In Reply.鈥擠r Meyer and colleagues raise an interesting point regarding resuscitation of victims of out-of-hospital cardiac arrest. We agree that the most important prognostic factor in the ultimate survival of victims of out-of-hospital cardiac arrest is the length of time between arrest and the administration of definitive resuscitation. This point is well supported in the literature.1-6 Computerized dispatching of ambulances, 911 numbers, mobile intensive care units, citizen cardiopulmonary resuscitation education, and the availability of highly trained paramedics has clearly lowered the average response time and increased the survival rate in such urban areas as King County, Washington1,4,5 and Hennepin County, Minnesota.3 However, these maneuvers have not yet been proven effective in rural communities.6 Their proposal to include physicians as first (or second) responders in the field may prove effective in urban areas, but is probably impractical for rural areas. Additionally, cost factors should be considered