This paper provides a human face to advanced life support (ALS) and its assention within rural nursing practice. Over the past 5 years the issue of defibrillation and who performs it has been debated. This paper will add to the discussion. It examines the history surrounding the development of ALS, education within the hospital and isolated rural setting competency testing. It questions the limited role of current nursing practice and makes recommendations for stretching the boundaries of the nursing role in ALS. Emphasis is placed on the rural perspective and its consequent implications for individuals living in a rural environment.