C.A.R.E.S. Cardiac Arrest Registry to Enhance Survival Allie Crouch, MPH Program Coordinator Bryan McNally, MD, MPH Principal Investigator NAEMSP Presentation January 24, 2008

Survival Rate (percent) Time to Defibrillation (minutes) A Time-Critical EMS Condition Survival reduced by ~7-10% each minute defibrillation delayed

JAMA, December 18, 2002-Vol 288, No. 23 Three-Phase Time-Sensitive Model of Cardiac Arrest Becker, L., M. Weisfeldt

Timely care is vital! Only 1 in 4 victims receives bystander CPR Definitive care useless if no ROSC in field Currently, community survival rates vary by a factor of ten or more Disparate outcomes are almost certainly due to timeliness and quality of treatment

“Most cities don’t measure their performance effectively, if at all. They don’t know how many lives they are losing, so they can’t determine ways to increase survival rates.” - Robert Davis, USA Today 2003

Domino’s vs. EMS Hungry? –30 minutes call-to-door guaranteed. –Customer input for QI –Cost: $9.95 (plus tip) Cardiac Arrest? –Call-to-door time rarely tracked –No performance metrics, no QI – Cost: Priceless Angelo Salvucci, MD

IOM Report on Emergency Services “What is missing is a standard set of measures that can be used to assess the performance of the full emergency and trauma care system within each community, as well as the ability to benchmark that performance against statewide and national performance metrics.”

CARES SURVEILLANCE NETWORK

CARES DATABASE Sansio –Mainframe housed in Duluth, MN Internet database system – –HIPAA compliant security Unifies EMS, 911, and Hospital data –Any EMS system throughout US

NEMSIS

EMS COMPONENT Direct Entry Online Mobile Field EntryOptically Scanned Form THREE DATA COLLECTION OPTIONS

Hospital Component Hospital contacts at receiving facilities Hospital follow-up only required on patients with: –‘ongoing resuscitation’ –‘presumed cardiac etiology’ CARES software generates to primary contact at selected Hospital destination. When CARES dataset is complete, the record is de-identified.

HOSPITAL COMPONENT

COMPUTER AIDED DISPATCH (CAD) COMPONENT

CARES ULTIMATE GOAL Help local EMS administrators/medical directors identify: –Who is affected. –When and where cardiac arrests occur –Which elements of the system are functioning well and those that are not. –How changes can be made to improve cardiac arrest outcomes.

CARES Create a model cardiac arrest registry capable of identifying and tracking all cases in a defined geographic area. Year One -- Fulton County, Georgia. Year Two -- Multi-County Area of metropolitan Atlanta, Georgia. Year Three (2006) – Began National Expansion. Ultimate goal is to be universally applicable to EMS operations nationwide.

Location Type TotalPercentage Home/Residence % Public Building % Street/Hwy % Nursing Home/Assisted Living Center % Residence/Institution % Physician Office/Medical Clinic % Educational Institution % Hospital % Recreation/Sport Facility % Industry % Jail % Other % Airport % Null1 0.01% Total: % Location Demographics

CARES Summary Report – Sample

UTSTEIN SURVIVAL

CARES Summary Report – Sample BYSTANDER CPR RATES

CARES Current & Focus Sites ( )

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Summary The CARES Program: –Integrates EMS, 911, and Hospital components. –Provides feedback to healthcare providers and community stakeholders –Allows systems to internally and externally benchmark –Provides a model national OHCA surveillance registry. –Ultimate goal to improve survival for OHCA

SOFTWARE DEMONSTRATION

This presentation and more information about the program can be found on the CARES website under the NAEMSP tab.