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C.A.R.E.S. Cardiac Arrest Registry to Enhance SurvivalAllie
Crouch, MPHProgram Coordinator
Bryan McNally, MD, MPHPrincipal Investigator
NAEMSP Presentation January 24, 2008
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020406080100Survival Rate(percent)Time to Defibrillation
(minutes)A Time-Critical EMS Condition 510152025Survival reduced by
~7-10% each minute defibrillation delayed
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JAMA, December 18, 2002-Vol 288, No. 23Three-Phase
Time-Sensitive Model of Cardiac Arrest Becker, L., M. Weisfeldt
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Utstein Criteria
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Timely care is vital!Only 1 in 4 victims receives bystander
CPRDefinitive care useless if no ROSC in fieldCurrently, community
survival rates vary by a factor of ten or moreDisparate outcomes
are almost certainly due to timeliness and quality of treatment
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Most cities dont measure their performance effectively, if at
all. They dont know how many lives they are losing, so they cant
determine ways to increase survival rates.
- Robert Davis, USA Today 2003
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Dominos vs. EMSHungry?30 minutes call-to-doorguaranteed.Customer
input for QICost: $9.95 (plus tip)
Cardiac Arrest?Call-to-door time rarely trackedNo performance
metrics, no QI Cost: Priceless
Angelo Salvucci, MD
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IOM Report on Emergency ServicesWhat 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.
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CARES SURVEILLANCE NETWORK
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CARES DATABASESansioMainframe housed in Duluth, MNInternet
database systemhttps://mycares.netHIPAA compliant securityUnifies
EMS, 911, and Hospital dataAny EMS system throughout US
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NEMSIS
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EMS COMPONENTDirect Entry OnlineMobile Field EntryOptically
Scanned FormTHREE DATA COLLECTION OPTIONS
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Hospital ComponentHospital contacts at receiving
facilitiesHospital follow-up only required on patients with:ongoing
resuscitationpresumed cardiac etiologyCARES software generates
email to primary contact at selected Hospital destination.When
CARES dataset is complete, the record is de-identified.
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HOSPITAL COMPONENT
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COMPUTER AIDED DISPATCH (CAD)COMPONENT
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CARES ULTIMATE GOALHelp local EMS administrators/medical
directors identify: Who is affected.When and where cardiac arrests
occurWhich elements of the system are functioning well and those
that are not.How changes can be made to improve cardiac arrest
outcomes.
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CARESCreate 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.
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Chart1
269
621
961
1320
1962
2968
3741
4636
6252
7974
9500
11010
Column2
Total CARES Records
Sheet1
Column1Column2
Dec '05269
Mar '06621
Jun '06961
Sep '061320
Dec '061962
Mar '072968
Jun '073741
Sep '074636
Dec '076252
Mar '087974
Jun '089500
Sep '0811010
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Chart1
5567
3710
18
Gender
Gender Demographics
Null 0.19%
Female 39.91%
Male59.89%
Sheet1
Gender
Male5567.00
Female3710.00
Null18.00
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range.
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Chart1
230
168
392
1057
1802
1871
1714
2006
55
Series 1
Age Demographics
Sheet1
Series 1
0-19230
20-29168
30-39392
40-491057
50-591802
60-691871
70-791714
80+2006
Null55
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range.
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Chart1
84
125
2794
17
3577
59
2062
577
Sales
Ethnicity Demographics
Null1%
Asian1.34%
Black/African-American30.06%
Native Hawaiian/Pacific0.18%
Sheet1
Sales
null84
Asian125
Black/African-American2794
Native Hawaiian/Pacific17
White3577
American-Indian/Alaskan59
Unknown2062
Hispanic/Latino577
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range.
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Location Demographics
Location TypeTotalPercentageHome/Residence601464.70%Public
Building5696.12%Street/Hwy4745.10%Nursing Home/Assisted Living
Center131614.16%Residence/Institution1171.26%Physician
Office/Medical Clinic1972.12%Educational
Institution260.28%Hospital290.31%Recreation/Sport
Facility1251.34%Industry1031.11%Jail430.46%Other2352.53%Airport460.49%Null10.01%Total:9295100%
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CARES Summary Report Sample
Chart1
0.1720.253
0.0320.04
0.1860.229
Agency
National
Sheet1
Column1AgencyNational
Bystander CPR17.2%25.3%
Bystander AED3.2%4.0%
Utstein18.6%22.9%
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range.
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CARES Summary Report SampleUTSTEIN SURVIVAL
Chart1
0.150.231
0.1980.22
0.04950.312
0.1250.337
0.060.176
0.030.111
Agency Utstein
National Utstein
Sheet1
Agency UtsteinNational Utstein
Jan-Feb15.00%23.10%
Mar-Apr19.80%22.00%
May-Jun4.95%31.20%
Jul-Aug12.50%33.70%
Sep-Oct6.00%17.60%
Nov-Dec3.00%11.10%
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range.
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CARES Summary Report SampleBYSTANDER CPR RATES
Chart1
0.150.237
0.2490.225
0.1220.255
0.1890.266
0.1380.26
0.190.281
Agency Bystander CPR
National Bystander CPR
Sheet1
Agency Bystander CPRNational Bystander CPR
Jan- Feb15.00%23.70%
Mar-Apr24.90%22.50%
May-Jun12.20%25.50%
Jul-Aug18.90%26.60%
Sep-Oct13.80%26.00%
Nov-Dec19.00%28.10%
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range.
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CARES Current & Focus Sites (2008-2009)
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Insert TOR Article
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SummaryThe CARES Program:Integrates EMS, 911, and Hospital
components.Provides feedback to healthcare providers and community
stakeholdersAllows systems to internally and externally
benchmarkProvides a model national OHCA surveillance
registry.Ultimate goal to improve survival for OHCA
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SOFTWARE DEMONSTRATION
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https://mycares.net/This presentation and more information about
the program can be found on the CARES website under the NAEMSP
tab.
*CARES is a CDC funded and AHA endorsed program out of Emory
University in Atlanta GA.***For every minute that defibrillation is
delayed, the chances of surviving sudden cardiac arrest (SCA) are
reduced by approximately 10%. Survival chances drop particularly
fast in the first five minutes.Since rapid time to defibrillation
is so critical, expanding the number of early defibrillator
responders offers SCA patients a real chance to survive an
otherwise lethal event.In fact, by extending defibrillation skill
using AEDs to more responders, survival rates have increased
dramatically in some settings; e.g.:40%
survival-to-hospital-discharge (neurologically intact) in
Rochester, MN with police first responders (White RD. Resuscitation
1998).70% survival-to-hospital-discharge in Nevada casinos
(Valenzuela TD Acad Emerg Med 1998).80% survival-to-discharge in
the Chicago Airport System, compared to a 3.5% save rate in Chicago
with a paramedic response (USA Today, December 28, 1999).
***********Since hospital outcomes are critical in determining
survival from out of hospital cardiac arrest, CARES asks for
voluntary participation from every hospital where an EMS agency
transports cardiac arrest patients. A CARES contact is identified
at each participating hospital who is responsible for entering
outcomes for pts transported to their hospital. A CARES event is
initiated by EMS personnel. When it is indicated on an EMS dataset
that the arrest is of presumed cardiac etiology, resuscitation is
attempted by EMS, and there is ongoing resuscitation in the ED, the
CARES software generates a generic email to the hospital contact at
the receiving facility saying a pt has been transported to their
facility. When it is convenient for the hospital contact perhaps
once every two weeks or a month (depending on the call volume) the
hospital contact can log-in and complete the outcomes for pending
pts. The hospital dataset consists of 4 simple questions and only
takes a few minutes to complete. Once a CARES event is complete the
record is scrubbed of all pt identifiers.
We do ask that the CARES data use agreement is signed by a
supervisor at each hospital to ensure confidentiality of data
exchange.*This is just a snapshot of the hospital data entry
screen. You can see the four hospital questions. There is also a
transfer feature where if a pt was transported by EMS to hospital
#1 then the pt was transferred from Hospital #1 to Hospital #2
there is a way to indicate this by selecting the transfer hospital
in the drop-down menu. The hospital contact at #2 gets an email and
the pt is now in there box for pending hospital outcomes. ****In
summary, CARES uses the internet to bring together 3 silos of data
to streamline the data collection process for OHCA. CARES
participants not only have real time access to their own data but
also have access to a de-identified national aggregate report which
allows for both internal and external benchmarking. The ultimate
goal obviously being to improve survival for OHCA.*