1/17/2009. NAEMSP Presentation January 24, Survival reduced by ~7-10% each minute defibrillation delayed. Survival Rate (percent)
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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 A Time-Critical EMS Condition Survival Rate (percent) Survival reduced by ~7-10% each minute defibrillation delayed Time to Defibrillation (minutes) 1
2 Utstein Criteria Three-Phase Time-Sensitive Model of Cardiac Arrest Electrical Phase Circulatory Phase Metabolic Phase Minutes Becker, L., M. Weisfeldt JAMA, December 18, 2002-Vol 288, No. 23 2
3 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) Angelo Salvucci, MD Cardiac Arrest? Call-to-door time rarely tracked No performance metrics, no QI Cost: Priceless 3
4 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 4
5 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 THREE DATA COLLECTION OPTIONS Direct Entry Online Mobile Field Entry Optically Scanned Form 5
6 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 6
7 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 Total CARES Records Dec '05 Mar '06 Jun '06 Sep '06 Dec '06 Mar '07 Jun '07 Sep '07 Dec '07 Mar '08 Jun '08 Sep '08 7
8 Gender Demographics Null 0.19% Female 39.91% Male 59.89% Age Demographics Null Ethnicity Demographics His panic/l atino 6% Null Asian 1% 1.34% Unknown 22% Black/African American 30.06% American Indian/Alaskan 1% Native Hawaiian/P ac ifi c 0.18% White 8
9 Location Demographics Location Type Total Percentage 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 % Null % Total: % CARES Current & Focus Sites ( ) 2009) 9
10 Insert TOR Article 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 registry. Ultimate goal to improve survival for OHCA 10
11 SOFTWARE DEMONSTRATION This presentation and more information i about the program can be found on the CARES website under the NAEMSP tab. 11
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