Evidence map›Paper›PMID 41827040›Full record

ArticleScandinavian journal of trauma, resuscitation and emergency medicine2026

Barriers and enablers to public access defibrillation - an international RAND-UCLA consensus study.

K C Thies, C Metelmann, B Metelmann, T Marks, T Scquizzato, C D Deakin, R Greif, E Baldi, T Barry, B W Böttiger and 34 more

Abstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

44 authors.

K C ThiesDepartment of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, University of Bielefeld, EvKB University Hospital of Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33167, Bielefeld, Germany. Karl.Thies@evkb.de.
C MetelmannDepartment of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany.
B MetelmannDepartment of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany.
T MarksDepartment of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany.
T ScquizzatoDepartment of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
C D DeakinUniversity Hospital Southampton, Southampton UK & South Central Ambulance Service, Otterbourne, UK.
R GreifFaculty of Medicine, University of Bern, Bern, Switzerland.
E BaldiDivision of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
T BarryUCD School of Medicine, University College Dublin, Dublin, Ireland.
B W BöttigerFaculty of Medicine, and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.
J BrayMonash School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
H J BuschDepartment of Emergency Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
M L CaputoCardiocentro Ticino Institute-Ente Ospedaliero Cantonale, Lugano, Switzerland.
S CheskesDepartment of Emergency Medicine, Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
R CrestaTicino Cuore Foundation, Lugano, Switzerland.
E DegraeuweDepartment of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
A A DoshiDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
M M EkkelAmsterdam UMC Location AMC, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.
D ElschenbroichCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
D FredmanHeartrunner Citizen Responder System, Heartrunner Sweden AB, Solna, Sweden.
L GamberiniEmergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
J GanterDepartment of Anaesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
F L HenriksenDepartment of Cardiology, Odense University Hospital, Odense, Denmark.
C J JagtenbergSchool of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
M KhalemskyDepartment of Management, Jerusalem Multidisciplinary College, Jerusalem, Israel.
T A KooyStan, Citizen Responder Network HartslagNu, Elburg, Netherlands.
K G MonsieursAntwerp University Hospital and University of Antwerp, Edegem, Belgium.
E MoensGhent University, Ghent, Belgium.
W M NgDepartment of Emergency Medicine, Ng Teng Fong General Hospital, Jurong East, Singapore.
J S PoothDepartment of Emergency Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
S PrasseMobile Retter E.V, Köln, Germany.
D D SalcidoDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
A ScapigliatiCardiac Anesthesia and Postoperative ICU, Fondazione Policlinico A.Gemelli, IRCCS. Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy.
S SchnaubeltEmergency Medical Service Vienna, Vienna, Austria.
S S ScholzDepartment of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, University of Bielefeld, EvKB University Hospital of Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33167, Bielefeld, Germany.
P ShahriariEmergency Medical Services, Capital Region of Denmark, Ballerup, Copenhagen, Denmark.
P SnobelenPeel Regional Paramedic Services, Mississauga, ON, Canada.
R StieglisAmsterdam UMC Location AMC, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.
B StrickmannEmergency Medical Service, District of Gütersloh (Kreis Gütersloh), Gütersloh, Germany.
H L TanDepartment of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
G TrummerDepartment of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen`, Medical Faculty - University of Freiburg, Freiburg, Germany.
S VercammenEVapp NGO, Ghent, Belgium.
W A WetschFaculty of Medicine, and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.
M P MüllerDepartment of Anaesthesiology, Intensive Care, and Emergency Medicine, St. Josefs Hospital Freiburg, Freiburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundImmediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research.

methodsDuring the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range.

resultsAll nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs.

conclusionThis international consensus study underscores the need for coordinated policy, robust AED registries, widespread training and multi-tier response models to improve PAD implementation. The identified priorities and innovative deployment strategies offer an agenda for future system development.

Indexed as

Cardiopulmonary ResuscitationDefibrillatorsElectric CountershockEmergency Medical ServicesHealth Services AccessibilityOut-of-Hospital Cardiac ArrestHumansAutomated external defibrillatorsBystander interventionCardiopulmonary resuscitationDefibrillationEmergency medical servicesOut-of-hospital cardiac arrestPublic access defibrillationSurvival rate

Identifiers

PMID41827040
PMCPMC13063452

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.