Public awareness of automated external defibrillator (AED)s and their location: Results of a cross-sectional survey in North Carolina

Bystander defibrillation, a key step in improving survival rates in out-of-hospital cardiac arrest, relies on public awareness and action.1, 2 However, public understanding of automated external defibrillator (AED) use, willingness to act, and knowledge of AED locations remain underexplored in the U.S.³ This study evaluated public knowledge and preparedness to use AEDs in urban North Carolina, identifying gaps in awareness, proficiency, and willingness.

Between March and May 2024, we conducted a cross-sectional survey with 94 eligible participants across eight high-traffic locations identified using publicly and locally available AED registries (Table 1). All locations had an AED within 275 m. This study used a 14-item survey to assess AED knowledge, cardiopulmonary resuscitation (CPR) training, and willingness to use AEDs. The survey was pre-tested with a small convenience sample. Surveys were conducted face-to-face with adults in public settings and recorded electronically using REDCap. This study was powered to provide a 95% confidence interval with a ± 10% margin of error for primary outcomes. Ethical approval was obtained from Duke University’s Institutional Review Board.

Table 1.

Patient demographics.

Characteristic	Responders n = 94
Age categories n (%)
18–24	18 (19.2)
25–34	21 (22.3)
35–44	13 (13.8)
45–54	15 (16.0)
55–64	12 (12.8)
65 or over	15 (16.0)
Sex n (%)
Male	54 (57.4)
Female	40 (42.6)
Race n (%)
White	40 (42.6)
Black	40 (42.6)
Hispanic	5 (5.3)
Asian	9 (9.6)
Native Hawaiian or Other Pacific Islander	0 (0.0)
Highest degree or level of school completed n (%)
Less than a high school	5 (5.3)
High school graduate or equivalent (e.g., GED)	20 (21.3)
Some college/associate degree	18 (19.2)
Bachelor's degree	33 (35.1)
Advanced degree	15 (16.0)
Trade/technical/vocational training	3 (3.2)
Work/has worked as a nurse, doctor, EMT or paramedic n (%)
Yes	7 (7.4)
Have you ever received CPR instruction or training n (%)
Yes	64 (68.1)

Our findings reveal both promising findings and critical gaps. While 69% of participants (95% CI: 59%–78%) were familiar with AEDs, only 23% (95% CI: 16%–33%) knew how to use one, and 19% (95% CI: 13%–28%) could locate the nearest AED. Encouragingly, 83% (95% CI: 74%–89%) expressed a willingness to use an AED in an emergency, suggesting the primary barrier is knowledge, not willingness. Awareness of the Good Samaritan Law was low (27%), underscoring the need for education on liability protections. Participants with prior CPR training were more likely to know what an AED was (75% vs. 57%), how to use it (31% vs. 7%), and where to locate one (23% vs. 10%), although the 95% confidence intervals for these estimates overlapped.

Regional differences in AED awareness may reflect varying public health initiatives. For example, a national survey in Australia reported AED awareness at 84%, higher than the 69% observed in our study.⁴ Our survey assessed general awareness and spatial familiarity, identifying gaps that could be addressed through targeted education.

These findings highlight opportunities to optimize public access defibrillation programs. Poor signage, inaccessible AED placement, and limited training hinder effective use, even among willing bystanders.5, 6, 7 Addressing these barriers requires targeted interventions such as placing AEDs in visible, outdoor locations; improving signage; and linking AED registry locations with emergency dispatch systems. Expanding CPR and AED education, particularly through school-based train-the-trainer programs, could ensure lasting community impact.⁸

While our study has limitations, including its small sample size, urban focus, and reliance on self-reported data, which may overestimate actual willingness to act in emergencies, these findings offer actionable insights. The non-random selection of high-traffic sites may limit generalizability but highlights critical gaps that can guide interventions in similar urban areas.

Our findings suggest that interventions are needed to improve AED knowledge and location awareness. Enhancing visibility, accessibility, and integration with dispatch systems could strengthen public awareness and response. Targeted resource allocation should address these gaps while considering the study’s limitations.

Declaration of interest

Dr. Yonis reports receiving a grant from TrygFonden.

Dr. Nouhravesh reports receiving speaker fees from Bayer A/S and AstraZeneca.

Dr. Mark reports grant support from HeartFlow, Inc. during the conduct of this study; grant support from Merck and Novo Nordisk; grants or research support from NIH/NHLBI and the American Heart Association; consulting fees from CeleCor, Novartis, and Boehringer Ingelheim; and honoraria from Elsevier.

Dr. Blewer receives grant funding from the NIH, the American Heart Association, and the Laerdal Foundation. Dr. Blewer also receives in-kind support from the American Heart Association and WorldPoint.

Dr. Hansen reports grants from TrygFonden, Helsefonden, the Novo Nordisk Foundation, the Independent Research Fund Denmark, and the Capital Region of Denmark Research Fund.

Dr. Kragholm reports research grants from the Novo Nordisk Foundation and the Laerdal Foundation.

Dr. Torp-Pedersen has received grants from Novo Nordisk and Bayer outside of the current study.

Dr. Starks reports grant funding from the American Heart Association (HERN Grant-23HERNPRH1150361) and the National Institutes of Health/National Heart, Lung, and Blood Institute (1K23HL153889-05).

Dr. Krychtiuk reports receiving speaker fees from Daiichi Sankyo, Amarin and Zoll Medical; consulting fees from Amarin, Novartis, and Sanofi; and travel support from Daiichi Sankyo, Amgen and Sanofi.

Dr. Granger reports receiving personal fees and grants from Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Pfizer, Janssen, Bayer, AbbVie, Abiomed, Alnylam, Cardionomic, CeleCor Therapeutics, HingRui, Medscape, Medtronic, Merck, Novo Nordisk, Novartis, PLX Pharma, REATA, NephroSynergy, and Boston Scientific.

All other authors declare no financial conflicts of interest.

CRediT authorship contribution statement

Harman Yonis: Conceptualization, Investigation, Methodology, Writing – review & editing, Data curation, Project administration, Visualization, Writing – original draft. Lisa A. Kaltenbach: Formal analysis, Methodology, Writing – review & editing. Nina Nouhravesh: Data curation, Methodology, Writing – review & editing. Daniel Mark: Methodology, Writing – review & editing. Audrey L. Blewer: Methodology, Writing – review & editing. Carolina Malta Hansen: Methodology, Writing – review & editing. Kristian Kragholm: Methodology, Writing – review & editing. Christian Torp-Pedersen: Methodology, Writing – review & editing. Monique A. Starks: Methodology, Writing – review & editing. Sana M. Al-Khatib: Methodology, Writing – review & editing. Lisa Monk: Methodology, Writing – review & editing. James Jollis: Methodology, Writing – review & editing. Comilla Sasson: Methodology, Writing – review & editing. Konstantin A. Krychtiuk: Methodology, Supervision, Writing – review & editing. Christopher B. Granger: Conceptualization, Investigation, Methodology, Supervision, Writing – review & editing.

Funding

The study is funded by a grant awarded to the RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) Trial. NIH/NHLBI: 5UH3HL146935-03; and 1U24HL146938-03.

ClinicalTrials.gov Identifier: NCT04660526.

Trial Website: https://racecarstrial.org.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.