Out-of-Hospital Cardiac Arrest: A Strategy for Scotland

The Out-of-Hospital Cardiac Arrest(OHCA) strategy, which has been developed in collaboration with a range of stakeholders, is a 5 year plan with the aim of ensuring that by 2020 Scotland becomes an international leader in OHCA outcomes. The headline aim is to save an additional 1,000 lives by 2020.


This strategy, which has been jointly produced by a broad coalition of stakeholders, sets out our commitment to improve outcomes after out-of-hospital cardiac arrest (OHCA) and an ambition that by 2020 Scotland will be an international leader in the management of OHCA.

  • We aim to increase survival rates after OHCA by 10% across the country within five years. Reaching this level of performance would mean around 300 more lives being saved every year compared to recent years. Starting an improvement programme now could result in a total of 1,000 additional lives saved by 2020.
  • We aim to equip an additional 500,000 people with CPR skills by 2020. Increasing the incidence of bystander CPR is the cornerstone of improving outcomes because prompt bystander CPR can increase the likelihood of survival after OHCA by 2 or 3 times.

Out-of-hospital cardiac arrest (OHCA) remains a significant healthcare challenge in Scotland. Approximately 3,500 patients undergo attempted resuscitation each year after OHCA. Nationally, survival rates from this condition are low compared to the European average, with considerable variation in outcomes between communities. European centres with the best survival rates return almost a quarter of all OHCA victims home alive. In Scotland around 1 in 20 survive to hospital discharge.

The key factors in determining survival from OHCA are early, high quality cardiopulmonary resuscitation (CPR) and counter-shock therapy (defibrillation). All patients who have a survivable cardiac arrest require CPR and the majority also require defibrillation, both of which must be applied in a matter of minutes in order to be successful. CPR and defibrillation can be performed by ambulance first responders, other first responders in the community, or bystanders (if equipment and instruction are made rapidly available). The interplay of these key elements forms the 'Chain of Survival' which a person must successfully pass through in order to go home from hospital neurologically intact. Optimising the Chain of Survival across the whole system of OHCA management means delivering:

  • Prompt recognition of OHCA and call for help
  • Early, high quality cardiopulmonary resuscitation (CPR) to buy time
  • Early defibrillation to restart the heart
  • Rapid access to advanced resuscitation skills (e.g. airway management, oxygen therapy, fluid resuscitation and drugs) for those requiring further resuscitation
  • Prompt, high quality post resuscitation care
  • Transport to the nearest appropriately equipped centre for specialist support. After the return of a pulse (ROSC - return of spontaneous circulation) patients usually require admission to an Intensive Care Unit (ICU) with Cardiology input to preserve heart and brain function
  • Co-ordinated rehabilitation services to care for patients and their families

It is essential that the Chain of Survival is underpinned by good data. A comprehensive registry of OHCA cases is at the heart of all the conspicuously successful centres around the world. Scotland's uniquely rich healthcare data offers the possibility of a truly world-leading system, collating information about the whole chain of survival across the whole of the country. This would be a powerful driver for improvement.

The success of this strategy will depend upon the commitment and action of many individuals and organisations. It will require concerted clinical and political leadership and a change in culture around OHCA. A coalition of stakeholders including emergency services, primary and secondary healthcare providers, third sector groups and academics will be required to ensure impact, efficacy and sustainability of a national solution to increased survival from OHCA.

Implementation of this national strategy will be focused on the following aims:

A. Early Recognition

Aim: To ensure that those who witness an out-of-hospital cardiac arrest (OHCA) promptly call 999 and are enabled to carry out immediate Cardio-Pulmonary Resuscitation (CPR) and use a Public Access Defibrillator (PAD), where available, until support arrives.

B. CPR (Cardio-Pulmonary Resuscitation)

Aim: To increase the rate of bystander CPR.

Aim: To equip an additional 500,000 people with CPR skills by 2020 and create a nation of life savers.

C. Defibrillation

Aim: To rapidly deploy available assets which routinely carry defibrillators - ambulances and others where appropriate such as Scottish Fire and Rescue Service (SFRS) and Community First Responders.

Aim: To put in place effective arrangements to ensure that Public Access Defibrillators (PADs) are mapped, maintained and accessible to the public.

D. Pre-Hospital Advanced Life Support

Aim: To ensure high quality resuscitation is delivered consistently in the pre-hospital care environment.

Aim: To ensure that patients - either during or after cardiac arrest - are taken to a location with appropriate post cardiac arrest care.

E. Post Resuscitation Care

Aim: To ensure that patients treated in hospital following OHCA receive optimal care.

F. Rehabilitation and Aftercare

Aim: To ensure that post event care and support is available to patients and their families/carers after OHCA.

Aim: To ensure that bystanders and others impacted by OHCA are supported after the event.

G. Culture and Context

Aim: To collect, analyse and report accurate and complete data on OHCA in order to inform decision making and improve outcomes after cardiac arrest.

Aim: To improve and simplify the capture of data by SAS to support clinical care and contribute to the cardiac arrest registry.

Aim: To reduce inequalities in survival after OHCA.

Aim: To strive to ensure that communities in remote and rural locations have equity of treatment for OHCA.

Aim: To encourage a greater public awareness of the 'right thing to do' and an increased willingness to help when present as a bystander at an OHCA.

Aim: To engender the belief amongst staff and members of the public that with effective action, OHCA can be a survivable event.

Aim: To develop and maintain an environment which supports innovation and research leading to improved outcomes in OHCA.


Email: David Cline

Back to top