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Systemic solutions to the Chinese puzzle
  1. Andrew S Lockey
  1. Emergency Department, Calderdale Royal Hospital, Halifax, UK
  1. Correspondence to Dr Andrew S Lockey, Accident and Emergency, Calderdale Royal Hospital, Halifax HX3 0PW, UK; Andrew.lockey{at}

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There is an old saying that ‘you can lead a horse to water, but you can’t make it drink’. This is particularly true if (1) the horse is not thirsty, (2) the guide does not know the way, (3) the water is unpleasant to drink, (4) there is no water or (5) the horse is perfectly happy where it is! In other words, there are multiple complex factors that need to be addressed to influence one seemingly simple behavioural change.

This is especially relevant in the quest to improve survival rates from out-of-hospital cardiac arrest (OHCA). The International Liaison Committee on Resuscitation (ILCOR) have recently published updated recommendations for cardiac arrest management.1 They emphasise the importance of evaluating performance in communities with OHCA and subsequently targeting these key areas in order to improve patient outcomes. The use of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is one of many evidence-based approaches advocated by ILCOR to increase survival, although studies providing evidence for its successful implementation are generally from communities where bystander awareness and training in cardiopulmonary resuscitation (CPR) already exists, or DA-CPR is one part of a suite of interventions.1 The Global Resuscitation Alliance (GRA) also details ten programmes that they …

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  • Handling editor Ellen J Weber

  • Contributors ASL is the sole contributor to this manuscript.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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