Defibrillator deserts: why millions in England and Wales live too far from a life-saving device

When someone's heart suddenly stops beating effectively, the single biggest factor in whether they survive is not which hospital they are eventually taken to. It is what happens in the first few minutes, before any ambulance can realistically arrive. New research from the Heart Restart campaign puts a stark number on how many people in England and Wales are poorly positioned for those crucial minutes: more than 16 million live further than a 1km round trip from a defibrillator they can access at any hour of the day or night.

A cardiac arrest is different from a heart attack, though the two are often confused. In a cardiac arrest, the heart's electrical system malfunctions and stops pumping blood effectively, causing the person to collapse and lose consciousness within seconds. Without intervention, survival chances fall by roughly ten percent with every passing minute. An automated external defibrillator, a device designed to be used safely by untrained bystanders, can deliver a shock that restores a normal heart rhythm.

The Heart Restart analysis, which mapped publicly available defibrillators against population data, found that the problem is broader than the 16 million figure alone suggests. Across England and Wales, some 35 million people, more than half the population, do not live within the three-to-five-minute brisk walk recommended as the outer limit for a defibrillator to be useful in an emergency. Of that group, about half live further than a 1km round trip from a device that is accessible around the clock.

That distinction, between any defibrillator and one that is accessible 24 hours a day, matters enormously. Many public defibrillators are housed inside locked buildings, such as schools, gyms, or offices, and are only reachable during opening hours. A device installed in a workplace lobby is of little use to someone who collapses in the same neighbourhood at 11pm. Campaigners argue that mapping and publicising which devices are genuinely always accessible is as important as installing new ones.

The scale of the underlying problem is significant. More than 40,000 out-of-hospital cardiac arrests occur in the UK each year, according to figures cited in the research, and fewer than one in ten of those who experience one outside a hospital survive. That survival rate, low as it is, rises substantially when bystanders begin CPR and use a defibrillator before paramedics arrive, a sequence of actions often referred to as the "chain of survival."

Public defibrillator schemes have expanded significantly over the past two decades, often funded through a patchwork of charity fundraising, local council grants, and community group initiatives rather than a single coordinated national programme. That funding model has produced dense coverage in some areas and near-total gaps in others, frequently correlating with the wealth or organisational capacity of the local community rather than the underlying medical need.

Rural areas face a distinct version of the problem. Even where a defibrillator exists, ambulance response times in sparsely populated regions can be considerably longer than in cities, making the presence of a nearby, always-accessible device more critical, not less. Campaigners have pushed for registries that let ambulance dispatchers direct 999 callers to the nearest available defibrillator in real time, a system already used in parts of the UK but not universally.

Public awareness of how to use a defibrillator remains another barrier, separate from geography. The devices are designed with voice instructions and automated shock delivery specifically so that untrained members of the public can use them safely, but survey data cited by cardiac charities has repeatedly found that many people either do not know a nearby defibrillator exists or feel unsure about approaching and using one during an emergency.

Addressing the gap identified by the research would likely require both new installations in underserved areas and a shift toward ensuring existing devices are accessible at all hours, rather than locked away outside business hours. Some local health bodies have begun experimenting with outdoor, weatherproof cabinets that allow round-the-clock access even when the building behind them is closed.

For the millions of people the research identifies as living in a defibrillator desert, the gap is not an abstract statistic but a measure of how far they are, in the worst moment of their life, from the intervention most likely to save it. Campaigners say closing that gap is less about extraordinary new technology and more about ensuring the technology that already exists is placed, and kept accessible, where it is needed most.