- Analysis of registered public access defibrillators (PADs) across England led by University of Warwick reveals inequality in where they are located
- Areas with a greater number of defibrillators tend to be more affluent and with high socio-economic occupations, with fewer residents that identify as non-white
- Only 27.4% of the most deprived areas had at least one defibrillator compared to about 45% in the least
- Researchers call for more PADs to be registered with new national database The Circuit, which will help to support an evidence-based approach to the placement of defibrillators
Public access defibrillators are disproportionately lacking in the most deprived areas of England, which are among the communities at the greatest risk of cardiac arrest, according to new analysis led by the University of Warwick.
Using information from ambulances services in England on defibrillators that have been registered with them, researchers have also found that fewer defibrillators are installed in residential areas – at locations such as outside community halls and primary schools – where cardiac arrests are most likely to occur.
The study is part of a project at the University of Warwick funded by the National Institute for Health Research (NIHR), the research partner of the NHS, public health and social care, investigating where defibrillators should be installed to optimise their accessibility and is published in the journal Resuscitation.
Many, but not all, defibrillators are registered with ambulance services. A registered defibrillator is more likely to be used because when a member of the public calls 999 in an emergency the call operator can direct them to the nearest one.
The researchers from Warwick Clinical Trials Unit and the NIHR Applied Research Collaboration (ARC) West Midlands, used data from ten of the eleven* ambulance services in England on registered defibrillators in their areas and combined this with information from the Office for National Statistics on the characteristics of the population in those areas, such as ethnic backgrounds, education level and types of employment. They also used the Index of Multiple Deprivation, which is the official measure of relative deprivation for small areas (or neighbourhoods) in England.
This allowed the researchers to establish an overall picture of the distribution of registered defibrillators in England, which revealed that the more deprived areas tended to have the lowest number of defibrillators. Only 27.4% of areas in the lowest decile of the Index of Multiple Deprivation had at least one defibrillator, compared to about 45% in the highest.
Defibrillators are more likely to be placed in areas where people are likely to work rather than residential areas. Areas with a larger proportion of the population that identified themselves from mixed and non-white ethnic background were also less likely to have a registered defibrillator.
However, because there is no legal requirement to register a defibrillator with an ambulance service, there is uncertainty around the number of unregistered ones in these communities. As 999 call operators would not know the location of the nearest defibrillator in an emergency, it means those communities will be experiencing a health inequality compared to less deprived areas.
Lead author of the study, Dr Terry Brown from Warwick Clinical Trials Unit, said: “We know that cardiac arrests occur more often in deprived areas, but registered defibrillators are more likely to be found in areas where the population is more affluent, predominantly identify as white ethnic, and with high socio-economic occupations. The question is whether this is because they’re not registered in more deprived areas, or because there aren’t any?
“We want to get more defibrillators registered. Any future programme that aims to get defibrillators out there should be targeted to the areas that need them most. In particular, they should be put in more deprived communities, and in accessible locations in residential areas given that more than 80% of out of hospital cardiac arrests happen in the home. There should be a more evidence-based distribution programme to ensure they are accessible.
“If they are registered, more easily accessible, and people had the confidence to use them, we believe there will be an improvement in survival rates from cardiac arrest.”
Many defibrillators are installed by local community groups, often as a result of fundraising efforts, or by businesses. The lifesaving benefits of community defibrillators is substantially reduced if they are not registered with ambulance services. Defibrillator guardians are being encouraged to register their defibrillators onto The Circuit, national defibrillator network. (www.thecircuit.uk).
Sue Hampshire, Director of Clinical and Service Development at Resuscitation Council UK, said: “A cardiac arrest can happen to anyone, anywhere, at any time. Not only is defibrillator use a crucial step in the Chain of Survival, the presence of defibrillators in public places can help raise awareness and stimulate people to think about what they would do in an emergency.
“The findings of this important study show that there currently unacceptable inequalities in the provision and availability of Public Access Defibrillators across the country. Out of hospital cardiac arrests are more likely to happen in the areas with neighbourhood characteristics where AED provision is currently lower. If more lives are going to be saved through CPR and defibrillation, a more evidence-based and coordinated approach to their placement is needed and we encourage community groups and other organisations to make use of guidance and existing evidence.”
Professor Melanie Davies, Director NIHR Leicester Biomedical Research Centre, said: “Evidence shows that access to public defibrillators vastly improves the chances of surviving life-threatening cardiac arrests.
“Central to NIHR’s mission is to tackle health inequalities and their wider determinants. That’s why it’s important this high quality research has cast a light on the gap in provision of defibrillators in some of the most deprived areas and in residential areas. These findings provide robust evidence in another step to help improve the quality and accessibility of health services.”
- T.P. Brown, G.D. Perkins, C.M. Smith, C.D. Deakin, R. Fothergill, Are there disparities in the location of Automated External Defibrillators in England?, Resuscitation (2021), doi: https://doi.org/10.1016/j.resuscitation.2021.10.037.
- * Data from one ambulance service was not available at time of analysis.
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Notes on defibrillators
Public Access Defibrillators (PADs) are Automated External Defibrillators that are installed for use by members of the public. They are designed so that anyone can use them on someone experiencing a cardiac arrest as the machine provides clear instructions telling the user what to do. Using a public access defibrillator alongside CPR as quickly as possible during a cardiac arrest while waiting for an ambulance to arrive significantly increases someone’s chances of survival.
To help save more lives, the BHF, RCUK, St John Ambulance and AACE urge people who look after defibrillators in places such as offices, communities, shopping centres and leisure centres, as well as in public places, to register them on a pioneering database called The Circuit: The national defibrillator network.
It’s free to register your defibrillator onto The Circuit, and you only have to do it once. You can also register multiple defibrillators if you are the guardian to more than one. Visit TheCircuit.UK for more information or to register your defibrillator.
A Guide to AEDs, published by Resuscitation Council UK in collaboration with British Heart Foundation provides information on the factors to take into consideration when thinking about where to install PADs. These include footfall, how likely it is a cardiac arrest will happen near to a location, any legal duty and the time and distance involved for the emergency services to get to a collapsed person. This research also highlights the importance of them being placed in residential areas.
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Are there disparities in the location of Automated External Defibrillators in England?
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