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Over half a million people experience sudden cardiac arrest (SCA) in the U.S. every year.1 Adults who are in the hospital when this occurs have a roughly 25 percent chance of survival.2,3 And although that figure would likely improve with more consistent implementation of best practices,4-6 it’s still far better than the chances of survival when cardiac arrest occurs outside the hospital (OHCA).

Unfortunately, OHCA accounts for more than half of these events — around 383,000 per year — and carries a survival rate below 10 percent.7 This discrepancy in survival is primarily due to the reduced likelihood and/or speed with which OHCA victims receive potentially life-saving resuscitation treatment. 

After all, in a hospital, patients are surrounded by trained professionals who have all the medications and equipment they need within arms’ reach. But even without a medical degree or supplies, non-clinical bystanders can triple a victim’s chances of surviving cardiac arrest by providing basic life support (BLS).7

BLS skills are relatively easy to learn — so why are professional EMS responders often the first to use them? Keep reading to find out — and to learn about strategies for equipping more non-clinical bystanders with BLS skills that could prevent thousands of deaths per year.

The Current State of BLS Training

In the most general terms, basic life support skills for bystanders include8,9:

  • Recognizing the signs of cardiac arrest, such as sudden collapse with no detectable pulse or breathing.
  • Properly performing cardiopulmonary resuscitation (CPR) or, essentially, pushing hard and fast on the center of the chest.
  • Using an automated external defibrillator (AED) to assess the need for and deliver an electric shock that could bring the heart back into a normal rhythm. These can be found in most public places, including offices, schools, shopping malls, grocery stores, and airports.

These skills are simple enough that virtually anyone can learn them. Yet only 32 percent of cardiac arrest victims receive assistance from a bystander.7 There are two main issues at work here.

1. Not enough people receive BLS training. 

Considering the extremely high prevalence of cardiac arrest in the U.S., it’s shocking that BLS certification is not more widespread — or at the very least mandatory for professionals in high-risk fields. Requirements vary from state to state, but there are no universal guidelines for:

  • Athletic coaches, personal trainers, gym employees, and physical therapists – People overexerting themselves while exercising are at risk of going into cardiac arrest. You might assume someone nearby in these situations would have BLS training — but you would likely be wrong.
  • Teachers, school staff, and childcare professionals – Cardiac arrest affects people of all ages. But if a child collapses unresponsive at school, day care, or an after-school program, there’s no guarantee that the adult in charge will be able to help.
  • The general public – Over 1,000 cardiac arrests occur outside of hospitals every day in the U.S.7 And the speed with which a victim receives BLS assistance directly impacts their chances of survival.10 Yet there is no nationally mandated BLS training program to help ensure more people have access to this life-saving knowledge.

2. BLS training and skills lapse.

It’s critical that those who receive BLS training work to maintain their knowledge over time. Even clinicians who are required to have a BLS certification must regularly practice or attend refresher sessions to keep their muscle memory sharp. This is especially true for CPR, as retention time for these skills can be as low as three months.11 

This is likely why 70 percent of Americans feel helpless to act in an emergency cardiac arrest event.7 Although retention is typically much better for use of an AED, it’s still not as simple as a “one-and-done” session. Of course one session is preferable to no training at all and, unfortunately, more than most people across the U.S. get.

Improving Access to BLS Training

So how can we ensure more non-clinical bystanders are equipped to assist victims of sudden cardiac arrest? The following strategies might take some time and effort to implement — but the lives saved would be well worth the trouble.

1. Make annual BLS training mandatory for all public school students.

There are nearly 50 million public school students in the U.S. today.12 And while many states mandate that all students must learn at least some elements of BLS before highschool graduation, none require ongoing training or refreshers.

If we teach all public school students basic life support every year, we will dramatically increase the likelihood that any given victim of sudden cardiac arrest would be in the same room as a skilled bystander. Plus:

  • Annual reinforcement will help to strengthen their skills and knowledge over time until BLS becomes second nature, like fundamental math and reading.
  • Kids are likely to share their knowledge with their less-informed family members, helping to equip even more people with life-saving skills. 
  • The impact could be especially significant for low-income and minority communities, which are affected disproportionately by SCA fatalities.13

The American Heart Association has already developed a CPR in Schools course that is easy to understand, caters to many learning levels, and covers all aspects of CPR, including hands-only CPR, and how to use an AED. And for a one-time investment of only a few hundred dollars per school on a kit that can be used by any instructor* to facilitate the course, this would be very easy and inexpensive to incorporate into one health or sports course annually.

2. Make BLS certification mandatory and free for professionals in high-risk jobs.

If you manage a sports team, physical therapy practice, child care facility, or school, you could make BLS certification a requirement for your employees. It would be important to subsidize this effort so there’s no out-of-pocket cost for your staff, but the investment would be well worthwhile in value to your customers and the community.

If you run any business, in fact, you may want to consider this option, as OSHA recommends that every business include one or more employees who are certified in first aid, including CPR.

3. Institute hospital-led community outreach training programs.

If you manage a hospital, you could organize free BLS training programs for your area. This would help to not only equip more non-clinical bystanders with BLS skills, but also strengthen your hospital’s ties to the local community.

In Short, Anything is Better Than Nothing.

While OHCA can be scary and stressful, a bystander equipped with basic life support skills can make all the difference. Whether you’re advocating to teach CPR annually in your local school, subsidizing BLS certification for your own employees, organizing a community outreach program at your hospital, or even just seeking your own BLS certification — you’re taking critical steps toward a safer, healthier future.


Ready to Learn More?

Now that you’ve read about out-of-hospital cardiac arrest, learn about the prevalence and impact of in-hospital cardiac arrest — and what hospitals can do to save more lives. It’s all in our blog, In-Hospital Cardiac Arrest: The Elephant in the Hospital Room.


  2. Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019 July;12:1-8.
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  4. IOM (Institute of Medicine). 2015. Strategies to improve cardiac arrest survival: a time to act. Washington, DC: The National Academies Press.
  5. Chan PS, Krein SL, Tang F, et al. Resuscitation practices associated with survival after in-hospital cardiac arrest: a nationwide survey. JAMA Cardiol. 2016;1(2):189-197.
  6. Kronick SL, Kurz MC, Lin S, et al. Part 4: systems of care and continuous quality improvement. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(suppl 2): S397-S413.
  7. Cpr statistics – aha cpr & first aid blog. (n.d.).
  10. Bobrow, B. J., & Panczyk, M. (2018). Time to compress the time to first compression. Journal of the American Heart Association, 7(9).
  11. Kovács, E., Jenei, Z., Csordás, K., Fritúz, G., Hauser, B., Gyarmathy, V., Zima, E., & Gál, J. (2019). The timing of testing influences skill retention after basic life support training: A prospective quasi-experimental study. BMC Medical Education, 19(1).
  12. Fast facts: Back-to-school statistics (372). (n.d.). Retrieved March 11, 2022, from
  13. Girotra S, van Diepen S, Nallamothu BK, Carrel M, Vellano K, Anderson ML, McNally B, Abella BS, Sasson C, Chan PS; CARES Surveillance Group and the HeartRescue Project. Regional variation in out-of-hospital cardiac arrest survival in the United States.Circulation. 2016; 133:2159–2168. doi: 10.1161/CIRCULATIONAHA.115.018175
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