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JAMA. 1992;268(16):2289-2295.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

IN RECENT YEARS many clinicians, administrators, and researchers have recognized the need to improve the total emergency cardiac care (ECC) system to optimize patient survival. This section presents the structural components of a "chain of survival" required to save victims of out-of-hospital cardiac arrest (Fig 1)¹ and presents methods for evaluation of an emergency system. Communities must identify weaknesses in the ECC system, implement modifications, and optimize treatment for these critical patients.² Methods for achieving an effective emergency medical services (EMS) system as discussed here are Class I recommendations (definitely effective) (see p 2174).

The central issue is whether a community's ECC system results in optimal patient survival. Achieving the optimal survival rate for out-of-hospital cardiac arrest in every community is the challenge now and in the future. However, what is optimal in one community may not be possible in all communities. Early reports of high survival in . . . [Full Text PDF of this Article]

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