Do AEDs go to bed? The Circadian Dilemma

The town of Benfleet, home to Sudden Cardiac Arrest UK, on the Essex Riviera, is perhaps not the first place one would expect to find a nexus of cutting-edge medical debate. Yet, like many towns and cities across the UK, it grapples with a quiet but pressing concern: the accessibility of automated external defibrillators (AEDs). These unassuming devices, often found hanging on the walls of community centres, gyms, and train stations, hold the potential to be life savers during sudden cardiac arrests (SCA). However, what happens when these facilities close their doors for the night?

Do the AEDs, in a manner of speaking, go to bed?

A recent study from Italy, submitted to the journal Resuscitation, raises precisely this question, highlighting a “circadian dilemma” in public access defibrillation (PAD). The article, penned by a team including Guglielmo Imbriaco and ERC Chair Federico Semeraro, explores the availability of AEDs in the Italian cities of Bologna and Cuneo.

What they found is stark: while AEDs are vital for the management of out-of-hospital cardiac arrest (OHCA), their accessibility often plummets outside of regular working hours, with up to a 60% decrease during nighttime and weekends. This means that a device meant to be a readily available lifeline is often out of reach when emergencies strike outside typical work hours.

The UK Perspective

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The implications of this study resonate deeply within the UK, where similar patterns of AED availability likely exist. Many of the 4000+ members of Sudden Cardiac Arrest UK understand only too well that speed in accessing an AED can be the difference between life and death.

A person suffering from SCA requires immediate action, ideally CPR and defibrillation, within the first few minutes. However, precious time is lost if the nearest AED is locked away behind the closed doors of an office or school.

The Italian study’s findings illustrate a reality that is surely not unique to Italy.

The authors found that only 24% and 19% of AEDs in the city centres of Bologna and Cuneo, respectively, were available 24/7. This is because many AEDs are located in buildings that are not always open. As the article points out, the loss in AED coverage can reach 34.2% during evening hours and 42.3% during the night, and these numbers rise to 42.1% and 50.9% on weekends. The benefits of a rapid AED response are disproportionately reduced during night hours, as the facilities that house them—schools, offices, and community centres—are usually closed. This creates an uneven distribution of cardiac arrest care with time of day, and therefore who benefits from access to care.

Solutions for UK Towns and Cities

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The question is how UK boroughs, towns and cities, like Benfleet, or larger urban areas such as Manchester and Birmingham, address this discrepancy. The Italian research proposes a few potential solutions which are directly applicable to a UK context:

  • Outdoor Deployment: One of the most effective ways to improve AED accessibility is to move them outside. The article suggests using weather-resistant AED cabinets that can be placed in public areas, making them available 24/7. The cost, typically around £400–500, makes it a reasonable option. These cabinets should also have security features, including lighting, alarms, and potentially video monitoring. This cost-effective approach ensures that the device is visible and that people know where to find an AED if needed.
  • Strategic Placement: Placing AEDs in locations that operate 24/7, such as transport hubs, is another strategy for widening accessibility. Train and bus stations, petrol stations, and even some supermarkets that are open late could all be ideal locations. It’s all about thinking about how the public moves and the hours of the day they move. It is essential to identify those areas of the city or town where an AED would be most helpful and ensure they are placed in those areas.
  • Reliable Information: It is also crucial to have reliable data on AED locations and their accessibility times, for example the Circuit. This means keeping up to date, ideally, using an app or website where members of the public and emergency services can find their nearest device and know that it is available.
  • Community Awareness: An AED located outdoors is more visible and increases public awareness of its location. When it is indoors in a specific location, community members are often unaware of its presence.

A Coordinated Effort

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The Italian study emphasizes that a legislative and societal commitment to public access defibrillation is necessary to ensure that no one suffering from OHCA is disadvantaged due to the time of day. This may mean looking at how local and national policies are structured around AED placement and availability in the UK context. It might also mean having more discussions with communities and working closely with groups like The Chain of Survival UK, the SCAUK-run group for those involved with or who have witnessed a resuscitation attempt. This includes those close family who may not have been present at the scene but will be involved in the recovery stage. A joined-up approach is essential.

While the risk of vandalism or theft of outdoor AEDs is a genuine concern, the Italian study also points out how this can be mitigated. GPS tracking capabilities may help prevent the theft of an AED, and insurance can cover the cost of any damage that may occur.

The Importance of 24/7 Availability

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Photo by Steve Johnson on Pexels.com

While specifically focused on Italy, the study offers a crucial perspective for the UK. It highlights that we cannot afford to be complacent about AED availability. For effective public access to defibrillation, accessibility needs to be a 24/7 commitment. It is not enough to have AEDs in cities; we must ensure they are available and accessible. When the sun goes down, the need for accessible AEDs does not. As the authors state, “Tackling the nighttime and holiday gap in AED accessibility is an urgent public health priority”.

Ultimately, the aim is that no one in Benfleet, or anywhere else in the UK, should face a cardiac arrest and be unable to access a potentially life-saving AED. These devices shouldn’t be “going to bed” when they’re most needed; they must be readily available, day and night. That’s a challenge we all have a role to address.

1 thought on “Do AEDs go to bed? The Circadian Dilemma”

  1. Thought-provoking, Paul. Just down the road from you, in Southend, the Council has defibs locked in several buildings. No public access after-hours – which is a shame. I did compile a list of them all 3 years ago. I’ll use this article to lobby again for more AEDs to be on the outside walls of buildings.

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