) accessibility, particularly whether to lock AED cabinets, is quite nuanced. Here are some key points:

Benefits of Locked AED Cabinets:
1. Security Locks can help prevent theft or vandalism, ensuring the AED remains available when needed [43dcd9a7-70db-4a1f-b0ae-981daa162054](https://www.sussexheartcharity.org/life-saving-accessibility-why-unlocked-aed-cabinets-matter/?citationMarker=43dcd9a7-70db-4a1f-b0ae-981daa162054 "1").
2. Protection Cabinets can protect AEDs from environmental damage, such as dust or water [43dcd9a7-70db-4a1f-b0ae-981daa162054](https://ddisafety.com.au/aed-cabinet-guide-ensuring-safety-and-accessibility/?citationMarker=43dcd9a7-70db-4a1f-b0ae-981daa162054 "2").

Harms of Locked AED Cabinets:
1. Delayed Access: In an emergency, every second counts [43dcd9a7-70db-4a1f-b0ae-981daa162054](https://www.sussexheartcharity.org/life-saving-accessibility-why-unlocked-aed-cabinets-matter/?citationMarker=43dcd9a7-70db-4a1f-b0ae-981daa162054 "1"). Locked cabinets can delay access, potentially impacting survival rates[43dcd9a7-70db-4a1f-b0ae-981daa162054](https://www.sussexheartcharity.org/life-saving-accessibility-why-unlocked-aed-cabinets-matter/?citationMarker=43dcd9a7-70db-4a1f-b0ae-981daa162054 "1").
2. Complexity: If a lock is used, someone must know the code or have access to it, which can complicate the response during an emergency [43dcd9a7-70db-4a1f-b0ae-981daa162054](https://www.sussexheartcharity.org/life-saving-accessibility-why-unlocked-aed-cabinets-matter/?citationMarker=43dcd9a7-70db-4a1f-b0ae-981daa162054 "1").

Recommendations:
-Unlocked Cabinets Many experts recommend keeping AEDs in unlocked, clearly marked cabinets to ensure immediate access during emergencies [43dcd9a7-70db-4a1f-b0ae-981daa162054](https://www.sussexheartcharity.org/life-saving-accessibility-why-unlocked-aed-cabinets-matter/?citationMarker=43dcd9a7-70db-4a1f-b0ae-981daa162054 "1").
- Strategic Placement AEDs should be placed in highly visible and accessible locations[43dcd9a7-70db-4a1f-b0ae-981daa162054](https://aedadvantage.ca/blogs/resources/the-importance-of-aed-placement-accessibility-and-availability?citationMarker=43dcd9a7-70db-4a1f-b0ae-981daa162054 "3").


Reply
GUEST
Nazir Akber Ali

(modified: )

With an experience of over 30 years in emergency medicine and 10 years' experience with AED in specialty clinics and public places/ Religious gatherings areas, i have realized that its essential to keep AED unlocked but with an alarm while opening and with clear instructions as to who should open this and how important its not to use if you have no past experience of using it. Since the defib pads are for one time use only and it takes a while to replace it.

Keeping AED Locked have many pitfalls as to find the person with the key at the right time is not always possible and any delay in that process will decrease the chances of keeping alive the whole mankind. As Saving one life is as if saving the whole mankind. And by chance if u get AED box open and are able to restore Cardiac activity there is a chance of not getting beneficial neurological outcome.

And not only that then there is a grave consequence of a person with restored Cardiac activity but with poor neurological outcome not only on that person but on the family and on the society as a whole.

So to sum up AED Boxes should not be locked but with some important information on the box for the person who is opening it.

Reply
GUEST
Sherry Campbell

(modified: )

The format in which this article has been set up is very clear and easy to read.

An area that was not discuss was the demographic location of the AEDs - does identify community (not in a building), but what area in the community are these AEDs located? Outside a shopping plaza, busy intersection, etc.? What country - In Canada - USA - Europe?

Thank you for allowing me to review.

Reply
GUEST
Ryan Brown

(modified: )

Methodologically sound ScR. Important work with important results. The research backs up my gestalt on access to AEDs.

Reply
GUEST
Brenda Propp

(modified: )

I believe easy access to AED's is critical to the outcome of persons requiring this service however there is a concern of theft or even the pads drying out or being removed, continued research on the best method to make this possible would be my personal recommendation.

Reply
GUEST
Daniel Cherrier

(modified: )

According to my experience in emergency field and as an instructor for many years, it is obvious to me that AED should not be in a locked cabinet. When an emergency occurs, as far as cardiac arrests are concerned, stress among the emergency personnel and also with the layperson who is willing to help the cardiac arrest patient is at its most high level. So if the accessible AED is in a locked cabinet, that will bring confusion and increasing the stress level to the rescuers. In a lot of public facilities, it is difficult and a waste of precious seonds to try to get the AED and some security personnel has the bad idea of thinking that they are the only individuals to respond to a cardiac arrest episode. We all know that this is not true at all, every person who is trained to perform CPR should have access to an AED, no questions asked.

Reply
GUEST
Lino Masotti

(modified: )

Locked vs Unlocked AEDs for Public - LINO MASOTTI. (Heart and Stroke Foundation (CANADA) Experienced Instructor/Instructor Trainer - 23 years)

AEDs have proven to save lives and there have been many success stories with PROMPT public AED intervention in a CA. The PROS of having AED CABINETS “unlocked” in the General Public - ready for use especially in areas of increased pedestrian traffic areas (malls, plazas/piazza, convention areas, arenas/stadiums… ) greatly out weighs the disadvantages in when emergency medical services are immediately called.

From personal experience, a major concern is that a significant number of AEDs in my community are improperly maintained, lacking a maintenance plan. When I teach out-of hospital resuscitation programs; as part of training, I ask students to locate their in house AED and on several occasions find low batteries, expired pads…

On one occasion, while I was teaching, a student became severely ill and after assessing the student, called 911, had a staff member go and retrieve AED “just in case of cardiac event ” - after EMS had taken the patient to hospital, I checked the unit with the staff - low batteries and expired AED pads. I think this is an issue that needs to be addressed with certain workplaces as I do my best to make sure that they are informed about the proper maintenance and offer them solutions on updating their AEDs - this isn’t my job, but I care about healthcare making our community safer.

PROS UNLOCKED

  • Effortless public access
  • Immediate bystander CPR/AED -improving overall survivor stats.

CONS UNLOCKED

  • Theft
  • Lack of maintenance plan/control
  • Environment conditions
  • Vandalism

LOCKED AED CABINETS

Recommendation in environments controlled by a specialized emergency response team trained in a variety of emergencies with a duty to respond.

Facilities may also have oxygen, trauma kits, emergency medicine.

My input on where I would have a locked access AED cabinet:

PROS LOCKED

CONTROLLED ACCESS, BETTER MAINTENANCE, OTHER EMERGENCY EQUIPMENT

  • Civil/Commercial aircraft
  • Public transportation
  • Medical/Dental Offices
  • Event First Aid Stations

CONS LOCKED

  • AEDs are inaccessible
  • Alarms scare individuals
  • Delays: If a key is required, retrieving the AED takes valuable time.

In conclusion locked/unlocked AEDs involves weighing accessibility against security/maintenance concerns. Balancing these approaches optimizes both public access and readiness which they were ultimately meant for.

Hope this information helps. Keep up the excellent work.

Reply
Lino Masotti
(1 posts)

(modified: )

Locked vs Unlocked AEDs for Public - LINO MASOTTI. (Heart and Stroke Foundation (CANADA) Experienced Instructor/Instructor Trainer - 23 years)

AEDs have proven to save lives and there have been many success stories with PROMPT public AED intervention in a CA. The PROS of having AED CABINETS “unlocked” in the General Public - ready for use especially in areas of increased pedestrian traffic areas (malls, plazas/piazza, convention areas, arenas/stadiums… ) greatly out weighs the disadvantages in when emergency medical services are immediately called.

From personal experience, a major concern is that a significant number of AEDs in my community are improperly maintained, lacking a maintenance plan. When I teach out-of hospital resuscitation programs; as part of training, I ask students to locate their in house AED and on several occasions find low batteries, expired pads…

On one occasion, while I was teaching, a student became severely ill and after assessing the student, called 911, had a staff member go and retrieve AED “just in case of cardiac event ” - after EMS had taken the patient to hospital, I checked the unit with the staff - low batteries and expired AED pads. I think this is an issue that needs to be addressed with certain workplaces as I do my best to make sure that they are informed about the proper maintenance and offer them solutions on updating their AEDs - this isn’t my job, but I care about healthcare making our community safer.

PROS UNLOCKED

  • Effortless public access
  • Immediate bystander CPR/AED -improving overall survivor stats.

CONS UNLOCKED

  • Theft
  • Lack of maintenance plan/control
  • Environment conditions
  • Vandalism

LOCKED AED CABINETS

Recommendation in environments controlled by a specialized emergency response team trained in a variety of emergencies with a duty to respond.

Facilities may also have oxygen, trauma kits, emergency medicine.

My input on where I would have a locked access AED cabinet:

PROS LOCKED

CONTROLLED ACCESS, BETTER MAINTENANCE, OTHER EMERGENCY EQUIPMENT

  • Civil/Commercial aircraft
  • Public transportation
  • Medical/Dental Offices
  • Event First Aid Stations

CONS LOCKED

  • AEDs are inaccessible
  • Alarms scare individuals
  • Delays: If a key is required, retrieving the AED takes valuable time.

In conclusion locked/unlocked AEDs involves weighing accessibility against security/maintenance concerns. Balancing these approaches optimizes both public access and readiness which they were ultimately meant for.

Hope this helps.

Keep up the excellent work!

Reply
GUEST
Edward Mak

(modified: )

Agree.. Communities with a good PAD program are typically in areas where there is sufficient funding. There is already a demographic bias because most PAD locations are typically the well funding areas. PAD programs need to focused on deploying AEDs in areas where EMS arrivals are >10mins. Strong recommendations EMS to be involved in ANY PAD program deployment.

Reply
GUEST
Edward Mak

(modified: )

Agree.. Communities with a good PAD program are typically in areas where there is sufficient funding. There is already a demographic bias because most PAD locations are typically the well funding areas. PAD programs need to focused on deploying AEDs in areas where EMS arrivals are >10mins. Strong recommendations EMS to be involved in ANY PAD program deployment.

Reply
GUEST
Dorothy (Doreen) Igharo

(modified: )

I think it might be possible to tack and retrieve stolen AED but vandalized AED require to be replaced. “AEDs can be recovered through tracking devices (Page 2024 110227)”. It also depends on the setting itself, inner circle query. Who are those stealing and vandalizing the AED? There could be one or more inner circle of the community groups involve otherwise, who else? I know this was not mention though in the research evidence

I think education in form of community groups public awareness/campaigns may play a vital role on the use of AEDs prevent vandalism and theft (Brugada 2014 S57). Thus, focuses on the importance of AED in resuscitation process, the chances of victims to survive rely greatly on AED accessibility. Vandalized and stolen AED impede the chances of victim survival rate. Even when AED are in locked or unlocked cabinets, as per this research evidence it “revealed that theft and vandalism was seen in both locked and unlocked cabinets”. However, if the community setting policy is to locked up AEDs in cabinets, instructions to access the keys should be make clear

Reply
GUEST
Curtis Edmondson

(modified: )

This makes sense on the surface. If an AED is in a locked cabinet, then it will inevitably increase the time it takes to access the AED. I agree with the conclusions set forth in this study. AEDs should be as easily accessible as possible, and if they must be locked in a cabinet or other such device, the instructions should be very clear and easy to follow.

When people are in an emergency situation, they are not able to think critically or follow complicated instructions very well. If the only option to keep an AED in a location is to keep it locked up, that would be better than having no AED, but clear instructions for opening the cabinet should be kept locally and given to 911 call takers for that area.

Reply
GUEST
Darlene M Hutton

(modified: )

While I agree with your recommendations against locked cabinets, for all the reasons stated, I feel that there continues to be a knowledge gap in the training of health care providers on the use of AED. As a BLS and ACLS instructor for over 25 years, I have witnessed health care providers apply the AED to a patient with an unstable tachycardia with a pulse numerous times. Their rationale at the time of the training scenario is something along the lines of "I'll apply the pads just in case they require the AED". Having trained and certified many health care providers, I realized that they are not routinely aware of the nuances of AEDs, specifically when it comes to an AED differentiating between how patients can present when in ventricular tachycardia. Approximately half of the healthcare providers that I certify doing BLS do not realize or are not confident in their knowledge that the AED cannot differential between a pulseless VT and an unstable VT with a pulse.

It's understandable why healthcare providers might err on the side of caution with unstable tachycardia, but the misconception about AED use in such cases highlights a need for added education.

Reply
GUEST
Uwe Kreimeier

(modified: )

Dear Janet, dear Gavin:

As stated in the draft paper vandalism as well as robbery of AEDs are rare. An organization´s investment into an AED takes into account the potential loss of that device, e.g. not returning it after use.

Therefore I suggest instead of preventing robbery by means of locking, to enable the localization of the AED through a built-in Airtag chip. To my mind this solution has the benefit - in addition to fighting robbery - to track the AED after use.

In the long term, this has the perspective to incorporate geographical tracking of the AED in existing software-driven solutions for alarm systems used by first aid responders and dispatch centers.

Additionally, such a solution should display the status of the AED, e.g. by labelling active devices “green” and used devices “red”.

Sincerely,

Uwe Kreimeier, M.D.

Reply
GUEST
Peter Mertins

(modified: )

I agree with this articles concluding statements. AED cabinets should not be locked to public,an if so, an easy,safe and effective method should be devised to gain access..

Reply
GUEST
Suzanne Vanderlip

(modified: )

I agree with the challenges outside healthcare and EMS stations related to locked boxes that contain an AED. In this day and age of easy access to cell phones the public can call 911 or (other emergency number of the area or country) to ensure that EMS response is activated. However with the encouragement of training the public in bystander CPR and early defibrillation it is important to have access to an AED. The idea of tracking the AEDs related to theft is an option as well.

Reply
Mike Janczyszyn
(1 posts)

(modified: )

This is an interesting topic to explore. Being a public access to defibrillator coordinator, I deal with questions about this all the time. We unofficially keep track of our 24/7 cabinets that are unlocked.
While not having accessed the research, I have concerns that thefts might be underreported as they are here. They rarely get reported to police and they just end up not buying another AED and leaving that area empty, or they replace it at a cost to themselves.

I'm a little confused with the search criteria; one says it ended in May 2024 while the other paragraph said June 2024. Petty difference, I know…

I'd be curious about the differences between the locked cabinets as well. Some would have a physical key vs. a keypad. We have just introduced a phone application called GoodSAM that would give someone the keypad number if someone called 911. Even in that instance, I would still see a potential delay in getting the code to the right person. The app holder would have it but maybe it's needed sooner. The call-taker may be busy with other things to provide the code right away as well; or maybe all the codes are the same; just providing a deterrent.

Another interesting avenue would be the education part. It is mentioned once in there. More education would hope to receive less theft (that's the hope anyway).

Very excited to see further reviews and research on this and hoping Canada can be part of one such study.

Reply
GUEST
Andrew Benson

(modified: )

I would strongly advise against having locked cabinets in the setting of public access defibrillators. The program I was associated with for 25 years supported in excess of 400 public access defibrillators and never had an incident of vandalism or theft. I will qualify the statement that our experience was almost exclusively with indoor AEDs. we have limited experience with AEDs place in outdoor public settings.

As has been well established, ready access to defibrillators enhance the outcome of victims of cardiac arrest. Our own experiences would indicate better than a 50% survival to discharge when a PAD device is used.

I believe several aspects need to be balanced: ownership and cost of the AED will at times heighten the concern and implications for theft and vandalism which can be offset by support of a program (and back up devices should it occur); vs the public perception of a locked device suggesting it is not for everyone's use, regardless of training and may create inherent delays in access and application of the AED as well potential for damage to the case and or the individual trying to access the AED.

We need to ensure everyone has access to these potentially life saving devices as well as educating the public about their availability and need.

Thanks for the opportunity

Andy Benson

Reply
GUEST
Andrew Benson

(modified: )

I would strongly advise against having locked cabinets in the setting of public access defibrillators. The program I was associated with for 25 years supported in excess of 400 public access defibrillators and never had an incident of vandalism or theft. I will qualify the statement that our experience was almost exclusively with indoor AEDs. we have limited experience with AEDs place in outdoor public settings.

As has been well established, ready access to defibrillators enhance the outcome of victims of cardiac arrest. Our own experiences would indicate better than a 50% survival to discharge when a PAD device is used.

I believe several aspects need to be balanced: ownership and cost of the AED will at times heighten the concern and implications for theft and vandalism which can be offset by support of a program (and back up devices should it occur); vs the public perception of a locked device suggesting it is not for everyone's use, regardless of training and may create inherent delays in access and application of the AED as well potential for damage to the case and or the individual trying to access the AED.

We need to ensure everyone has access to these potentially life saving devices as well as educating the public about their availability and need.

Thanks for the opportunity

Andy Benson

Reply
GUEST
Wendy Bissett

(modified: )

Excellent review - thanks for sharing And providing the opportunity for feedback. I think a simple cabinet with an alarm triggered door (like some fire extinguishers) would be enough of a deterrent to theft but not delay access.

Reply
GUEST
Brenda Brandt

(modified: )

Working and Living in rural Saskatchewan can sometimes be a challenge. Our town of approx 300 people and surrounding community of another 300 people have access to 3 AEDs The unfortunate part is where they are located - in the school, community hall and skating rink/swimming pool {dependent on the season} These are great locations provided the emergency happens during school hours, when the rink or pool are open or if there is a community function on at the hall.

I know the community does not want free access to the building housing the AEDs but they cannot be accessed at any other times virtually rendering them useless. I am not sure what a good place with available access would be. People being people also do inappropriate things - I have heard of incidents where intoxicated persons thought it might be fun to try out the AED and of course damaged it. I have used an AED in my EMS career with positive results so know how valuable and timely there uses is. Good luck on finding an appropriate way to access and utilize this lifesaving resource

Reply
Caitlyn Pavey-Smith
(1 posts)

(modified: )

Conflicts of interest: Financial relationships

Thank you for the opportunity to comment on this draft CoSTR.

We are concerned about the wording of the Good Practice Statement that “We advise against using locked cabinets”. While it is immediately followed by a statement around unlocking instructions, this may lead to design of a system requiring unlocked cabinets that may be suboptimal for the setting.

In Western Australia, our locked cabinet system, which uses a keypad combination provided during emergency calls, has benefits like confirming an emergency call has been made and tracking defibrillator deployment for quick consumable replacement. While we agree that unlocked cabinets are generally better for patients, we believe that not all scenarios are equal.
As we discuss in our (accepted but not yet published) correspondence in reply to the recently published scoping review, our experience is that locked cabinets are far more acceptable to organisations considering making their AED publicly accessible based on a perception of risk of theft or vandalism.

In regions where Public Access Defibrillators (PADs) are funded by governments or health services, unlocked cabinets may be ideal. However, in places like WA, many PADs come from organisations that may lack the resources to replace stolen devices. In these cases, a locked cabinet can encourage more PADs to be available, despite the minor delay in unlocking.

Acceptability and feasibility will vary by EMS systems based on resource availability, risk perceptions, and system capability. In our region, we provide unlocking codes during emergency calls, minimising delays. We are aware that this capability does not exist in all EMS systems for many reasons including that an EMS system may not operate their own emergency call-taking and dispatch service so cannot provide information on nearby PADs and unlocking codes on the emergency call. In such cases it may be that regardless of acceptability, unlocked cabinets are the practical solution.

Given these variations and the limited evidence available, we recommend that the good practice statement be rephrased more cautiously. EMS systems should evaluate their specific circumstances to decide which model strikes the best balance between the accessibility of unlocked cabinets and the security of locked systems.

Lastly, we support careful design considerations for cabinets to prevent rescuer injury, such as avoiding break-glass designs.

Reply
GUEST
Janet Bray

(modified: )

Thank you all for your comments, which will be considered by the BLS Task Force. Janet Bray (BLS Task Force Chair)

Reply
GUEST
David Fredman

(modified: )

Locked AED cabinets is an effective way to reduce the efficiency of AEDs, be it in public locations or anywhere. In Sweden, and likely other countries as well, insurances are offered that will replace an AED if it´s stolen or vandalized, and in some instances even replace electrodes and batteries if the AED instead is used.

I´d encourage more insurance companies in more countries to move in this direction, to increase the likelihood of AED use and the chance to survival.

I believe fear of theft can be mitigated through insurances and thus more AEDs could be available in public. But I would also encourage researchers and other entities (national resuscitation councils etc.) to dig a bit deeper in to the sources around theft. Currently in Sweden the media boosts stories on stolen AEDs more than stories on successful rescuing with an available public AED. Another angle on the story could be if theft of AEDs are a big problem on societal level or is it a big problem on an individual level. The individual level issue could be mitigated through insurances, and if the theft issue is big on a national level I´d encourage AED vendors and producers to work with police and second-hand sales platforms to block sales of electrodes and batteries to AEDs that were reported stolen. If we work together to stop that “second hand” market, the theft of AEDs would likely decrease. And I´m looking at the big fishes here, the serial number of an AED could be used for so much more than it is today, and theft prevention is one thing. We need to work together to make sure that AEDs can reach their full potential in public locations, and locking them in is not the way to go.

Reply

Sort by

Time range

Categories

Domains

Status

Review Type