Resuscitation 83 (2012) 1067–1071 Contents lists available at SciVerse ScienceDirect Resuscitation jo u rn al hom epage : www.elsevier.com/locate/resuscitation Clinical paper Engaging a whole community in resuscitation  Anne Møller Nielsen a,* , Dan Lou Isbye a , Freddy Knudsen Lippert b , Lars Simon Rasmussen a a Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark b Emergency Medicine and Emergency Medical Services, Head Office, The Capital Region of Denmark, Kongens Vænge 2, 3400 Hillerød, Denmark a r t i c l e i n f o Article history: Received 29 December 2011 Received in revised form 8 March 2012 Accepted 22 April 2012 Keywords: Cardiopulmonary resuscitation Out-of-hospital cardiac arrest Community-based DVD-based basic life support training Survival a b s t r a c t Background: Survival after out-of-hospital cardiac arrest (OHCA) is influenced by each link in the chain of survival. On the Danish island of Bornholm (population 42,000, area 588 km 2 ) none survived an OHCA in 2001–2003. Therefore, we designed a multifaceted community-based approach aiming at strengthening each link in the chain of survival. The purpose of this study was to evaluate the effect of implementation of the intervention on bystander basic life support (BLS) rates and survival to hospital discharge after OHCA. Methods: Laypersons completed 24-min DVD-based-self-instruction BLS courses in schools and work- places or 4-h BLS/automated external defibrillator (AED) courses. The local television station had broadcasts about resuscitation. The ambulance personnel were trained and the staff at the island hospital completed BLS courses or more advanced courses. Results: During 2 years 9226 people (22% of the population) completed the short course and 2453 (6% of the population) completed the 4-h course. The number of AEDs increased from 3 to 147. The bystander BLS rate for OHCAs with a presumed cardiac aetiology (N = 96, incidence 114/100,000 person-years) was 47% [95% CI 30–50] and for witnessed OHCAs (N = 35) it increased significantly from 22% (2004) to 74% [95% CI 58–86]. The AEDs were deployed in 9 cases. Survival to discharge for all-rhythms OHCA was 5.4% [95% CI 2–12], and for witnessed ventricular fibrillation (N = 17) 18% [95% CI 5–42]. Conclusion: Strengthening all links in the chain of survival was associated with significant increases in bystander BLS rates and survival after OHCA on a rural island. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health problem in the industrialised world. Survival rates vary consider- ably, but are generally below 10%. 1 Actions needed to improve the dismal survival rate are well described in the chain of survival. The first link indicates the importance of recognising an impending car- diac arrest and activating the Emergency Medical Services (EMS). The central links emphasises the importance of early bystander basic life support (BLS) to maintain a circulation until attempted defibrillation can occur. The final link focuses on post-resuscitation care in order to preserve myocardial and cerebral function. 2 Imple- mentation of the initiatives in the chain of survival is the key to improved survival. On the Danish island of Bornholm 22% of witnessed OHCA patients received bystander BLS in 2004 and none survived an OHCA in 2001–2003. 3 To improve this situation we designed a  A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.04.012. * Corresponding author. Tel.: +45 3545 3478; fax: +45 3445 2950. E-mail address: mnielsen.anne@gmail.com (A. Møller Nielsen). multifaceted approach to engage layperson in resuscitation and improve the quality of care provided by health care professionals. Recognising that cost, time and logistics are barriers towards widespread BLS training 4 we focused on short DVD-based self-training courses 5–7 in schools and workplaces to enhance implementation. Layperson incentive was reached through local television campaigns. Being able to improve survival on Bornholm, which is rural and with most OHCAs being unwitnessed, would mean that the initiatives might be more effective in other places and thus the intervention could provide a template for other regions. Our hypothesis was that implementation of this multifaceted community-based intervention would increase the bystander BLS rate and survival rate after OHCA. The purpose of this study was to evaluate the effect of the intervention on bystander BLS rates and survival to hospital discharge after OHCA of presumed cardiac aetiology. 2. Methods 2.1. Study design, setting and population This prospective, community-based cohort study was con- ducted on the Danish island of Bornholm from September 28th 0300-9572/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2012.04.012