b"CARES 2023 Annual ReportOHCAs in Urban vs Rural settings:Studies have revealed that the management and outcomes of OHCA cases differ significantly between urban and rural settings. Urban areas are densely developed territories that include residential, commercial, and other nonresidential urban land uses. To be classified as urban, an area must have at least 2,000 housing units or 5,000 people. All population, housing, and territory not included within an urban area are designated as rural (non-urban). 8Rural OHCAs present several challenges for effective care and outcomes, such as delays in defibrillation and longer distances to hospitals offering advanced post-resuscitation care. Kragholm et al. (2020) 6utilized Environmental Systems Research Institutes (ESRI's) GIS mapping software to analyze the spatial distribution of OHCA cases in urban and non-urban areas. This mapping approach allowed researchers to visualize the geographic patterns of OHCA incidence, the locations of EMS agencies, and the proximity of hospitals providing post-resuscitation care. By mapping these data, the study could assess the geographic accessibility of advanced care facilities for OHCA patients in both urban and non-urban settings. Results highlighted significant differences in care and outcomes between urban and non-urban settings. Non-urban OHCAs experienced longer median times to defibrillation (8 vs. 6 minutes) and longer median distances to hospitals with post-resuscitation care (27.3 vs. 5.7 miles) compared to urban OHCAs. Despite similar rates of bystander CPR between urban and non-urban areas (53.3% vs. 54.4%), survival rates to hospital discharge were notably lower in non-urban areas compared to urban areas (9.3% vs. 13.7%). However, upon adjusting for covariates, the differences in survival rates did not reach statistical significance. Non-urban OHCAs were less likely to receive advanced airway management (6.5% vs. 11.6%) and less likely to achieve return of spontaneous circulation (ROSC) in the field (32.3% vs. 38.8%) compared to their urban counterparts. These results highlight the disparities in care and outcomes for OHCA patients in non-urban areas, emphasizing the need for targeted interventions to improve access and quality of care in these regions. Building off this study, Grubric et al. (2022) 7used a two-level multivariable logistic regression analysis, with CARES patients nested within EMS agencies, to examine the association between bystander interventions CPR alone or automated external defibrillator (AED) use and survival to hospital discharge with good neurological outcome. The analysis calculated crude odds ratios (ORs) and adjusted ORs (AORs) with 95% confidence intervals (CIs), using no bystander intervention as the reference. The adjusted model controlled for various confounders such as age, sex, race/ethnicity, arrest etiology, witness status, rhythm type, arrest location, year of arrest, median household income, and EMS response time. Table 1. Bystander AED Use and CPR Impact on Survival with CPC 1 or 2 Across the Urban-Rural Spectrum: AOR (95% CI).50 51"