title: Engaging a whole community in resuscitation.
abstract: 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 km2) 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 workplaces 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].
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. mnielsen.anne@gmail.com
authors.forename: Anne
authors.initials: A
authors.lastname: Møller Nielsen
authors.forename: Dan
authors.initials: D
authors.lastname: Lou Isbye
authors.forename: Freddy
authors.initials: F
authors.lastname: Knudsen Lippert
authors.forename: Lars Simon
authors.initials: LS
authors.lastname: Rasmussen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012111:Residence Characteristics; D012151:Resuscitation; D015996:Survival Rate