CARES Annual Report 2017 | 13 registry showed that their efforts thus far had already made significant improvements in cardiac arrest survival rates in the City of Chicago and their 2013-2016 data show a more than four-fold increase in survival over previously published rates. CARES registry data and collaboration with Illinois Heart Rescue also helped identify other areas for out-of- hospital cardiac arrest quality improvement. New dispatch CPR protocols and training were initiated, as well as a more formalized quality assurance call review process. Bystander CPR training initiatives were led by the Illinois Heart Rescue Community Sphere, which focused efforts on medically underserved areas of the city with a high incidence of cardiac arrest. Both of these initiatives have led to a more than doubling of bystander CPR rates in Chicago. Finally, new EMS protocols were developed requiring that resuscitated cardiac arrest patients be transported only to hospitals able to perform 24/7 percutaneous coronary intervention (PCI) and targeted temperature management (TTM). Hospital based CARES data is additionally used to give feedback to these hospitals on the quality of care they deliver to these patients. Chicago has made great strides in their approach to cardiac arrest over the past several years. Their basic approach and use of CARES data to measure and improve is now an example for communities of any size, that improving cardiac arrest survival is possible anywhere. Criteria Based Dispatch in Anchorage By Dr. Mike Levy, EMS Medical Director, Anchorage Fire Department Imagine you work as a Telecommunicator (aka Dispatcher) at your local public safety access point (PSAP) taking calls for the fire-based EMS system. It is a pretty busy place that processes 80,000 calls for service in a year that may include EMS, Fire and requests from other agencies for help. The callers could be reporting the smell of smoke in a structure, a psychological emergency, a gunshot wound, a heart attack...the potential is almost endless. As an added twist, the callers will cover an immense gamut of communication skills and primary languages. Anchorage, Alaska is by some accounts the most diverse city in the US 3 . The local school district reports that there are 99 languages besides English spoken by its student body. Those who call may, of course, be very emotional in response to the incident. How do emergency telecommunicators rapidly process calls to identify a life-threatening emergency? Anchorage Fire Department uses a system called Criteria Based Dispatch (CBD) which was developed at King County EMS. Once basic location information is obtained, the dispatchers ask two key questions on all calls: 1) “Is the person awake and alert?” 2) “Is (s)he breathing normally?” If the answer to those questions is “no” then the dispatcher tells them to start CPR and gives instructions. This is the so- called “No-No-Go” method that was pioneered in Seattle/King County. This method is likely the fastest means of initiating CPR with lay rescuers and has resulted in significant improvement in the time to first CPR as well as the number of times that CPR is performed in the Anchorage system. Using the CARES Dispatcher Assisted CPR module, Anchorage FD was able to track numerous time intervals as well as monitor barriers encountered by the dispatcher. After implementing CBD in the spring of 2014 (and using the CARES Dispatcher Module when it became available in late 2015), the table below shows how Anchorage FD has been able to far exceed the national standards in Telephone CPR 4 . Call receipt to CPR recognition Call receipt to first compression National Standard: High Performance 60 seconds 120 seconds National Standard: Minimum 120 seconds 180 seconds Anchorage FD 2016 44 seconds 100 seconds Anchorage FD 2017 52 seconds 111 seconds 3 4