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There are approximately 360 000 out-of-hospital cardiac arrests (OHCAs) in the United States each year, accounting for 15% of all deaths.1 Striking geographic variation in OHCA outcomes has been observed, with survival rates varying from 0.2% in Detroit, MI,2 to 16% in Seattle, WA.3 Survival variation can be explained in part by differing rates of bystander cardiopulmonary resuscitation (CPR), a vital link in improving survival for victims of OHCA. For every 30 people who receive bystander CPR, 1 additional life is saved.4 Communities that have increased rates of bystander CPR have experienced improvements in OHCA survival5,6; therefore, a promising approach to increasing OHCA survival is to increase the provision of bystander CPR.Yet provision of bystander CPR varies dramatically by locale, with rates ranging from 10% to 65% in the United States.7,8 On average, however, bystander CPR is provided in only approximately one fourth of all OHCA events in the United States despite public education campaigns and promotion of CPR as a best practice by organizations such as the American Heart Association and American Red Cross.9–11 Internationally, similar variation exists, with rates of bystander CPR reported to be as low as 1%12 and as high as 44%.13 Therefore, it is important to understand why certain communities have low bystander CPR rates and to provide recommendations for how to increase bystander CPR provision in these communities.Four critical steps are involved in providing bystander CPR as part of a coordinated community emergency response (Figure 1). First, the potential rescuer must recognize that the victim needs assistance. Early recognition may include the bystander recognizing that the victim has had a cardiac arrest, or simply that the victim needs assistance from emergency medical services (EMS). Second, the …

Increasing Cardiopulmonary Resuscitation Provision in Communities With Low Bystander Cardiopulmonary Resuscitation Rates