Automated External Defibrillator Availability, Accessibility, and Usability in High-Risk Out-of-Hospital Cardiac Arrest Neighborhoods of Birmingham, Alabama

Automated external defibrillators (AEDs) are infrequently used by laypersons in Birmingham, Alabama, yet the factors contributing to low utilization are poorly understood. We sought to assess the availability, accessibility, and usability of AEDs in Birmingham’s highest-risk out-of-hospital cardiac arrest (OHCA) neighborhoods and to compare AED density with published benchmarks.

We conducted an observational descriptive study in the three Birmingham neighborhoods previously identified as having the highest OHCA incidence. Official neighborhood boundaries were obtained as GeoJSON files and converted to KML format for mapping. All potential public AED sites, defined as properties other than single-family residences, were identified using Google Maps landmark data. Sites were contacted by phone or in person to confirm AED presence. Device-specific characteristics were assessed on site when AEDs were reported. Outcomes included AED availability (≥1 AED present), accessibility (public access and hours), and usability (ability to power on with adult and pediatric pads). Usable devices were classified as “at risk” if batteries or pads were expired. AED density (devices per square mile) was calculated and compared with the recommended benchmark of 5 AEDs per square mile.

The three neighborhoods included 3,254 residents across 2.6 square miles. Of 287 potential AED locations identified, 284 (99%) were successfully contacted. Fifty-six AEDs were reported across 44 sites; 19 (33.9%) were not publicly accessible. Among 37 publicly accessible AEDs, none were available 24 hours per day. Thirty-five devices (94.6%) were usable, while two (5.4%) failed to power on. Five devices (13.5%) were classified as at risk due to expired batteries and/or pads. The density of usable AEDs was 13.5 devices per square mile, approximately 2.5 times the recommended benchmark.

Despite AED density exceeding recommended levels by more than twofold, substantial barriers to utilization persist in Birmingham, including limited public access and inadequate device maintenance. A comprehensive public access defibrillation program emphasizing improved accessibility, routine maintenance, and community education is needed to enhance AED use and OHCA outcomes.