Very early and progressive EMS system, driven by people like Dr Copass (https://www.seattletimes.com/seattle-news/health/dr-michael-...) who helped pioneer a lot of what you'd see in EMS in the early 1970s, and came from a very strong focus in cardiac outcomes. Although that would be unfair to Medic One's cofounder, Dr Cobb (also mentioned in that article) - Copass was the director of emergency medicine at Harborview (Seattle's Level 1 Trauma Center) for 35 years, but had a background in neurology, and Dr Cobb was a cardiologist.
Throughout the PNW (or I'm talking specifically the Puget Sound region - Snohomish, King, Pierce and Thurston counties), that has lived on, with a huge emphasis in bystander CPR as well as heavy participation in research around arrest outcomes and survivability.
So, heavily cultural. Though not perfect (there's certainly areas of EMS in the PNW that can be not as progressive - my own county took far too long to change the scope for long backboard use, i.e. spinal immobilization, finding that there was no real evidence to support its use for that purpose, and often caused patient injury/pain/discomfort or poorer outcomes).
Throughout the PNW (or I'm talking specifically the Puget Sound region - Snohomish, King, Pierce and Thurston counties), that has lived on, with a huge emphasis in bystander CPR as well as heavy participation in research around arrest outcomes and survivability.
So, heavily cultural. Though not perfect (there's certainly areas of EMS in the PNW that can be not as progressive - my own county took far too long to change the scope for long backboard use, i.e. spinal immobilization, finding that there was no real evidence to support its use for that purpose, and often caused patient injury/pain/discomfort or poorer outcomes).