Transcript C.A.R.E.S.
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 100 80 60 Survival reduced by ~7-10% each minute defibrillation delayed Survival Rate (percent) 40 20 0 5 10 15 20 Time to Defibrillation (minutes) 25 Three-Phase Time-Sensitive Model of Cardiac Arrest Electrical Phase Circulatory Phase Metabolic Phase 0 5 10 15 Minutes Becker, L., M. Weisfeldt JAMA, December 18, 2002-Vol 288, No. 23 20 25 Utstein Criteria 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 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 – https://mycares.net – 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 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. 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. T otal C AR E S R ec ords 12000 10000 8000 6000 4000 2000 0 Dec Mar J un S ep Dec Mar J un S ep Dec Mar J un S ep '05 '06 '06 '06 '06 '07 '07 '07 '07 '08 '08 '08 G ender Demog raphic s Null 0.19% F emale 39.91% Male 59.89% A g e Demog raphic s 2000 1800 1600 1400 1200 1000 800 600 400 200 0 0-19 20-29 30-39 40-49 50-59 60-69 70-79 80+ Null Ethnicity Demographics Hispanic/Latino 6% Null 1% Unknown 22% Asian 1.34% Black/AfricanAmerican 30.06% AmericanIndian/Alaskan 1% Native Hawaiian/Pacific 0.18% White 39% Location Demographics Location Type Total Home/Residence Percentage 6014 64.70% Public Building 569 6.12% Street/Hwy 474 5.10% 1316 14.16% Residence/Institution 117 1.26% Physician Office/Medical Clinic 197 2.12% Educational Institution 26 0.28% Hospital 29 0.31% Recreation/Sport Facility 125 1.34% Industry 103 1.11% 43 0.46% 235 2.53% Airport 46 0.49% Null 1 0.01% Nursing Home/Assisted Living Center Jail Other Total: 9295 100% CARES Summary Report – Sample CARES Summary Report – Sample UTSTEIN SURVIVAL CARES Summary Report – Sample BYSTANDER CPR RATES CARES Current & Focus Sites (2008-2009) 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 surveillance registry. – Ultimate goal to improve survival for OHCA SOFTWARE DEMONSTRATION https://mycares.net/ This presentation and more information about the program can be found on the CARES website under the NAEMSP tab.