Considerable effort and large sums of money have been spent on constructing a risk profile for sudden death in the myocardial infarction survivor at the time of discharge from hospital. However, these patients are only a minority among those dying suddenly outside hospital. The majority of sudden death victims cannot be identified before the event and their survival depends on the presence of people knowing how to perform basic life support and the rapid availability of advance life support systems. This suggests that measures other than the assignment of expensive therapy to a small segment of the population might be more cost effective and numerically more successful.