CARES Annual Report 2018 | 7 A Year in Review Dear CARES Community, We are pleased to share the CARES 2018 Annual Report which includes our most recent OHCA metrics and several community based improvement activities. Contributions from Alaska, Colorado, Delaware and Ohio provide a snapshot of some of the “measure and improve” activities that are strengthening the “chain of survival” for patients locally. We also appreciate former Governor Tom Ridge sharing his Story of Survival. Our goal of onboarding all 50 States in advancing CARES as the National Cardiac Arrest registry is aligned with our mission and vision goals. MISSION: To help communities determine standardized outcome measures for out-of-hospital cardiac arrest allowing for quality improvement efforts and benchmarking capability to improve care and increase survival. VISION: To become the standard out-of-hospital cardiac arrest registry for the United States allowing for uniform data collection and quality improvement in each state and nationally. This year’s report also recognizes the significant regional variation in OHCA patient outcomes between communities in the United States. There is a 5-fold difference in overall survival and 6-fold difference in bystander CPR provision in communities that have at least 150 cases a year (see page 36). Neighborhood disparity also exists and has been associated with socio-economic realities. In a recent CARES publication focusing on pediatric OHCA, Dr. Maryam Naim and colleagues found that “Racial and neighborhood characteristics are associated with bystander CPR in pediatric OHCA. Targeted CPR training for non-white, low-education and low-income neighborhoods may increase BCPR and improve pediatric OHCA outcomes”. This represents both a challenge and an opportunity for communities to develop and implement improvement activities focused on increasing bystander CPR compliance and minimizing the delay between initial patient collapse and first chest compression. Effective telephone-CPR education for dispatchers and quality improvement follow-up using the CARES T- CPR module are available and logical for communities to implement. New Castle County EMS’s efforts in Delaware toward developing a successful program are highlighted in this issue (see page 17). We believe more communities need to adopt their own programs and fortunately, the NHTSA Office of EMS has recently developed an open source national curriculum ( as a blueprint to get communities started. The percentage of OHCA cases recognized by the telecommunicator, time to first instruction, and time to first compression are three telephone CPR metrics that every community should consider tracking locally in the near future if not already. Adopting a “measure and improve” approach locally can be the first step in increasing a patient’s chances of surviving an OHCA event while also addressing disparity concerns. We hope you enjoy the 2018 report and look forward to your feedback. Respectfully, Bryan McNally, MD, MPH Executive Director CARES Professor of Emergency Medicine Emory University School of Medicine Rollins School of Public Health Atlanta, Georgia USA