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Bystander CPR refers to CPR performed by someone who was already present at or passing by the patient’s location. This contrasts with CPR performed by dispatched emergency responders. Bystanders have the earliest opportunity to provide CPR to the cardiac arrest victim. Multiple studies have demonstrated the survival benefit of bystander CPR, as well as the increase in mortality associated with delays in CPR delivery [35, 36]. EMS medical directors and agencies should monitor and optimize the rate of bystander CPR in their communities [37]. Prior efforts have included community education about OHCA and the importance of CPR, increasing access to training, and teaching CPR in schools to develop a culture of bystander assistance.

Table 12.1 CARES Public Reporting of State Aggregate Metrics, 2019.

Source: Reproduced with permission from CARES 2019 Annual Report. Available at: https://mycares.net/sitepages/uploads/2020/2019_flipbook/index.html?page=39. Accessed August 30, 2020. © 2019, MyCares.net.

State	OHCA Incidence	Non‐Traumatic Etiology Survival Rates	Bystander Intervention Rates
CARES Cases Reported (n)	2019 CARES Population Catchment (n)	2019 Total State Population (n)	Population Covered (%)	Incidence Rate (per 100,000)	Overall Survival to Hospital Discharge (%)	Utstein Survival (%)	CPR (%)	Public AED Use (%)
National	100,956	131,905,913	328,239,523	40.1	76.5	10.5	33.2	41.2	12.2
Alaska	394	611,330	731,545	83.6	64.4	16.0	44.1	73.3	2.7
California	16,100	24,681,023	39,512,223	62.5	65.2	9.0	32.1	43.5	12.0
Colorado	2,074	3,616,495	5,758,736	62.8	57.4	12.3	39.4	41.7	15.1
Delaware	1,165	967,171	973,764	99.3	120.5	11.8	30.4	36.2	6.5
Hawaii	1,321	1,415,872	1,415,872	100.0	93.3	11.3	31.4	49.2	13.2
Michigan	7,727	7,896,597	9,986,857	79.1	97.9	8.7	30.3	40.2	13.9
Minnesota	2,537	4,887,375	5,639,632	86.7	51.9	13.5	38.5	37.5	14.1
Mississippi	1,825	1,778,516	2,976,149	59.8	102.6	6.0	22.1	36.5	10.1
Montana	507	642,348	1,068,778	60.1	78.9	11.2	36.8	48.5	5.2
New Hampshire	1,059	1,359,711	1,359,711	100.0	77.9	10.2	28.2	53.5	14.4
North Carolina	5,965	7,114,453	10,488,084	67.8	83.8	12.6	32.4	37.1	13.6
Oregon	2,410	3,895,582	4,217,737	92.4	61.9	14.7	35.6	57.4	13.9
Pennsylvania	8,013	9,973,687	12,801,989	77.9	80.3	9.5	31.4	36.4	10.0
South Carolina	2,551	2,760,590	5,148,714	53.6	92.4	11.8	28.2	37.4	10.9
Utah	1,321	3,161,105	3,205,958	98.6	41.8	8.6	26.8	36.9	10.2
Vermont	4,81	623,989	623,989	100.0	77.1	10.2	36.0	43.0	6.6
Washington	4,210	7,273,113	7,614,893	95.5	57.9	15.0	42.5	57.3	12.2
District of Columbia	886	702,455	705,749	99.5	126.1	7.7	31.0	33.6	6.9

Figure 12.2 The frame of survival. Source: Nadarajan GD, Tiah L, Ho AFW, et al. Global resuscitation alliance utstein recommendations for developing emergency care systems. Resuscitation 2018;132:85–8. Used with permission of Elsevier.

When callers do not know CPR, the telecommunicator should provide real‐time instructions over the phone. Most current dispatch protocols include detailed, specific CPR instructions [38]. Growing evidence suggests that properly performed chest compressions are more important than ventilations [39–40]. The AHA recommends that bystanders not trained in CPR and those trained but not confident or willing to perform ventilations should perform chest compression‐only CPR until a defibrillator is ready for use [41]. Many emergency dispatch protocols now favor providing instructions only for chest compressions. Unrecognized fatigue is common after just 1‐2 minutes, so bystanders providing chest compressions should switch frequently [42].