Heart attacks are, quite simply, deadly.
More than 350,000 cardiac arrests take place outside of a hospital each year, with the odds of survival hovering at just under 1 in 10. That survival rate hasn’t significantly improved for three decades, although it does vary widely – and at times puzzlingly – depending on geographic area, economic status, and race.
There are a number of different indicators which reliably predict survival in the case of cardiac arrest, from if there’s a bystander or EMS team on hand to whether CPR is instituted or if signs of life like light breathing or a pulse return naturally. It can be difficult to determine how to improve response to these incidents because of the wide range of factors involved, from 911 call centers and first responders to the EMS agencies and hospitals that set the procedures for care, particularly when so much depends on how quickly the victim can be treated.
Still, the wide discrepancies between communities where the survival rate is abysmally low and others where it is remarkably high suggest dramatic improvement is possible. Of the numerous studies investigating the problem, almost all call for a national registry of cardiac arrests to monitor performance, identify problem areas, and gauge improvement.
Fortunately, South Carolina hospitals and EMS agencies now have the opportunity to take part in such a registry through the Cardiac Arrest Registry to Enhance Survival, or CARES. Launched in Atlanta in 2005 by Emory University and the Centers for Disease Control and Prevention (CDC), CARES is a comprehensive data collection system that can help measure the effectiveness of response systems by tracking a single case from first response through hospital treatment and provide a reliable assessment of any improvement strategies. Just as importantly, because it’s a national registry, it provides a benchmark for local communities to compare themselves to both statewide and nationally. The system is also quite easy to use—CARES is a secure, HIPAA-compliant web database that requires just a single administrator in a given organization to answer a handful of questions about each case.
CARES has already spread to 23 states, with more than 800 EMS agencies and more than 1,300 hospitals participating, many of whom have seen tremendous results from the system and lauded it with high praise. The city of Las Vegas, for instance, implemented a set of protocols that saw its survival rate go from a low of 5% to an average of 30% and a peak of 58%. Denver’s paramedic division and fire department used CARES to improve their EMS system and place an additional 2,000 AEDs in their metro area.
Many EMS agencies share a similar story as Angelo Salvucci, the Medical Director of EMS for Santa Barbara and Venture Counties in California.
“Prior to CARES, we had no organized structure or method to evaluate the treatment we were providing to our cardiac arrest patients,” he explains. “Training policies and treatment protocols were in place…but the process was really just an exercise in data gathering. The first CARES report was the start of a substantial shift in our understanding and direction. It gave us meaningful information—how many of our patients were leaving the hospital and going back to their families. It’s why we are in EMS.”
Salvucci and his EMS providers used the new data to refocus their quality improvement efforts, reworking their CPR training and instituting new feedback training and testing with Ambu SmartMan manikin systems. He credits the latter measure alone with increasing survival rates by 30%.
“We were doing better for our community. Cardiac arrest calls were an opportunity to help save a life—not an exercise in futility,” he says of the changes that CARE brought to the agency. “Everyone was paying attention.”
South Carolina, with the exception of a few early adopters, is just beginning the process of incorporating the registry into the health care system. Six agencies and 24 hospitals are now enrolled, with many more expected to come online by the end the year.
Greenville County EMS, one of the first agencies to begin using CARES, also has high praise for the registry, which they use alongside another data collection system, CoStat, to round out their analytics.
“We us it for a lot, really,” says Training Coordinator Lt. Jason Walchok, who particularly likes the ability to compare his agency to other systems as well as the prompt feedback on outcomes and mortalities. “We respond to 32 or so cardiac arrest incidents a month, and 53% of those are transported. The hospitals would give us the data on those outcomes, but we didn’t get that quick of a turnaround [before CARES].”
South Carolina has the potential for an unusually fast expansion of CARES since SCHA is serving as the sponsoring agent, making enrollment free for every agency or hospital who wants these life-saving metrics. The Association plans to gradually roll out CARES to adjacent county EMS agencies who service hospitals already in the system to cover as much of the state as possible.
For more information about CARES go to their website at mycares.net. If you’re a South Carolina healthcare or EMS professional interested in implementing CARES in your system, contact Beth Morgan.