Introduction: Incidence and survival rates following cardiac arrest vary significantly across Europe. While several studies have sought to address the knowledge gap in the epidemiology of out-of-hospital cardiac arrest (OHCA), they have not successfully identified the reasons behind these disparities. This study aims to provide an updated overview of European Emergency Medical Systems (EMS). Methods: A questionnaire consisting of 35 main questions was used. The survey encompassed topics related to ambulance and dispatch characteristics, on-scene cardiac arrest management, as well as the availability and scope of datasets in cardiac arrest registries. Results: Survey responses were received from 27 European countries. While there were differences in the proportion of staff with advanced life support skills between countries, these staff were almost invariably dispatched in the event of a cardiac arrest call. First responder systems were available in only 17 countries. There were huge differences in ambulance control models, with the number of dispatch centres ranging from 0.4 to 42.2 per million population. Nine countries reported having out-of-hospital registries of prehospital cardiac arrest with national coverage while only three countries had registries of in-hospital cardiac arrest with full coverage. Conclusions: There are differences in EMS structures and the management of OHCA across Europe. Understanding these discrepancies is essential for improving OHCA outcomes and fostering greater uniformity in emergency response protocols throughout the region. Although there has been an increase in the population covered by a cardiac arrest registry, there is still a need to expand registry coverage, especially for registries of in-hospital cardiac arrest. © 2025 The Author(s)