Optimising the emergency-readiness of public access defibrillators across Wales using quality improvement methodology.
BMJ open quality · 2026-04-10 · Implementation & quality improvement
Abstract
Early bystander cardiopulmonary resuscitation and use of automated external defibrillators (AEDs) have been shown to significantly improve survival from out-of-hospital cardiac arrest (OHCA). Public access to AEDs, also known as public access defibrillators (PADs), is hence a critical component for successful emergency bystander intervention.Wales currently has over 8000 PADs registered on a UK-wide defibrillator network-'The Circuit' supported by the British Heart Foundation. This enables emergency services to direct people to the nearest emergency-ready PAD when an OHCA occurs. However, not all PADs are on The Circuit as registration is not mandated, and maintaining PAD fleets in emergency-ready status represents a substantial challenge. Limited research exists regarding the veracity of operational status of PADs in real-world settings, or initiatives which increase numbers of available emergency-ready PADs.This national quality improvement (QI) project assessed the introduction, spread and scale across Wales of an innovative role, Community Coordinators, funded by Welsh Government through the Save a Life Cymru programme. The project aimed to increase the emergency-ready status of the Welsh PAD fleet by 5% from a baseline of 89% by June 2024. Data from The Circuit supported establishment of baseline measures and ongoing data analytics during the study period (August 2022-July 2024).The introduction of Community Coordinators increased the proportion of Wales' emergency-ready PADs from 0.89 to 0.94. Process measures indicated firstly, an increase in registered PADs in Wales from 6415 to 8638. Secondly, the proportion of PADs registered with a PAD Guardian on The Circuit increased from 0.73 to 0.89.This QI project demonstrated that the problem of PAD non-readiness is complex, multifactorial and dynamic. Networked Community Coordinators to support volunteer PAD Guardians increased the emergency-ready status of the all-Wales defibrillator fleet. This innovative Welsh model could benefit wider UK and international communities.