Background Out of hospital cardiac arrest (OHCA) is a major public health problem affecting greater than 356,500 persons annually in the UnitedStates. Although basic life support (BLS) interventions such as CPRand defibrillation form the foundation of OHCA resuscitation, efforts toimprove OHCA outcomes led to the introduction of advanced level in-terventions in the out-of-hospital setting. The contemporary model ofEmergency Medical Services (EMS) OHCA care in North America en-compasses simultaneous response of providers capable of BLS care with those capable of advanced life support (ALS) interventions such as endotracheal intubation, manual defibrillation, and intravenous drug therapy