b'CARES Annual Report 2020 | 19CARES Communities Respond to COVID-19The effect of the COVID-19 pandemic on resuscitation practices is evident in the national 2020 CARES dataset and is summarized on page 40 of this report. Understanding the impact of COVID-19 at the local level is important in helping communities develop strategies to improve OHCA care as we reemerge from the pandemic. Three CARES communities - Ventura County EMS in California; Chicago Fire Department in Illinois; and Wake County EMS in North Carolina - provide insight from the field about adapting their resuscitation practices due to COVID-19.Ventura County EMS, California By Daniel Shepherd, MD, Medical Director, Ventura County EMS In 2008, the Ventura County Emergency Medical Services Agency began implementing a novel approach to cardiac arrest resuscitation. Cardiac Arrest Management, or CAM, uses a pit-crew style approach and emphasizes performance-focused training, high-quality CPR, and early defibrillation. CAM improved survival, particularly in the Utstein subset. The percentage of survivors with a good or moderate CPC score doubled. Subsequent updates incorporated CPR instructions by emergency medical dispatchers, new ventilation techniques, and a post-resuscitation care bundle. In early 2020, the next evolution of CAM was being designed when the pandemic hit. Cardiac arrest survival soon declined and has yet to rebound. COVID-19 was the suspected cause, but everything was reviewed from recent protocol updates to ambulance deployments. The CARES data was shared with the dispatch agency, prehospital providers, Medical Examiner, and hospitals as leaders searched for a correctable cause. It was found that the number of arrests, specifically unwitnessed arrests, increased while the rate of bystander CPR and AED use decreased. Additionally, and potentially most importantly, the time from dispatch to initial defibrillation increased. Prehospital providers have always worn personal protective equipment (PPE) but caring for patients in the COVID-19 era requires additional PPE and other precautions. Prior to 2020, 42.7% of patients were defibrillated in under 8 minutes, 66.7% in under 10. In 2020, these rates were 30.8% and 58.2% respectively.The etiologies of arrest remained consistent, with the exception of overdose deaths, which increased by 69% in 2020. The stark reality of living during a pandemic is that the chances of surviving a cardiac arrest are lower than they otherwise would be. Care for chronic conditions is being deferred, people are afraid to go to the hospital, and some are reluctant to activate 911. EMS systems across the country are finding that cardiac arrest survival has declined during the pandemic. Ventura County is just beginning to emerge from a sizable surge of COVID-19.What remains to be seen is if survival from cardiac arrest will increase as the prevalence of coronavirus decreases. Chicago Fire Department, Illinois By Joe Weber, MD, FAEMS, Medical Director, Chicago West EMS System While the City of Chicago avoided the terrible crises from COVID-19 seen on the east and west coasts, the pandemic still had a significant impact on the city and the EMS System. The first coronavirus case was recorded in early March 2020 and was followed by a significant first wave that peaked at the end of April, with new case counts above 1,400 patients per day.Early in the pandemic, with a stay-at-home order in effect, the overall EMS transport volume for the Chicago Fire Department decreased by 13%. At the same time, however, the out-of-hospital cardiac arrest (OHCA) call volume greatly increased with cases in April, May and June averaging 53% above the historical baseline. The Chicago Fire Department has prioritized high quality OHCA care for many years and the significant increase in patient volume combined with the inherent obstacles of caring for patients during an infectious disease pandemic put significant strains on EMTs and paramedics. Chicago Fire Department and EMS system leaders partnered to reprioritize the approach to OHCA with a focus on EMS provider safety while maintaining the highest quality OHCA care.Specific initiatives included proper utilization of PPE during resuscitation, minimization of crew exposure, and utilization of advanced airways with viral filters. There was a continued emphasis for on scene resuscitation and field termination of resuscitation with a goal of transporting patients with return of spontaneous circulation and a de-emphasis on epinephrine use after three doses.The men and women of the Chicago Fire Department, like EMS agencies all across the country, quickly embraced the new challenges presented by COVID-19 and, in time CARES data will reveal how resuscitation practice is impacted in the long term.'