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The key elements of a community cardiac arrest care system were initially described in the “chain of survival.” However, for this to be effective, there need to be other supporting pre‐requisites within the system. This can be depicted in the “frame of survival”, which has the chain of survival at its core, encapsulated by the prerequisites (Figure 12.2). The inner frame depicts pre‐requisites that are within the control of local EMS, while the outer frame are those subjected to governmental bodies. The EMS medical director has an important role as the bridge between the inner and outer frames.

Such a framework can guide EMS systems at different stages of development. For example, in certain systems, the cultural views of resuscitation may need to be modified for the community element to be effective in improving OHCA survival. Even in more developed systems, the emergency care network can be further developed to allow data sharing to improve OHCA survival outcomes [30]. Community‐oriented approaches in collaboration with organizational stakeholders are essential in facilitating improved cardiac arrest survival. EMS medical directors and agencies cannot successfully care for victims of OHCA in isolation. They must collaborate with the community to optimize all elements of care and should serve leadership roles in this effort.