BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a global health issue, for which rapid public access defibrillation (PAD) increases survival. OBJECTIVES: The purpose of this study was to evaluate international legislation relating to PAD and develop legal recommendations to improve PAD in OHCA. METHODS: Searches covering 5 domains (automated external defibrillator [AED] provision, funding, identification, maintenance, lay responder training) were conducted in 99 jurisdictions worldwide: United States (50) and Canada (13) analyzed at state/province level
36 other countries analyzed at national level. Forty-nine legislation sources were searched from September 27, 2021, to May 5, 2022. Legislative data were classified: Enabling Legislation (facilitating PAD) or Disabling Legislation (hindering PAD). Based on retrieved data, recommendations for international AED laws were developed. RESULTS: Searches identified 419,248 legal records. Enabling Legislation regarding AED provision in public areas was present in 60% U.S. states, 8% Canadian provinces, and 22% of nations studied from the rest of world. Disabling Legislation regarding registration of AEDs, that could potentially discourage AED ownership, was found in 37 North American jurisdictions. Enabling Legislation regarding AED signage was found in 66% U.S. states and 39% of all jurisdictions worldwide. Overall, 48% of worldwide jurisdictions studied had legislative requirements for AED maintenance, including 80% of all U.S. states. Internationally, 49.5% of jurisdictions studied had Enabling Legislation mandating AED training, and 66% United States had this for schools. Only 4 jurisdictions worldwide gave implicit authorization to laypersons for AED use in emergencies. CONCLUSIONS: There is significant variability in international legislation relating to PAD. All countries should consider Enabling Legislation that could decrease delays to PAD. Similarly, Disabling Legislation potentially hindering prompt PAD during OHCA should be withdrawn.