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We read with interest Williamson et al’s1 study on the use of audio prompts in automatic external defibrillators to improve cardiopulmonary resuscitation (CPR) in untrained and trained lay subjects. We report a study from an emergency department (ED) using trained ED staff (doctors and nurses) and paramedics. Through our own departmental video audit we have observed great variability in the rate of external cardiac compressions (ECC) (median 140 compressions per minute (cpm); range 100–180 cpm). This rapid rate of ECC is of concern since it is faster than the recommended 100 cpm.2 Studies suggest that rescuers may fatigue after only one minute of CPR3 and there …