Background and aims: Pediatric out-of-hospital cardiac arrest (POHCA) has less than 10% survival. Optimal scene time and emergency medical services (EMS) response are unknown. Aims: To determine if advanced life support skills and longer scene time would result in improved survival in POHCA. Methods: We studied patients, aged 3 days to 19 years, with non-traumatic OHCA from 2005 to 2012 using the Resuscitation Outcomes Consortium database from 11 regions in North America to determine the relationship between demographics, event characteristics, the level and timing of EMS care, times on the scene and survival to hospital discharge. Results: Data was available for 2239 patients (933 infants, 663 children, 644 adolescents). Infants had the lowest rate of survival (3.5%) compared to children (9.4%) and adolescents (16.1%). The study site and time on scene were associated with survival (p < 0.0001 and p = 0.01, respectively) with the greatest survival rates occurring with scene times between 10 and 30 minutes. There was a negative association with resuscitation medication delivery and survival (p<0.001). An EMS team with advanced life support skills was present for most patients (97.1%). Defibrillation, the arrival time of an advance life support EMS team and attempts to establish an advanced airway were not however associated with improved survival. Conclusions: This study highlights the importance of EMS staying on the scene beyond 10 minutes to provide basic life support while minimizing interruptions for advanced airway insertion. Patients who respond to these measures are more likely to survive than those requiring medications during resuscitation on the scene.