C.A.R.E.S. Cardiac Arrest Registry to Enhance Survival

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

3. A Time-Critical EMS Condition 100 80 Survival reduced by ~7-10% each minute defibrillation delayed 60 Survival Rate (percent) 40 20 0 5 10 15 20 25 Time to Defibrillation(minutes)

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

7. 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

8. “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

9. 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

10. 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.”

12. CARES SURVEILLANCE NETWORK

13. CARES DATABASE • Sansio • Mainframe housed in Duluth, MN • Internet database system • https://mycares.net • HIPAA compliant security • Unifies EMS, 911, and Hospital data • Any EMS system throughout US

14. NEMSIS

15. EMS COMPONENT THREE DATA COLLECTION OPTIONS Mobile Field Entry Optically Scanned Form Direct Entry Online

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

17. HOSPITAL COMPONENT

18. COMPUTER AIDED DISPATCH (CAD)COMPONENT

19. 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.

20. 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.

25. Location Demographics

26. CARES Summary Report – Sample

27. CARES Summary Report – Sample UTSTEIN SURVIVAL

28. CARES Summary Report – Sample BYSTANDER CPR RATES

29. CARES Current & Focus Sites (2008-2009)

31. Insert TOR Article

33. 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

34. SOFTWARE DEMONSTRATION

35. https://mycares.net/ • This presentation and more information about the program can be found on the CARES website under the NAEMSP tab.