16 From Agency to State Implementation in Ohio By Dr. David Keseg MD, FACEP, FASAM, Medical Director, Columbus Division of Fire, Columbus, OH In 2007, the Columbus Division of Fire had a problem. We wanted to improve our survival rates from sudden cardiac arrest, but didn’t have any idea what our current survival rates were. We attempted to set up a local registry, but it was too resource intensive. When I attended an EAGLES EMS conference and heard about the Cardiac Arrest Registry to Enhance Survival (CARES) program that was expanding outside of the metro Atlanta area, I knew we had our answer. Columbus Division of Fire began CARES participation in September 2007 and has been collecting OHCA data for more than 10 years. Through CARES, we are able to obtain precise, real-time measurements on critical community components like bystander CPR and AED use, as well as identify geographic areas with high risk for sudden cardiac arrest and low bystander CPR and AED utilization, which has allowed us to allocate our resources for maximal impact. We have been able to see the direct benefit of programs like pit crew CPR training and strategic AED deployment in our community. Over our numerous years of participation, we have experienced many improvements including increases in bystander CPR and our Utstein survival rates. In 2016, a group comprised of key stakeholders from existing CARES participants and local EMS leadership began exploring the potential of enrolling Ohio as a CARES state participant. As a first step, this group of stakeholders committed to monthly calls in order to work through the infrastructure and financial needs for participation. Second, we developed a letter requesting funding support for the program and shared it widely with our State EMS Office, Academic Medical Centers, Hospitals and non-profit groups in the state. In parallel, we received commitment from the existing CARES participants in the state to donate the following year’s subscription fee towards the initiative. Third, we tasked ourselves with identifying a potential human resource “home” for the state coordinator. We also created an Ohio-CARES website to begin marketing the project and host easily accessible resources for interested agencies. In addition, we partnered with the HeartRescue project and AHA to assist in the implementation of resuscitation academies around the state, to both encourage CARES participation and work towards improving the professional EMS response to cardiac arrest. And lastly, we created the Ohio-CARES Board that would oversee the various aspects of state participation. The state of Ohio began state participation in January 2018. Our state coordinator is located at the Ohio State University (OSU) Center for EMS, and the Ohio Department of Public Safety (ODPS) has committed to covering the subscription fee for the initial 3 years of participation. In addition to the OSU Center for EMS and the ODPS, current funders include University Hospitals, the Cleveland Clinic, and Mount Carmel Health. We are grateful for the support that has allowed the vision of Ohio-CARES to become a reality. The stakeholder group and the Ohio-CARES Board continue to meet every other month to review CARES expansion, resuscitation academy plans, funding initiatives and other relevant topics as needed. (See examples of the Ohio-CARES expansion dashboard figures that are reviewed and discussed each call, to the left). To date, Ohio-CARES has over 35% of the state population participating and has conducted five resuscitation academies throughout Ohio with another three scheduled through the end of 2019. We have found there is a direct correlation between agency engagement in making system improvements and participation in CARES and we incorporate this message into our resuscitation academies to encourage CARES participation. Our goal is to have 90% of our EMS agencies participating within the next 5 years and be designated as a HeartRescue state. We are hopeful that these efforts will result in an improvement in survival from sudden cardiac arrest in Ohio. If you can’t measure what you hope to improve, then it becomes impossible to achieve your goals. Signing-up for CARES all the way back in 2007 was one of the best things we have done in Columbus to enhance our survival from sudden cardiac arrest. Now the state of Ohio has taken the same step. Through the help of the program sponsors, partners and participants, we are on a mission to improving cardiac arrest survival in our state. Now every agency and community in the state has access to CARES and can benefit from both measurement and improvement to save countless lives in Ohio.