The Malta Resuscitation Council has called for automated external defibrillators (AEDs) to become more accessible across Malta, saying that too many of these life-saving devices remain hidden inside offices, hotels and other private buildings where members of the public either do not know they exist or cannot access them during an emergency.

Chairperson Dr Tanya Esposito and vice-chairperson Dr Marius Caruana told The Malta Independent that improving cardiac arrest survival rates depended not only on increasing the number of AEDs, but also on ensuring they were publicly registered, visible and available round the clock. Improving public confidence in cardiopulmonary resuscitation is only one part of increasing survival rates following cardiac arrest, the two said.

The other, is ensuring that members of the public are able to quickly locate and use an automated external defibrillator (AED) when one is needed. Esposito and Caruana said Malta had seen a steady increase in the number of AEDs installed across the islands over recent years, yet argued that many remained inaccessible, unregistered or simply unknown to the public. "They're like fire extinguishers. People walk past them, and they don't realise that they're there," Esposito said.

The council has spent years encouraging organisations and businesses not only to invest in AEDs but also to register them through a publicly accessible mobile application, allowing members of the public to identify the nearest available device during an emergency. Esposito explained that one of the greatest obstacles was not necessarily the number of AEDs available but public awareness of where they were located.

She pointed to Valletta as one example, noting that six publicly accessible AEDs funded with the council's support had been installed across the capital and remained available round the clock, yet many people who regularly visited the city remained unaware they even existed. "There are six which we have actually funded, scattered throughout Valletta.

They are public access twenty-four seven," she said. The council believed that increasing visibility was just as important as increasing numbers. Caruana showed The Malta Independent the AED mapping application currently used to identify registered devices across Malta, saying the map demonstrated that AEDs were becoming increasingly common but also highlighted the importance of ensuring they were publicly accessible.

He said that too many organisations purchased an AED, only to keep it inside their premises where it could be accessed solely by employees during office hours. "I think we need to promote for, especially those people who have it inside, to put it on the outside," he said. Businesses often viewed AEDs as equipment intended primarily for their own staff, Caruana added, when in reality placing one outside a building created benefits extending far beyond that workplace.

"We have to understand the multiplier effect of having that available just outside your door. It is serving your employees, but it is serving also if something happens." Esposito said the council regularly promoted examples of businesses that had voluntarily installed externally accessible AEDs, pointing to a restaurant in Għajnsielem whose owners had chosen to install one outside their premises despite receiving no legal obligation to do so.

 She described such initiatives as examples of the kind of community responsibility the council hoped to encourage elsewhere. The pair said that Malta should eventually move towards a system where every publicly accessible AED was registered, maintained and easy to locate during an emergency, reducing the likelihood of precious minutes being lost simply because bystanders did not know where to find one. Registration, Esposito added, would also improve awareness among neighbouring businesses and residents.

"One could be just outside the door, if they're not registered, people don't know where they are, she said. While legislation requiring registration would undoubtedly help, the council believed cultural change remained equally important. People needed to begin viewing AEDs not as specialist medical equipment but as emergency devices intended to be used by ordinary members of the public. Although many people worried they might use an AED incorrectly, both doctors stressed that the machines had been specifically designed to guide inexperienced users through every step of the process.

"The AED itself will tell you what to do. You open it up, it tells you take off the pads, tells you where to put the pads." That simplicity is precisely why greater public familiarity with AEDs could significantly strengthen Malta's response to cardiac arrests. While increasing the number of publicly accessible AEDs remains one of the council's priorities, Esposito and Caruana argued that simply installing more devices would not, on its own, improve survival rates unless they were accompanied by greater public awareness and practical training. The pair said they would ultimately like to see AEDs become a normal feature of everyday life, much like fire extinguishers, particularly in apartment blocks, residential complexes and other locations where large numbers of people lived or gathered. Esposito recalled the experience of a woman whose husband suffered a cardiac arrest while they were staying in an apartment block abroad. Although she immediately began performing CPR, nobody came to help despite her calling for assistance. "

She did a great job because her husband survived and survived well, but nobody came to help," Esposito said. The experience reinforced the council's belief that residential buildings should eventually begin considering AEDs in the same way they already consider fire safety equipment. "Why not put an AED for every ten units? We can perhaps have one AED for a block of flats." She acknowledged that such a system represented a long-term aspiration rather than an immediate proposal, but said that as apartment developments continued to grow larger, the need for readily available emergency equipment would only increase. The council also believes that public access should remain at the centre of future planning.

 Esposito said that AEDs which are currently located inside hotels, offices and businesses where they become inaccessible once premises close, limits their usefulness during emergencies occurring outside business hours. Caruana said organisations investing in AEDs understandably viewed them as equipment intended primarily for employees or customers but encouraged businesses to instead consider the wider benefit of making those devices accessible to surrounding communities. "Especially those people who have it inside, I think we need to promote for them to put it on the outside," he said. He noted that AEDs were designed specifically to be used by ordinary members of the public and posed no danger if applied incorrectly.

"This machine doesn't do anything else. If the heart stops, and there is a situation where it needs a shock, it will give a shock. It does nothing else," he said. Beyond equipment and training, the council also highlighted an area of cardiac arrest recovery that it believed remained largely overlooked - the emotional impact on both survivors and those who had attempted to save them. Esposito explained that while attention naturally focused on whether somebody survived, much less consideration was given to what happened afterwards, particularly for relatives, friends or complete strangers who had performed CPR.

The Malta Resuscitation Council is therefore working alongside the European Resuscitation Council to establish a support network bringing together both cardiac arrest survivors and the "co-survivors" - the people who had carried out CPR or witnessed the event. "There are people out there that we don't know about, and it would really be great if people want to come for support," Esposito said. Caruana said the psychological impact was frequently underestimated, with survivors often expected simply to be grateful they were alive despite the physical and emotional challenges many continued to face.

"You survived, everybody's happy. 'Oh, you survived.' You should be thankful. You've got your life back," he said, adding that those are frequent comments survivors receive, however, Caruana said that there is a trauma aspect to it. For relatives and bystanders, the burden could sometimes be equally significant. People who had attempted CPR often questioned whether they had done enough, while others never discovered whether the person they had tried to save ultimately survived.

"There are guilt feelings. They've tried their best, and there's nowhere where they can channel that grief, that doubt, those questions that they have," Caruana said. Esposito agreed, pointing out that healthcare professionals gradually learned to cope with unsuccessful resuscitation attempts through experience and training, whereas members of the public were often left carrying those emotions alone.

The first part of the feature was carried yesterday