AED Mapping
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& Emergency Response

TITLE OF THE DOCUMENT

Why is AED mapping crucial
and how can it help
increase the survival rate ofvictims of out-of-hospital
cardiac arrests?

AED Mapping & Emergency Response

Version: 2.0

EENA

Publication date 14/03/2023

European Emergency Number Association
EENA 112

Status of the document: FINAL

Avenue de la Toison d’Or 79, Brussels, Belgium
T: +32/2.534.97.89
E-mail: info@eena.org

Authors that contributed
to this document:This document was written
by members of EENA

AuthorsJérome PARIS (EENA)
Fulvio KETTE (Local Health
Unit, Friuli Occidentale, Italy)
Cristina LUMBRERAS (EENA)
Stephen HINES (London
Ambulance Service, UK)
Demetrios PYRROS (EENA)
Paweł DABROWA (Fire andRescue Unit, Poland)Alexis GIZIKIS (EENA)LEGAL DISCLAIMER:

This document is authored by EENA staff members with
contributions from individual members of EENA andrepresents the views of EENA. This document does not
represent the views of individual members of EENA, or
any other parties.
This document is published for information purposes
only and it does not declare to be a statement orinterpretation of EU law or the national law of EU
Member States. This document is entirely without
prejudice to the views of relevant national statutory
authorities and their legal functions and powers,
whether under EU law or the national law of their
Member State. Accordingly, under no circumstances
may reliance be placed upon this document by any
parties in compliance or otherwise with any applicablelaws. Neither may reliance be placed upon thisdocument in relation to the suitability or functionality of
any technical specifications, or any other matters
discussed in it. Legal advice, technical advice and otheradvice as relevant, may be sought as necessary.

EXECUTIVE SUMMARY ................................................................................................................................................ 4
1 | Introduction .......................................................................................................................................................... 5
2 | What is an AED & how can it increase survival from cardiac arrest? ..................................................................... 6
3 | Ownership & Maintenance ................................................................................................................................... 7
4 | Use of an AED and legislation ................................................................................................................................ 7
5 | Why an AED mapping? .......................................................................................................................................... 8
6 | How can AED mapping be implemented? ............................................................................................................. 8
7 | Implementation Caveats & Pre-requisites ............................................................................................................. 9Technical caveats .................................................................................................... 9
Organisation, information and communication caveats ................................................. 9
8 | Examples of AED maps in Europe .........................................................................................................................11
9 | Recommendations ...............................................................................................................................................12
Emergency Services .............................................................................................. 12
Public authorities ................................................................................................... 12
AED Mapping Companies / Apps .............................................................................. 13
AED Owners ......................................................................................................... 13
AED Manufacturers ................................................................................................ 13
REFERENCES ..............................................................................................................................................................13
Appendix: AED registration form ...............................................................................................................................15

3

EXECUTIVE SUMMARY
Sudden cardiac arrest is a leading
cause of death in the EU. The chancesof survival are low, and they decrease
rapidly in the absence of any
intervention. Early CPR and the use of
an AED can increase the survival rate.
The location of the AED nearest to theincident is needed to enable early use.
Some emergency services use AED
mapping to locate the closest AED to a
cardiac arrest incident so that people onsite
can start the rescue operation until
emergency services arrive. This document
highlights why AED mapping is crucial andhow it can help increase the survival rate ofvictims of out-of-hospital cardiac arrests. It
explains the challenges behind theimplementation, the maintenance of such atool and demonstrates good practices.

AED Mapping: An easily andpublicly accessible digital map orregistry providing information on
the location of AEDs nearest to apoint of interest taking into accountthe avaialbility of the device at
specific times.

Acronyms

AED

Automated External Defibrillator

AHA

American Heart Association

BLSD

Basic Life Support and Defibrillation

CA

Cardiac Arrest

CC

Chest Compression

CPR

Cardio Pulmonary Resuscitation

EDC

Emergency Dispatch Center

EMS

Emergency Medical Service

ERC

European Resuscitation Council

PSAP

Public Safety Answering Point

VF

Ventricular Fibrillation

The document is a revision of the
EENA document on AED mapping,first published on 4 May 2018. Thisversion has been enriched withmore
recentinformation
andupdates.

4

Survival rates decrease 10% aminute without CPR & AED use
1 | Introduction
Cardiac arrest is the sudden cessationof the spontaneous heart activity
leading to failure of blood, andtherefore oxygen, transport to allorgans and tissues. The predominant
underlying cause in adult population is theischemic coronary artery disease. The
partial or total obstruction of the coronary
arteries leads to an increased susceptibilityof the ischemic areas predisposing to thedevelopment of ventricular fibrillation (1).
The development of the electrical disorder(uncoordinated heart activity) causes the
cessation of the mechanical pump function.
An immediate restoration of an artificial
circulation through particularly
uninterrupted chest compression (CC) (2) ismandatory as survival dramaticallydecreases by approximately 10% for
every minute elapsed in the absence of
any intervention (3,4). Chest
compression alone, however, does notconvert VF into a pulsatile rhythm as only
an electrical defibrillation can interrupt themalignant arrhythmia.
Early chest compression and early
defibrillation have proven to be highly
effective in favoring the restoration ofcardiac and, in turn, of neurological
functions (5). Successful rates rose up
to 65% when lay people could begin
the initial Cardio Pulmonary
Resuscitation (CPR) maneuvers
together with an early defibrillation by
an Automatic External Defibrillator(AED) (6,7). These results prompted the
diffusion of these devices in many public

locations to allow anyone to defibrillateeven before the arrival of the ambulance orof the experienced emergency teams (8,9).
So far the overall proportion of cardiac
arrest victims treated by lay people
with both interventions (early CC andearly defibrillation) is less than 5%,
being the greatest proportion ofinterventions still performed by emergency
crews (3, 6-8, 10, 11). Recently, however,
The Resuscitation Outcomes Consortium
investigators showed a much higher
proportion of cardiac arrest victims
defibrillated by lay people (18.8% of theshockable rhythms), leading, in turn, to a
proportion of 66.5% of discharged alive
patients vs 43% of the group defibrillatedby the EMS personnel (12).
The AED diffusion is now favoured by large
information campaigns which prompted theacquisition of thousands of AEDs by either
individuals, authorities, companies or
associations (10-15). However, an AED
unknown to the local Emergency
Dispatch Center is a useless resourceas the dispatcher cannot activate iteven in case of a cardiac arrest in a
vicinity of a nearby AED (14). Indeed,
there is evidence that AEDs are still
infrequently used and that many of them
are unknown to the local EMS (16,17).
All representative members of EENA
and of the European countries
pinpointed the necessity to provide an
AED mapping to the Emergency
Dispatch Centers.

5

Defibrillation aims to interrupt
dangerous cardiac arrythmia
2 | What is an AED & how can it increase survival
from cardiac arrest?
An AED is a small portable device(approximately 20 x 20 x 7 cm) that can
automatically analyse the underlying
rhythm in a victim of suspected cardiac
arrest and determine if it is needed to givea high energy electric shock to the heart ofthe victim. This shock is called defibrillationand the AED can automatically determine if
defibrillation is required and deliver it to thevictim's heart. This feature relieves the lay
rescuer from choosing whether or not to
defibrillate, as they have the unique task ofguaranteeing the safety of the scene bypreventing anyone from touching thepatient while the defibrillator is operating.

having ascertained a real CA, as any delay
may compromise the restoration of the
cardiac (and ultimately neurological)
function.

The aim of the defibrillation is tointerrupt ventricular fibrillation, whichis the most dangerous cardiac
arrhythmia. Although the ultimate goal is
the return of a spontaneous cardiac
activity, the shock alone rarely converts VF
into a viable perfusing rhythm unless thetime interval between the collapse and thedefibrillation is very short (no more than 30-60 seconds). In most events of cardiac
arrest, it is the combination of both
early external chest compression andearly defibrillation that increases
survival. Accordingly, the Emergency
Dispatch Centres (EDC) must have a clear
overview on the AED location to favour
their early arrival to the scene.

In addition to delivering defibrillation, more
recent AED models have locations andconnectivity capabilities. Wi-Fi andmobile network data connectivity allow thedevice to communicate data such as its
status, battery capacity, call emergency
services or transmit cardiac arrest data to
medical professionals. Some AEDs also
have location capabilities enabling thedevice to precisely estimate its location.
Connectivity and location capabilities canprovide real-time data to an AED registry or
map and help overcome the challenge of
maintaining an up-to-date registry. For
example, if a device is out of order or has
been recently used, it could transmit its
status to the registry and be excluded fromnearby AED searches.

An issue that EENA is pursuing is thegoal that anyone should be allowed totake an AED and to apply the paddles
on the chest: the AED vocal prompts andthe dispatchers’ instructions are sufficient
to allow a correct use of the device. EENA
has published a document on “AED
Legislation”, describinf the legislation, rules
and recommendations regardin AED use in
22 countries (21).

It is important to look for an AED in every
instance of suspected CA and not only after

6

The combination of both early CPR and early
defibrillation can significantly increase survival.

3 | Ownership & MaintenanceAnyone can buy an AED. There is a wide availability of Automated Defibrillators on the market
and all possess the requirements of delivering energy of 150J for truncated exponential
waveform and 120J for rectilinear by-phasic waveform. There are, conversely, differences
concerning the peak current, the average current, the duration of the first and second phase as
each company developed its own software and algorithm (18).
AEDs can be deployed by the owners or others who receive the good from the owners(custodians). It is important to emphasise that the maintenance belongs to thecustodian, who has the task of guaranteeing that the device is fully operating. Device
manufacturers should specify the maintenance procedures and plan, including visual inspection,
checking the expiry date of electrodes, battery checks, replacing batteries or electrodes whenneeded and that all necessary secondary supplies are available, for example, razors, gloves,scissors, rescue masks, etc. Future development could favour private companies with whom anagreement of maintenance service on behalf of the local authorities could be activated.

4 | Use of an AED and legislation
Automatic External Defibrillators are designed to be usedby anyone without needing any prior training. When abystander turns on the AED, the device gives clear
instructions on how to apply the two adhesive jelly pads tothe chest of the unconscious victim. The device checks theheart rhythm and determines if a shock is needed.
The vocal prompts of the device ensure its correct use,which is also usually guided by the dispatchers who will
instruct the users on their proper deployment. The
European Resuscitation Council Guidelines (22) suggest
training as many citizens as possible, including school
children.
European countries have different ways of handling AEDs
use (20). National legislations vary from the absence ofrestrictions to strict regulations establishing that only those
who successfully accomplished a Basic Life Support andDefibrilation (BLSD) course can use an AED. EENA
advocates that the use of AEDs should be allowed in thelegislation and authorities should strive to train people in
CPR and defibrillation.

Europeancountries
have
different
ways ofhandling
publicAEDs…
7

In 2019, EENA published a document reviewing relevant
legislation related to using AEDs in different countries (21).

5 | Why an AED mapping?
The most important information the owner should know is the necessity to provide the data of
the purchased AED to the local dispatch centre such as to feed the database of AEDs. This
database should be continuously updated and the emergency service should be aware of the
precise location of the device and of its accessibility. The mapping system thus works byproviding to the dispatchers (and/or to the local Emergency Service) the exact
location of the Automated External Defibrillator spread on the territory and by
concurrently highlighting additional paramount information such as their accessibility,
the daily availability, the battery and paddle conditions. In addition, the software handling
the AED mapping should also allow the recruitment of the volunteers who could perform not only
the first resuscitation maneuvers (chest compression and/or artificial ventilation) but could also
use an AED.
AED mapping can then expectedly promote an increased survival rate from cardiac arrest thanks
to the activation of the closest and accessible AED by the operators of the Emergency Dispatch
Centers who could quickly indicate to the callers their location and by concurrently providing the
CPR with the pre-arrival instructions (telephone guided CPR).
Also by knowing the location of mobile AEDs such as those assigned to police cars, firefighters, taxi drivers, Coast Guard boats, and any other vehicle, the likelihood of early arrivalof a defibrillator to the scene may be further increased (19).

6 | How can AED mapping be implemented?
Pre-requisite is the definition of the items to be requested to the AED owner/users to create a
database. The dataset could be constituted as described in the appendix. These forms should betransmitted or made available in a website and downloaded by anyone who has an AED (owneror custodian). The information filled and returned to the dispatch center would feed the
database. Then the data have to appear on a screen map where the AED icons will be highlighted
indicating their precise location and accessibiity.

8

Caveats & pre-requisites toconsider for mapping AEDs…
7 | Implementation Caveats & Pre-requisite
There are some caveats and pre-requisitesthat need to be considered when looking to
the implementation of an AED Mapping.
Some of them result more from a technicalperspective, some of them are more
operationally driven

Technical caveats
Integration with the EDC software: The
software has to be structured so as not tointerfere with the software used to receive
the emergency calls and to activate theemergency means.
Information highlighted: It has to provide
information regarding the AED location in
the shortest time possible.
The software deployed for AED mapping has
to provide information about the status of
the AEDs and of the batteries and paddles.

Organisation, information andcommunication caveats
Protocol and operative instructions:
EDCs must have a detailed protocol whereby
each operator can decide when and how to
guide the caller as quickly as possible. The
protocol must carefully describe thesuggested ways to provide the AED location
information (the path, distance and time toreach the AED) to the person who can get
the device and should also consider ways toprovide links to navigation apps. The EDC
staff must precisely indicate the AED
location, as seconds are crucial to ensure its
arrival to the patient as quickly as possible.
Awareness: Public authorities, population,
political institutions, associations, sportsocieties and any other AED owners/users
have to be aware and informed about theimportance of providing the AED related
information to the dispatch centers. Indeed
each one can be active part of an emergency
process and can help to save a life. The
major concerns are related to medical andlegal issues which, so far, seem to be themajor limitation hampering the availability of
the information to the dispatch centers. As
some owners could not keep in mind theexpiration of the batteries and paddles, thesoftware should automatically warn of the
expiration date. Services should be set up toprovide assistance for the replacement of
the expiring materials.
Label and visibility: Although the AEDs arecommonly identified by a green label withthe text “AED” (according to the languages),
it is important to share a common decisionof the kind of label (i.e. the term “AED”
should always be written and the acronyms
in the own language should also appear tofacilitate the comprehension to the nonEnglish speaking people).
Gold standard or minimum acceptable
criteria: To facilitate the wide spreaddiffusion of the AEDs and their recognition,
EENA proposes to achieve a minimum
standard based on the presence of a system
within the EDCs able to indicate to the callers
the closest and accessible AED.
Data acquisition and analysis: The
organisation responsible for an AED registry
should provide a facility for AED owners toprovide device data to the registry. The AED
registry can provide data for subsequent
analysis for collecting insights on how to
improve its use, including assessments of
AED positioning in comparison to past
9

AED Map updates is one of thebiggest challenges currently
locations of OHCAs and in an attempt toidentify geographical areas that require an
increase of AED availability.
Keeping AED registries up to date:
Keeping the data up to date is one of thebiggest challenges in AED mapping.
Relevant authorities should define clear
procedures for registry updates, including
descriptions of how AED owners should
update the AED registry. The increasing
availability of AEDs with connectivity
capabilities that can remotely update an AED
registry about their status without humanintervention will
reduce the current
difficulties in keeping information up to date.
Whenmanualupdatesareneeded,authorities should consider evaluating
practices already successfully implemented
in some countries. These practices differ intheir approach and three approaches havebeen identified so far:programmes. Citizen responders provide aneffective way to increase CPR and AED use
and help resolve an operational issue during
the emergency call.
The
European
Resuscitation
Council
Guidelines suggest CPR as a top priority in
OHCA, followed by the use of AED.
Emergency services staff have reported that
it is not always possible to use an AED, even
if one is nearby. The priority of the call-taker
is to provide verbal CPR guidance during the
emergency call. It is only sometimes
possible to inform bystander about thenearest AED without interrupting the CPR
guidance. Notifying the volunteers in thevicinity of the incident is the most effective
way to maintain CPR guidance while a citizen
responder fetches an AED.
EENA has published the document “Citizen
response to cardiac arrest” (23) withinformation about these programmes.

1. campaigns to have the registry
updated by the public, who can win a
prize for their contributions
2. frequent reminders to owners/people
responsible for validating/updating
the information previously provided
to the registry
3. regular inspections to make sure thatthe information provided in theregistry is accurate
The procedures can extend to define theconditions for deleting data from theregistry, after a certain number of failed
update notifications or after a certain timewith no updates.
Need to develop a citizen responder
programme: Citizen responders show
excellent potential to increase the use of
AEDs in out-of-hospital cardiac arrests. The
European Resuscitation Council Guidelines(22) suggest setting up citizen responder10At least 14 countries in Europe
have AED maps
8 | Examples of AED maps in Europe
The table below provides a non-exhaustive list of the online AED registries and maps in Europe.
To view a demonstration of some examples of good practice in the implementation of the AEDmaps, please view the webinar “Findings of the ‘Galileo for AEDs’ project” and the presentation
on “Best practices in AED mapping”. Other countries that may have smartphone apps thatprovide similar information are not listed in the table.

Country

URL

Austria

https://definetzwerk.at

Belgiumhttps://www.monrythmecardiaque.be/defibrilator.php

Croatia

https://www.hzhm.hr/en/aed-device-network-in-roc

Czechia

https://www.zachrankaapp.cz/cs/aed

Denmarkhttps://hjertestarter.dk/find-hjertestartere/find-hjertestartere

Finlandhttps://defi.fi/?lang=en

Germany

http://definetz.online/defikataster-hp

Greecehttps://kidssavelives.gr/aed/

Ireland

http://cfr.ie/maps/

Luxembourg

https://www.reagis.lu/#!/reperage

Netherlands

https://hartslagnu.nl

Norwayhttps://www.113.no/hjertestarterregisteret

Swedenhttps://www.hjartstartarregistret.se/

United Kingdom

https://www.thecircuit.uk

11

9 | Recommendations
Many of the recommendations listed below
are outcomes of the EENA Members
Workshop 2017, which contained a session
about
AED
Mapping.
These
initialrecommendations have been extended by
EENA’s activities in AED mapping since 2017.

• Develop a programme on how to feeddata to the AED map and how to keep thedata up to date

Emergency Services• Make sure that anyone is allowed to use
AEDs

AED location:• Provide data to public authorities on
locations with relatively high incidences ofcardiac arrests (based on figures they
have and/or thanks to mathematicalmodels that can be used to optimise theplacement of AEDs)
Caller location:• Make sure to have the most accurate
caller location as possible (so that theclosest accessible AED can be located andused)
Use of AED:

• Develop protocols on when and how
emergency call-takers should provide thelocationofthenearestAED
tocitizens/callers, while maintaining theprovision of CPR guidance verbally• Build a communityofvolunteers(citizen/community responders) able toreach very quickly the scene of incident
and knowing how to perform CPR and how
to use an AED.
AED map:• Integration of AED mapping in the
GIS/CAD or Access to cloud based AED
map• Make the AED map is publicly available

Public authorities
Legislation:

AED provision:• Make AED provision mandatory in public
locations, both in highly populated as wellas in remote isolated areas• Clarify who pays what (e.g. battery when
AED has been used)
AED location:• Define guidelines on how to optimize AED
placement, based on emergency services
data related to cardiac arrests locations
and/or based on mathematical models• Create and maintain a public database
where AED owners and emergency
services can share the location of AEDs
• MakeprovisionofAED
location
information into a public databasemandatory for AED owners
AED maintenance:• Make sure AED owners keep emergency
services informed on availability of their
AEDs and their good functioning• Future development of AED maintenancecould involve private companies who
could be responsible of a free-of-charge
service on behalf of Authorities and/or of
the owners
Use of AED:

12• Promote the ability for anyone to learn
CPR and experience the use of an AED

AED Mapping Companies / Apps
Sourcing:• Provide reliable AED mapping, accurate
AED location, and accurate routing to thenearest AED• Allow emergency services to provide data
to the map
Supervision:• Provide a mapping (location, AED
working) that is always up to date(reliability)• Make the map dynamic so thatemergency services can update the map
when AED has been used or an AED is
missing

AED Owners• Make sure their AEDs are always
operational and current• Keep the AED registry informed on when
their AEDs are available• Keep the AED registry informed on thegood functioning of their AED

AED Manufacturers
AED maintenance:• Define
clear
guidelines
forthemaintenance of AEDs
• Location:• All new AEDs to be able to geo-locate
themselves and share their location with
onlinedatabases
accessiblebyemergency services
Supervision:• AEDs to provide status of the machine(operational, need of maintenance... etc)

AED location:• Make the location of their AEDs public(online database accessible by emergency
services at least)
AED availability:

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14

Appendix: AED registration form
Form from: Database of the Emergency Dispatch Center (SORES, Sala Operativa Regionale Emergenza
Sani- taria, Friuli Venezia Giulia, ITALY) by the Regional AED Working Group
Type of information

Explanatory notes

Authority
Owner

State name or denomination of the AED owner

Maintainance responsibility

Write the name and phone number of the person(s) committed
to the AED control/maintenance

Municipality

Write the municipality where the AED is located

Address of location

Write the complete Address (Street, Square, civic number, zipcode) of the building where the AED is locatedLocation

Write the precise place where the AED is located (floor, room,
corridor, etc.)

Geographic coordinates (optional)

Indicate the geographical coordinates (i.e. Latitude, Longitude Lat 45.91, Long. 13.72)

Availability
Fixed location or mobile
Phone

Indicate time and days of the week when the AED can be
activated
Specify whether the AED remains permanently in the location
above described or whether is temporarily placed in a mobile
vehicle at certain situations (i.e. during racing or other events)
Write the phone number(s) required to activate the AED

AED
AED name and model

Write the name, model, and Company of the AED

Reference number

Write the reference/serial number of the AED

Date of battery expiration

Write the date of battery expiration

Date of expiration of adult paddle

Write the date of adult paddle expiration

Date of expiration of pediatricpaddleWrite the date of pediatric paddle expiration

Date of expiration of spare paddles

Write date of expiration of any (adult, pediatric) spare paddles

Number of subject authorized to the
AED use (if established by national,
regional or local law/policy)

Write the number of subjects authorized to the AED use (ifestablished by law/policy)

Trainer Authority

Write the name of the Trainer Authority that performed the
BLSD course1516