The addition of advanced-life-support interventions did not improve the rate of survival after out-of-hospital cardiac arrest in a previously optimized emergency-medical-services system of rapid defibrillation. In order to save lives, health care planners should make cardiopulmonary resuscitation by citizens and rapid-defibrillation responses a priority for the resources of emergency-medical-services systems.

UT-OF-HOSPITAL CARDIAC arrest survival remains poor in most jurisdictions more than 30 years after Pantridge and Geddes 1 introduced the concept of providing advanced cardiac life support (ACLS) care to patients with cardiac arrest outside of the hospital setting with mobile intensive care vehicles in Belfast. Reported cardiac arrest survival rates range from 1% to 20%, 2,3 and this variation can be attributed, in part, to community differences in the "chain of survival" as described by the American Heart Association. 4,5 Ideally, communities would optimize all 4 links: (1) rapid access through a 911 telephone system, (2) early cardiopulmonary resuscita-Author Affiliations and Financial Disclosures are listed at the end of this article.

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