• Amanda L Missel, Alejandro Gomez, Stephen R Dowker, Daniel Rizk, Robert W Neumar, and Nathaniel Hunt.
• Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
• Prehosp Emerg Care. 2025 Jan 13: 141-4.

ObjectivesOut-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR).MethodsWe conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LRs and FRs. The LRs received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. The FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer's recommendations and distance to anatomical landmarks. Incorrect AP placement was defined as the upper edge of the pad past the crest of the trapezius, the medial edge past midline, or the lower edge beyond the nipple line. Incorrect LP placement was defined as the upper edge of the pad past the nipple line, the medial edge past midline, or the lower edge beyond the navel line. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (<1 year) with AED application for FR using Fisher's exact.ResultsLay rescuers correctly placed the AP in 30/38 (78.9%) and the LP 30/38 (78.9%) simulations. Application did not differ significantly based on previous CPR training (AP p = .236, LP p = .621). The most common incorrect placement was too low for both AP (5/8, 62.5%) and LP (4/8, 50.0%). First responders applied the AP correctly in 16/18 (88.9%) and the LP in 14/18 (77.8%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP p = .497, LP p = .119). The most common incorrect placement was too low for both AP (2/2, 100.0%) and LP (3/4, 75.0%).ConclusionsThere is an opportunity for improvement for both LRs and FRs to apply AEDs per manufacturer's recommendations. Further research is needed to improve instructions and follow-up training to ensure accurate AED pad placement.

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