Strategic PAD positioning : a scoping review

Petravić, Luka (author), Gril Rogina, Kaja (author), Miklič, Rok (author), Lainščak, Mitja (author), Langus, Tinkara (author), Žnidaršič, Anže (author), Kukec, Andreja (author), Strnad, Matej (author)

Background Out-of-hospital cardiac arrest (OHCA) is a major contributor to overall morbidity and mortality. Survival depends on several factors, including rhythm shockability and timely defibrillation; for the latter, the availability of Public Access Defibrillators (PADs) is crucial. Across countries, PADs can be a limited resource, necessitating strategic placement to ensure optimal accessibility and effective utilization. The objective of this scoping review was to analyse existing experience with PAD positioning and to identify potential for the geospatial optimisation of PAD positioning. Methods An electronic search of PubMed and Scopus databases was performed to identify studies on PAD positioning. We included peer-reviewed articles as well as graduate and undergraduate theses, and excluded conference abstracts, books, and book chapters. Only English-language publications were considered. A Risk of Bias analysis was conducted and reported using Mixed Method Appraisal Tool. We adhered to PRISMA-ScR guidelines. Using the PCC framework, the Population was the general public, the Concept was PAD optimization, and the Context ranged from buildings to nations. Data charting was done manually. We quantitatively synthesized findings from included studies based on extracted data and Synthesis Without Meta-Analysis guidelines. Results We included 43 works, mostly from North America. We found substantial diversity in study methodologies, outcome measures and results reporting. Within buildings, PADs are recommended to be positioned centrally or in elevators. Outside, places with high-footfall were preferred. Optimisation models most often employed the Maximal Covering Location Problem. Most studies based their models on the locations of existing and candidate PADs, alongside historical or simulated OHCA occurrences, and tried to minimise that distance. Conclusions In this scoping review of studies optimising PAD network deployment, we found that PAD network optimisation is feasible and improves coverage of historical OHCA locations. Data-driven positioning strategies should incorporate historical OHCA locations, population health indicators, and socioeconomic variables to identify high-risk zones effectively and inform appropriate PAD density. Future studies should adopt prospective and real-world design, while adhering to guidelines for reporting results.

• Language: English
• Keywords: out-of-hospital cardiac arrest, automated external defibrillators, geographic information systems, models, theoretical models, algorithms, emergency medical services, emergency responders, time factors, socioeconomic factors, public health, defibrillators
• Work type: Article
• Typology: 1.02 - Review Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: 14 str.
• Numbering: Vol. 34, iss. 1, art. 3
• PID: 20.500.12556/RUL-178133
• UDC: 616.12-008.315
• ISSN on article: 1757-7241
• DOI: 10.1186/s13049-025-01527-8
• COBISS.SI-ID: 261235459
• Publication date in RUL: 19.01.2026

Record is a part of a journal

• Title: Scandinavian journal of trauma, resuscitation and emergency medicine
• Shortened title: Scand. j. trauma resusc. emerg med.
• Publisher: Springer Nature, Norwegian Air Ambulance Foundation
• ISSN: 1757-7241
• COBISS.SI-ID: 30081241

Licences

• License: CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
• Link: http://creativecommons.org/licenses/by-nc-nd/4.0/
• Description: The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.

Secondary language

• Language: Slovenian
• Keywords: zunajbolnišnični srčni zastoj, avtomatski zunanji defibrilator, geografski informacijski sistem, modeli, teoretični modeli, algoritmi, nujna medicinska pomoč, prvi posredovalci, časovni dejavniki, socioekonomski dejavniki, javno zdravje