A Public Access Defibrillation (PAD) program is the structured deployment of AEDs across community spaces — public buildings, parks, sports venues, schools, transit systems, retail districts, and houses of worship — paired with trained responders, registered devices, EMS coordination, and outcome tracking. Communities that build robust PAD programs see measurably higher out-of-hospital cardiac arrest survival rates than communities that don’t. Seattle’s King County is the most-studied example, with survival rates roughly 2–3× the U.S. national average after decades of community CPR/AED investment. This guide walks through the complete framework for designing and launching a PAD program from scratch — for municipalities, large enterprises, school districts, and community foundations.
~12%
U.S. average out-of-hospital SCA survival rateSource: AHA OHCA statistics
~50%
Witnessed SCA survival rate in King County PAD programSource: Seattle/King County EMS
2–3×
Survival rate uplift in mature PAD program communities vs. national averageSource: AHA Public Access Defibrillation outcome data
The history and framework of PAD programs
PAD programs originated in the late 1990s when the FDA and AHA recognized that survival was limited by the gap between collapse and defibrillation — and that placing AEDs in community spaces (not just hospitals and ambulances) could close that gap. The first major U.S. PAD initiative was the 2001 PAD Trial, a multi-site clinical trial demonstrating that community AED deployment with trained lay responders improved survival.
Modern PAD programs are typically run by:
- Municipal governments (cities, counties)
- Public health departments
- EMS agencies
- School districts (district-wide)
- Large enterprises with public-facing operations
- Community foundations and nonprofits
The 9-step PAD program builds a framework
1
Form the governance committee
Convene stakeholders: municipal leadership, EMS, public health, fire department, school district, hospital system, community foundations, insurance carriers, civic groups. Establish a steering committee with named roles, meeting cadence, and decision-making authority.
2
Conduct a community needs assessment
Map current AED deployment via PulsePoint or local registry. Identify high-traffic gathering areas (transit stations, parks, civic centers, sports venues, retail districts). Geocode existing AEDs and analyze coverage gaps using the AHA 3-minute rule. Prioritize high-density and high-traffic zones for new deployment.
3
Develop the program plan & budget
Quantify scope: how many AEDs, where, over what timeframe. Multi-year phasing (Year 1: priority sites; Year 2: secondary; Year 3+: maintenance and expansion). Budget device + cabinet + training + registration + ongoing maintenance. Typical PAD program cost: $3,000–$5,000 per deployed AED over 10 years.
4
Secure funding
Municipal budget allocation, state DPH grants, federal HRSA / FEMA grants where applicable, nonprofit foundation grants (Project ADAM, Sudden Cardiac Arrest Foundation), corporate sponsorship, civic-club partnerships (Rotary, Lions, Kiwanis), insurance carrier contributions, and memorial fundraising. See our AED Grants & Funding Sources guide for the complete funding map.
5
Select vendor & standardize equipment
Single-brand standardization across the program (Philips, ZOLL, HeartSine, Defibtech, etc.). Match brand to environment: outdoor deployments require IP55+ devices and heated cabinets in cold climates. Negotiate volume pricing through an enterprise contract. See Find Your Perfect AED.
6
Deploy & install
Site walkthroughs to verify access, ADA mounting, and signage. Install AEDs in cabinets with ISO 7010 signage at standardized heights (48–54″). Pair with PulsePoint registry so 911 dispatch can direct callers. Photograph each installation for the program record.
7
Train responders & community
Train designated responders at each site (Heartsaver CPR/AED). Optionally extend community training programs (Hands-Only CPR campaigns, free public classes). Partner with local training providers like CPR1, AHA-aligned training centers, or fire department community education programs.
8
Integrate with EMS dispatch
Coordinate with local EMS so 911 dispatchers can direct callers to the nearest registered AED. PulsePoint AED Registry integrates with 4,000+ U.S. communities. Implement PulsePoint Respond if your EMS agency uses it — notifies nearby trained citizens of cardiac events.
9
Establish ongoing governance & outcome tracking
Designate program coordinator. Quarterly program reviews. Annual outcome reporting (deployments, shocks delivered, survival outcomes). Public reporting to community stakeholders. Continuous program refinement based on data.
Site selection methodology
The single biggest determinant of PAD program effectiveness is where AEDs are placed. Best-practice site selection considers:
| Selection factor | Why it matters |
|---|---|
| Foot traffic/population density | Higher density = more potential SCA events per AED |
| Age demographics | Older populations have higher SCA risk |
| Vigorous activity venues | Gyms, sports fields, and pools have elevated SCA per visitor |
| EMS response time | Remote/long-EMS-time locations prioritize PAD coverage |
| Existing trained responders | Sites with police, security, or trained staff scale well |
| 24/7 access | Outdoor cabinets in all-hours access locations |
| Historical SCA incidence | Sites with prior events warrant immediate coverage |
| Equity considerations | Lower-income areas have historically had less PAD coverage |
Typical PAD program site priorities
| Priority tier | Site types | Rationale |
|---|---|---|
| Tier 1 — Highest priority | Transit stations · sports venues · large schools · gyms · convention centers | High SCA risk + high foot traffic |
| Tier 2 — High priority | Senior centers · libraries · community centers · municipal buildings · large retail | High traffic + older population |
| Tier 3 — Medium priority | Parks · outdoor sports complexes · houses of worship · medical office plazas | Seasonal or moderate traffic |
| Tier 4 — Coverage gaps | Lower-density areas not covered by other AEDs | Equity + 3-minute rule |
The King County / Seattle PAD model
Real-world case
King County, Washington — the gold standard
Seattle/King County, Washington, has become the most-studied PAD program in the U.S. — and the global benchmark for community AED deployment. Decades of investment in community CPR training (over 100,000 residents trained), strategic AED placement, integrated 911 dispatcher CPR coaching, and EMS-integrated bystander notification systems have produced witnessed-SCA survival rates around 50% — roughly 3× the U.S. national average. The model demonstrates that PAD programs, when designed with rigor and sustained over the years, can fundamentally change cardiac arrest outcomes at the community level. Published outcomes appear in the Seattle/King County EMS annual reports and have been replicated by other municipalities.
Funding strategies that work
PAD programs typically blend multiple funding sources:
- Municipal capital budget — Often the largest single funder for city/county programs
- State DPH grants — Several states maintain ongoing PAD grant programs
- Federal grants — HRSA Rural Health, FEMA Assistance to Firefighters Grant
- Nonprofit foundations — Project ADAM (schools), Sudden Cardiac Arrest Foundation
- Corporate sponsorship — Large employers funding community programs as CSR initiatives
- Civic clubs — Rotary, Lions, Kiwanis, VFW, American Legion
- Insurance carriers — Some commercial insurers contribute to community PAD initiatives
- Memorial campaigns — Family-initiated AED donations in memory of SCA victims
Multi-year programs typically blend 3–6 funding sources. See AED Grants & Funding Sources for the complete map.
EMS integration — the operational keystone
The single biggest force multiplier in a PAD program is integration with local EMS dispatch. Modern EMS-integrated PAD programs include:
- 911 dispatcher AED location lookup — Dispatcher tells caller the location of the nearest registered AED in real time
- Dispatcher-assisted CPR (T-CPR) — Dispatcher coaches the caller through CPR until EMS arrives
- PulsePoint Respond integration — Bystander notification app alerts CPR-trained citizens to nearby cardiac events
- Outcome data sharing — Hospital outcomes fed back to the program for tracking and refinement
For a PAD program to maximize impact, an EMS partnership is non-negotiable. The strongest PAD programs in the U.S. are EMS-led or EMS-co-led for exactly this reason.
Outcome tracking and reporting
Mature PAD programs track and publicly report:
- Total registered AEDs in service
- Deployments per year (events where an AED was used)
- Shocks delivered per year
- Survival outcomes (hospital discharge with neurological function)
- Time-to-defibrillation metrics
- Equity analysis (deployment coverage across neighborhoods)
Annual public reports demonstrate accountability, support continued funding, and inform program refinement.
Frequently Asked Questions
What is a Public Access Defibrillation (PAD) program?
A structured community-wide deployment of AEDs in public spaces — paired with trained responders, EMS integration, registration, and outcome tracking. PAD programs aim to close the gap between cardiac arrest and defibrillation by placing AEDs throughout the community rather than relying solely on EMS response.
How effective are PAD programs?
Best-practice PAD programs achieve out-of-hospital cardiac arrest survival rates 2–3× the national average. Seattle/King County, the most-studied example, reports survival rates around 50% for witnessed SCA — roughly 3× the ~12% U.S. baseline.
How long does it take to build a PAD program?
Typical launch timeline is 6–18 months. Larger programs (50+ AEDs) often phase over 2–5 years. Sustained programs run indefinitely with ongoing maintenance and expansion.
How much does a PAD program cost?
Plan for $3,000–$5,000 per deployed AED over 10 years, including device, cabinet, training, signage, maintenance, and replacement consumables. A 50-AED PAD program over 10 years typically costs $150,000–$250,000.
Who typically runs a PAD program?
Municipal governments, public health departments, EMS agencies, school districts, large enterprises with public-facing operations, and community foundations. The most effective programs are EMS-led or EMS-co-led because of the operational integration benefits.
Where should AEDs be placed in a PAD program?
Prioritize high-traffic gathering places (transit stations, sports venues, schools, gyms), older-population sites (senior centers, libraries), areas with delayed EMS response, and equity-driven coverage of historically underserved neighborhoods. Apply the AHA 3-minute rule for placement density.
How do we integrate our PAD program with 911 dispatch?
Coordinate with your local EMS agency and register every AED with the PulsePoint AED Registry. EMS dispatch systems that have integrated AED lookup can direct 911 callers to the nearest registered device in real time, dramatically improving time-to-defibrillation.
Get hands-on AED training in under 3 hours.
Sources & References
Disclaimer: PAD program design varies by community context, EMS infrastructure, and funding model. This article is informational; consult local EMS, public health, and counsel for program-specific design.
