AED placement decided the way an emergency physician would decide it: where the unit actually goes in a residence, an office or an aircraft, who is trained to open the cabinet, and why the walk to it is the number that matters.
I have inspected a lot of estates. The AED is almost always there. It is almost never findable.
The pattern repeats: a good unit, bought years ago, mounted in a staff corridor or a mechanical room, sometimes still in the shipping box on a shelf in the garage. Nobody on shift that day knows where it is. The pads expired in 2022. And the one person who was trained on it left the household in 2023.
A defibrillator is the single highest-yield piece of medical equipment you can put on a property, an office floor or an aircraft. It is also the piece most often defeated by where it was hung.
Why the walk to the AED is the whole problem
Sudden cardiac arrest from a shockable rhythm is a time-dependent event in a way almost nothing else in medicine is. Survival falls by roughly 7 to 10 percent for every minute that passes without defibrillation. Chest compressions slow that decay. They don’t stop it. The shock is what converts the rhythm.
So the useful question is never “do we have an AED.” It is: from the furthest point a person could collapse, how long until a shock is delivered?
The American Heart Association’s guidance is built around getting collapse-to-shock under 3 minutes. Work backwards from that and you get a practical rule: the AED should be no more than about a 90-second round trip from anywhere a person is likely to be. That means someone recognizes the arrest, someone else runs, retrieves, returns, and the pads are on the chest inside 3 minutes total.
On a 20,000 square foot residence with three floors, a pool deck and a guest house, one AED in the kitchen does not achieve that. Two or three units do. The cost difference between one and three is a rounding error against what these properties spend on security hardware.
How to decide AED placement in a residence
Walk the property with a stopwatch, at the pace a 55-year-old household manager would actually move, and time the round trip from each of these to your proposed cabinet:
- The primary bedroom suite. Overnight arrests are common and the response is slowest.
- The pool, spa or waterfront. Drowning and immersion arrest, plus the gym if there is one, since exertional events cluster there.
- The garage, and any long driveway. Gated estates add minutes at both ends.
- Guest houses and staff quarters, which are frequently outside the plan entirely.
- The furthest point of the main house from wherever you want to put the unit.
Anything over 90 seconds round trip gets its own unit. In practice most large properties need two, and a compound with outbuildings needs three or four.
Then get the details right, because they are what fail in the real event:
Unlocked. An alarmed cabinet is fine. A locked one is a decoration. If theft is the concern, the alarm and a camera solve it.
Signed. Standard AED wall signage, mounted high enough to see over furniture and people. A responding paramedic should be able to spot it from the doorway.
On the plan. The AED locations belong in the same document as the gate codes and the receiving hospital, and a copy belongs with the detail. This is part of what a property-by-property medical audit is for.
Registered. Many EMS agencies maintain an AED registry, and some dispatch centers will direct callers to the nearest registered unit. I ran a 911 medical dispatch center for 10 years. That data is only as good as what people bother to submit.
Offices, aircraft and vehicles
Corporate floors are usually the easiest, because the building code and the tenant improvement process already handle stairwell and elevator lobby placement. The gap tends to be executive floors with badge-restricted access, where the nearest unit is on the other side of a door most staff can’t open.
Aircraft are the surprise. US airlines have been required to carry an AED and an enhanced emergency medical kit since 2004, under 14 CFR 121.803. Part 91 private aviation carries no such requirement. A family flying privately is statistically in the worst position of anyone on this list: an older population, at altitude, hours from a hospital, on an aircraft with no legal obligation to carry the one device that matters. Ask the flight department directly. Ask to see it. Ask when the pads expire.
Vehicles are the weakest case. A follow car AED sounds appealing and it lives in a hot trunk, which shortens battery and pad life considerably. If the detail wants one in the vehicle, it needs a real maintenance interval, not an annual glance.
Maintenance is where programs quietly fail
Every AED self-tests and shows a status indicator. Somebody has to look at it. Monthly is the standard, and it takes 15 seconds per unit.
The consumables are the trap. Electrode pads carry a shelf life, usually 2 to 5 years, and the adhesive gel dries out whether the unit was used or not. Batteries have their own separate expiry. I have opened cabinets where the pads expired three years before the day I walked in, in houses with full-time staff and a security budget in the six figures.
Pediatric pads or a pediatric attenuator matter if children live on the property or travel with the family. Under roughly 8 years old or 25 kg, pediatric pads are preferred. If they aren’t available, adult pads on a child are still the right call. A shock delivered imperfectly beats no shock.
Training, and the thing people are afraid of
The device talks. It analyzes the rhythm and refuses to shock anything that isn’t shockable, which means a lay rescuer cannot hurt someone by attaching it to a person who doesn’t need it. Every state has some form of Good Samaritan protection covering lay AED use.
The barrier is almost never the machine. It is hesitation. Household staff and protection agents hesitate because nobody ever told them clearly that opening that cabinet is their job. Fixing that takes about 20 minutes of training pitched to what staff are actually authorized to do, repeated annually, plus one walkthrough per property so the location is muscle memory instead of a fact on a page.
Pair it with hands-only CPR and a clear script for the 911 call, including the gate code and the address the ambulance should actually navigate to, which on large properties is often not the mailing address.
The short version
Time the walk. Add units until every likely collapse point is inside a 90-second round trip. Leave the cabinets unlocked, sign them, register them, and check the pads on a schedule somebody owns by name.
If you want the rest of the equipment picture, the kit itself is a separate decision and it gets made badly for different reasons. Definitions for the terms above are in the executive protection medical terms reference, and if you want an honest read on what your properties currently cover, that starts with a program assessment.
Michael Guirguis, MD is a board-certified emergency physician, a Fellow of the American College of Emergency Physicians, and founder of Raven Medical Support Group. Kit and equipment specification for private families runs through family office medical support, under written medical direction.