Keeping Public Access Defibrillators (PADs) Alive: The Maintenance, Repair, and Care Practices to Ensure Functionality and Accessibility in an Emergency

Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency, and the prompt use of public access defibrillators (PADs) can significantly increase chances of survival. Drawing on 19 interviews with PAD guardians and key stakeholders, this paper investigates how PAD infrastructure is sustained in practice. We focus on the essential but often invisible labour carried out by PAD guardians in Scotland to ensure these lifesaving devices remain functional and accessible throughout their lifecycle. Our findings reveal that PAD infrastructure is fragile, prone to breakdowns, and reliant on ongoing collaborative practices of maintenance, repair, and care. We conceptualise PAD guardianship as a form of care work: relational, material, affective, and ethically charged. Importantly, we draw attention to the conditions under which this work is performed, arguing that caring for infrastructure necessarily includes caring for the people who sustain them. To move towards more resilient PAD infrastructures, we advocate reimagining guardianship as a collective practice, supported by systems explicitly designed with and for care – of devices, data, and the human networks that underpin effective emergency response.