The critical first step is recognition of out-of-hospital cardiac arrest (OHCA) and an appropriate response to the emergency. Most Americans are aware that they are expected to activate the EMS system in an emergency and are more than willing to dial 911. Taking the next step to actively intervene is challenging. Nationwide, only about 35 percent of OHCA victims receive any CPR prior to the arrival of a 911 responder, and only 3 percent receive the benefit of public access defibrillation.⁵ The reasons for inaction are complex and may include lack of knowledge about what cardiac arrest looks like, a sense of incompetence in performing life-saving actions, a diffusion of responsibility when multiple potential rescuers are present, fear of hurting the victim, and concern about exposure to legal consequences.

Data to quantify the effect that activities such as public service announcements or mass bystander CPR training have on bystander action are limited. Some communities have invested in these types of activities to encourage bystander action with promising results. A marketing campaign may inform potential rescuers about the opportunity to learn life-saving chest compressions. Marketing campaigns may also change the perception of bystanders from a fatalistic view to one that allows the potential for saving the victim; and can also educate about the lack of potential legal liability. The campaign can also change the social expectations for action. Messaging can raise an expectation for action.