Objective: To determine the availability of early defibrillation and automated external defibrillators in nursing homes in selected cities. Design: A standardized telephone survey was conducted of all skilled nursing facilities to characterize early defibrillation capabilities. Setting: The study involved nursing homes in Philadelphia, Omaha, Seattle, and Boston. Participants: All skilled nursing facilities not physically attached to hospitals in the selected cities based on listings from the Centers for Medicare and Medicaid Services as of January 2004. Measurements: Each site was queried as to whether or not they had an automated external defibrillator (AED), if they were physically freestanding facilities, if a manual defibrillator was present, and if staff were present 24 hours a day to use the defibrillator. Early defibrillation was defined as the presence of either a manual defibrillator or AED in addition to 24-hour trained staff availability. Results: There were 126 nursing homes identified from the Medicare listing and 81% (102) responded to our phone survey. After exclusion of nonfreestanding facilities, 90 nursing homes (71.4%) were available for analysis. Overall, 16.7% (95% CI 8.8-24.5) of nursing homes reported early defibrillation capabilities via manual defibrillator or AEDs; 6.7% (95% CI 1.4-11.9) of nursing homes reported AEDs; 10.0% (95% CI 3.7-16.3) of nursing homes reported manual defibrillators. Nursing homes in Seattle had a higher rate of early defibrillation capability than the other 3 cities. Conclusion: Despite the fact that nursing homes have been identified as locations with multiple cardiac arrests, the early defibrillation capabilities and prevalence of AEDs in this setting remains low. AEDs may play a role in improving survival from cardiac arrest in nursing homes. The placement of AEDs in nursing homes needs further consideration and study. © 2007 American Medical Directors Association.