b'20Wake County EMS, North Carolina By Jos G Cabaas, MD, MPH, FAEMS, Medical Director, Wake County EMS The Wake County EMS System reported 828 CARES arrests in 2020, compared with 701 in 2019. While the overall number of OHCAs increased, so did the percentage of arrests that occurred at home (73.7% in 2020 vs 67.4% in 2019) and the percentage of bystander witnessed arrests (43.4% in 2020 vs 41.3% in 2019). This is intuitive given the broad and long-lasting stay-at-home restrictions in our county and state. Conveniently, and possibly for the same reason, our rate of bystander CPR (36.6% in 2020 vs 33.6% in 2019) increased as well.From a professional response standpoint, there was concern that the additional COVID-19 PPE requirements would delay critical interventions, but aside from mandating a higher level of PPE, we did not change our standard response plans or cardiac arrest care protocols and procedures. Fortunately, our overall survival rate increased from 12% in 2019 to 14% in 2020, and our Utstein Bystander survival rate increased from 40.4% in 2019 to 46.8% in 2020.We believe that our CARES data from 2020 compared with 2019 highlights that the pandemic affected geographically separate EMS jurisdictions differently. EMS system medical directors must understand the current community disease burden prior to making changes in clinical care for time and intervention-dependent conditions. Before making significant changes to cardiac arrest care, ensuring EMS clinicians utilize a coordinated approach that allowsParamedics from Wake County EMS in Wake County, North donning necessary PPE while providing early time-criticalCarolina safely transfer an OHCA patient to a nearby ambulance interventions is valuable.during the COVID-19 pandemic. Summary These three EMS agencies provide local perspectives on how COVID-19 impacted both urban and suburban communities while suggesting how population density, bystander interventions and the timeliness of care may have impacted OHCA survival during the pandemic. Research utilizing national CARES data during the early months of COVID-19 highlighted the impact on resuscitation practice including decreased return of spontaneous circulation (ROSC) and survival, and a significant increase in termination of resuscitation (TOR) and overall incidence of OHCA8. Interestingly, communities with both low and high COVID-19 mortality were impacted during the initial pandemic period, although to varying degrees.The hope is that lessons learned in 2020 will translate into improved OHCA outcomes in 2021 and beyond. 8 Chan P, Girotra S, Tang Y, Al-Araji R, Nallamothu B, McNally B. Outcomes for Out-of-Hospital Cardiac Arrest in the United States During the Coronavirus Disease 2019 Pandemic. JAMA Cardiol. 6(3):296-303.'