Introduction. Because of the high incidence and low probability of a favorable outcome, out-of-hospital cardiac arrest (OHCA) remains one of the major problems of public health globally. The problem of OHCA in the Russian Federation is insufficiently studied, and there is no consistent strategy for decreasing mortality after OHCA so far. Aim. To investigate the state of the problem of OHCA in Russia, and to determine prioritised organisational measures aimed to improve OHCA survival. Material and methods. We analysed foreign and domestic studies concerned with OHCA epidemiology, outcomes of OHCA management, and development of methods for increasing effectiveness of OHCA management. Results. The lack of unified surveillance system for monitoring OHCA epidemiology, process and outcomes of prehospital management of OHCA in Russia, as well as the paucity of domestic research in this area, prohibit an objective evaluation of the extent of the problem at the country level. Results of a study of OHCA epidemiology in the Republic of Crimea confirm the high incidence of OHCA (689 cases of OHCA attended by emergency medical services (EMS) per 100,000 person-years) and the poor survival of victims (5%) despite resuscitation attempts. The main reason for the high mortality in OHCA is a delay in the provision of care, which is attributable to very rare cases of bystander resuscitation attempted before EMS arrival (no more than in 9% of cases). A survey of Crimean inhabitants showed that a low motivation towards the provision of first aid (FA) in OHCA is associated with insufficient knowledge and skills of cardiopulmonary resuscitation, that in turn is related to poor awareness of the OHCA problem and limited availability of the training. An analysis of web resources, which proposed anybody who wants to complete training in basic life support in the form of courses in the Russian language, demonstrated that the courses are few and mostly paid, while geography of the classroom training is limited to several dozens of Russian cities and towns. Low motivation of people towards provision of FA is also due to the shortcomings of the existing legal framework that regulates FA provision and FA training in Russia. Conclusions. The observed epidemiologic characteristics of OHCA in the Republic of Crimea suggest that in the Russian Federation the number of EMS-attended OHCA cases exceed 1 million per year, with mortality about 95%. As long as the high mortality in OHCA is primarily related to inability of bystanders to provide FA in due time, the measures aimed at maximal intensification of the lay public involvement into the process of care, including massive public training in FA and implementation of a dispatcher-assisted cardiopulmonary resuscitation program, alongside with institution of procedures for epidemiologic surveillance and enhancement of the legal regulation in regard to FA, constitute the priorities of organisational efforts.