The chance of survival from a prehospital cardiac arrest has increased enormously in recent years thanks to the efforts of civilian first responders. They can start CPR and possibly defibrillate while waiting for the ambulance. These civilian first responders regularly include professional caregivers who can provide advanced life support (ALS) together with ambulance personnel. This article describes the opportunities and challenges, and discusses competence and ability, the use of expertise, and crew resource management (CRM) to ensure that the available knowledge and skills are managed in the right direction. This can further improve the quality of patient care and thus increase the chance of survival.