Optimal access to- and response by-public and voluntary services, including the role of bystanders and family members, in cardiopulmonary resuscitation.

Victims of out-of-hospital cardiac arrest in most communities are not the beneficiaries of an optimal healthcare system response capable of providing survivors who live to hospital discharge. The public at large, including family members and bystander witnesses of cardiac arrest, must be expected to participate in this optimal response capability. The American Heart Association Chain of Survival defines the elements of a system capable of saving lives of victims of ventricular fibrillation cardiac arrest. Widespread dissemination of only the essential elements of life-saving steps, probably through media not yet used for this function, will be needed to reach the largest number of people possible. Emergency medical services systems need to devise innovative approaches to rapid provision of automated external defibrillation, in many cases no doubt outside the boundaries of traditional means of delivery of this intervention. Finally, it is likely that targeted responders among the public will be participants in a public access defibrillation approach to dealing with sudden cardiac death.