The problem was the Los Angeles Fire Department had not evaluated National Association of Emergency Medical Dispatch (NAEMD) Medical Priority Dispatch System Beta Version 11.2 C-Card "C-Card Airway/Arrest/Choking (Unconscious) Adult -greater than or equal to- 8 YRS", pre-arrival instruction for out-of-hospital cardiac arrest incidents. The purpose of this study was to conduct an assessment of the impact of the Beta Version 11.2 C-Card, which includes a "compression first" component, on out-of-hospital cardiac arrest Return of Spontaneous Circulation, Bystander CPR and Pre-Arrival Instruction compliance. This was an evaluative research project. The research questions were: 1.How did the level of dispatcher pre-arrival instruction compliance for cardiac arrest incidents before implementation of Beta Version 11.2 C Card compare to dispatcher pre-arrival instruction compliance for cardiac arrest incidents after implementation? 2. What was the level of Return of Spontaneous Circulation both before and after implementation of the Beta Version 11.2 C Card Protocol? 3. What was the level of Bystander CPR before and after implementation of the C Card Protocol? The procedure involved identifying the non-pediatric non-traumatic cardiac arrest incidents through the Cardiac Arrest Database, EMS Report Forms (F-902M), and compliance evaluation of Cardiac or Respiratory Arrest / Death, Workable Arrest (9E) dispatch audiotapes received at the Quality Improvement Section between January 1, 2004 and April 23, 2005.The pre-arrival instruction compliance evaluation of cardiac arrest incident audiotapes was conducted using National Association of Emergency Medical Dispatch Case Review Scoring Standard (7th Edition) and Medical Priority Consultant's (MPC) quality control software "Advanced Quality Assurance (AQUA)". The level of compliance was tabulated numerically and by percentages. The LAFD Cardiac Arrest database incident information was used to determine the level of Bystander CPR and Return of Spontaneous Circulation (ROSC) cases before and after Beta Version 11.2 Card implementation. Results were tabulated numerically and by percentage. The study results revealed cardiac arrest 9E PAI compliance dropped for the first five months following implementation of Beta Version 11.2 from 70.79% to 67.19%.However, after monthly C-Card Continuing Dispatch Education sessions in January and February 2005, there was a notable increase in March '05 dispatcher 9E PAI compliance to 80%. The level of Bystander CPR remained similar with pre-implementation at 25.53%, post-implementation levels 25.65% and March '05 at 25.97%. The ROSC increased over time from a pre-implementation level of 12.2% to a post level of 15.7% and a final March '05 level of 16.8%. Based on the study results, it is recommended that LAFD should continue to perform a periodic review of cardiac arrest incidents in order to ensure the community efficient and effective early access to appropriate type of dispatch life support. Additionally, continued Continuing Dispatch education (CDE) targeting effective delivery C Card Compression First Instruction is recommended.Finally, a future comparative studies of 9E PAI compliance for compression first verses ventilation first incidents should be conducted to ensure citizen access to the most appropriate and highest quality medical intervention during a sudden death crisis.