CARES encourages voluntary participation from hospitals where the participating EMS agency transports cardiac arrest patients. A CARES contact person needs to be identified at each participating hospital. The only requirements for a contact are that he/she has access to hospital records to obtain outcome data and has a clinical background. The hospital dataset consists of five simple questions and is only required for worked arrests of non-traumatic etiology where the EMS crew indicates there was ongoing resuscitation in the emergency department. The hospital contact will be given access to the CARES website (https://mycares.net) and can enter hospital outcomes at their convenience.

CARES uses Secure Socket Layer (SSL) encryption technology in transmitting Protected Health Information to redundant secure AWS EC2 servers to help ensure the integrity and privacy of the Protected Health Information provided to them via the Internet. Encryption involves systematically scrambling numbers and letters, so that even if someone managed to intercept the information, they would not be able to decode the information. In order to take advantage of this encryption technology, customers need to have an Internet browser that will support 128-bit encryption. The data is protected with an encrypted database with daily backups, and is securely accessible with redundant pathways via the CARES website. The entire system is protected by cutting edge AWS protection, with off-site data archiving to assure data integrity even in the event of a catastrophe.

Yes, CARES requires the use of a patient's name and date of birth (DOB) to link the EMS record with the hospital outcomes. The name and DOB are provided by the EMS agency. Once a record is determined to be complete by CARES staff, the record is de-identified, or "scrubbed", of patient name and DOB.

CARES was approved and considered exempt from further review by the Emory University IRB. CARES is considered to be a quality improvement/assurance program conducted by a covered entity and is thus considered "healthcare operations." Therefore CARES is not subject to Privacy Rule requirements for research activities or patient authorization. In general, the Privacy Rule permits the use or disclosure of patient information for a registry if the registries are supporting public health activities and/or registries developed for health care operations of health care providers, such as QA/QI. For more information, please see the letter from the CDC and the Memorandum of Understanding between Emory/CARES and the CDC on the CARES website.

Each participating EMS agency has access to all of the EMS and hospital data for their respective patients. EMS agencies do not have access to data from other participating agencies. Hospital contacts can view but not edit the EMS portion of the CARES form for patients transported to their facility and do not have access to other hospitals' data. However, Integrated Health Systems can request permission to establish a multi-hospital CARES account allowing for centralized data access and institutional level reporting. If the state is a CARES participant, the state coordinator has access to all EMS and hospital data within the state. CARES staff has access to all EMS and hospital data for monitoring and de-identification purposes.

CARES data helps local EMS administrators and medical directors identify which elements of the system are functioning properly and which elements are not, and how changes can be made to improve cardiac arrest outcomes. Using the CARES software, the EMS agency will have the ability to generate "real-time" Utstein Survival Reports, EMS and First Responder response interval reports, as well as demographic reports. The EMS agency can use this data to inform system changes that will improve outcomes for cardiac arrest patients. CARES allows for confidential internal benchmarking for the participating EMS agency. CARES data is also de-identified and aggregated each April allowing for annual reports to be shared locally, regionally, statewide and nationally for both benchmarking and research purposes. CARES participates in Healthy People 2030 in an effort to track bystander preparedness at the community level. External use of the dataset is managed through a formal data sharing process.

More information is available via the CARES website (https://mycares.net). Visit the CARES homepage and select the "About CARES" tab. Please feel free to contact CARES staff with any questions (information found on the "Contact Us" webpage).