A man goes down on the pavement outside a leisure centre at nine on a Sunday evening. Somebody kneels, somebody else calls for an ambulance, and a third person remembers the green sign with the white heart and the lightning bolt. It is twenty steps away, on the wall of the foyer, behind glass doors that were locked at six and open again on Monday morning. Everyone can see the cabinet. Nobody can reach it.
That is not a failure of generosity. Somebody bought the machine and pays to keep it charged. The failure sits in the hour, and the hour is the part nobody costed.
A green sign and a closed lobby
The defibrillator is an unusual piece of public equipment because its whole value is measured in minutes. It is worth something only inside a window that closes fast, and that turns every ordinary building habit, closing time, a fire door, a reception desk that goes home, into a clinical variable.
So the question about any given unit is not whether it exists. It is what fraction of the week a stranger can actually reach it.
Fifty out of five hundred and fifty-two
Danish researchers put a number on that fraction. Writing in Circulation in 2013 under the blunt title Automated External Defibrillators Inaccessible to More Than Half of Nearby Cardiac Arrests in Public Locations During Evening, Nighttime, and Weekends, Carolina Malta Hansen and colleagues took every cardiac arrest recorded in public places in Copenhagen between 1994 and 2011 and laid it over a map of every registered machine in the city.
Of 552 registered units, 532 could be reached in daytime on a weekday. That is 96.4 percent, which sounds like a solved problem. Then the same units were checked against the rest of the week, and 50 of them, 9.1 percent, were available at every hour. The other nine in ten went behind a door at some point.
Set that against when people actually collapse. Of 1,864 arrests in public locations, 1,152 happened in the evening, at night, or at a weekend. That is 61.8 percent of the events falling in the hours when roughly ninety percent of the equipment was shut away.
| Measure | Figure |
|---|---|
| Registered units in the study | 552 |
| Reachable weekday daytime | 532 (96.4%) |
| Reachable at all hours | 50 (9.1%) |
| Public arrests in the period | 1,864 |
| Arrests in evening, night or weekend | 1,152 (61.8%) |
Toronto counted the same gap
A second team ran the exercise in Canada and reached the same shape of answer. Their work appeared in the Journal of the American College of Cardiology in August 2016 and covered Toronto arrests from January 2006 to August 2014. Of 767 registered machine locations in the city, 542 were not open twenty-four hours, and 211 were closed at weekends.
The consequence was measurable. There were 451 arrests that happened near a registered unit, and only 354 of those fell at a moment when the unit could be reached. Roughly a fifth of the coverage the map promised did not exist at the time it was needed, and in evenings, nights and weekends the loss was closer to a third.
Two cities, two continents, two decades of records, one finding: the inventory is not the service. What a city owns and what a passer-by can use at eleven at night are different quantities, and only the first one gets reported.
Why the cabinet ends up indoors
Nobody chose this outcome. It is the sum of reasonable small decisions made by whoever paid. Indoors is warmer, which matters for battery life, and less likely to be vandalised or taken. Indoors means a member of staff can keep an eye on the pad expiry date. Every one of those reasons is real, and every one of them quietly prices the machine for office hours.
The alternative is an outdoor heated cabinet with a keypad, where the code comes from the ambulance dispatcher when a call is made. It costs more, it needs a power supply, and somebody has to check it. What it buys is the other eighty percent of the week, which is when most of the collapses happen.
The purchase gets a budget line and a photograph. The availability gets neither, so it drifts, much as it did with a fountain that works but nobody uses.
The map the dispatcher is looking at
There is a second failure mode, quieter than the locked door. A machine that nobody has registered is invisible to the person on the emergency line, and that person is the one who will tell a caller where to run.
Britain built a single answer to this. The Circuit, run by the British Heart Foundation with the ambulance services, became fully national on 10 October 2022 when London Ambulance Service joined, making it one database that all fourteen UK ambulance services read from. At that milestone the network had mapped about 50,000 devices against an estimated national stock of around 100,000. Half the machines in the country were, in the charity's own phrase, lost to the services that would need to point at them.
Registration is clerical work with no glamour attached. It is also the difference between a device that exists and one a stranger gets sent to.
Five minutes you can settle this weekend
This is worth doing once, calmly, on an ordinary afternoon, for the two or three buildings you spend the most time in or near.
- Find the nearest unit to your home, your workplace and wherever you exercise. Look it up on the national register for your country rather than relying on somebody's memory of having seen a green sign.
- Walk to it and note what stands between the street and the cabinet. A door, a reception desk, a lift, a keypad on a stairwell: each one is a delay, and each one has an opening time attached.
- Write down the hours the building is open, not the hours on a website. Ask the person at the desk what happens on a bank holiday, because that is the answer least likely to be published anywhere.
- If the unit belongs to a club, church, shop or office you are part of, check that it is on the national register and that the entry carries a working contact and the current access arrangement. An entry with a dead phone number is worse than none, because it directs somebody to a dead end.
- Where a machine sits indoors and the building shuts, raise moving it outdoors as a budget item rather than a complaint. The cost is a cabinet, a power feed and a named person who checks it.
- Tell one other person what you found. The knowledge is worth little held privately and a lot held by four people in a building.
The machine outside that leisure centre will be there on Monday, clean and charged and counted in the annual figures as a device in service. It was in service for about a third of the week. Describing that gap costs nothing, only somebody willing to write the opening hours next to the location and treat the smaller of the two numbers as the real one.