A team of researchers from the Duke Clinical Research Institute recently looked at CPR training in 3,143 counties (13.1 million people) in the United States to gauge whether geography and socioeconomics play a part in CPR training and preparedness.

The team discovered that counties with the lowest rates of CPR training (less than 1.29%) were more likely to have a higher proportion of rural areas, black, and Hispanic residents, a lower median household income, a higher median age, and fewer physicians. Counties in the South, Midwest and West were also more likely to have lower rates of CPR training than those in the Northeast.

Unavailability of CPR training organizations in the geographic areas, inability to afford the training courses, or longer travel times are possible reasons the researchers discovered for the lower rate of CPR training in America’s rural counties.

The strongest factor associated with low rates of CPR training was a high proportion of rural residents, according to researchers, who noted that studies of out-of-hospital cardiac arrest (OHCA) in rural areas have consistently shown uniformly poor survival after cardiac arrest — a finding usually attributed to the lack of consistently available paramedic and central dispatcher services. Longer response and transport times for emergency medical services also contribute to poorer survival.

“In this context, singly focusing on efforts to improve CPR and community education programs for use of automated external defibrillators may not improve survival without also addressing longer ambulance arrival times,” the authors noted. “Rather, policy efforts by national associations and federal organizations are needed to address the entire ‘chain of survival’ for prehospital care, including transfer to a tertiary care hospital for rural community residents who experience OHCA.”

Investigators noted that future trials are needed to determine cost-effective and efficacious interventions for rural communities.