b'162021 CARES Annual Report CARES in ActionProviding Lifesaving Equipment for Law Enforcement First RespondersIn order to improve out-of-hospital cardiac arrest survival, The Leona M. and Harry B. Helmsley Charitable Trust has equipped thousands of first responders with modern, life-saving equipment as part of its Rural Healthcare Program. This includes state-of-the-art connected AEDs and LUCAS chest compression systems to aid in CPR, as well as the training needed to use them effectively. Montana and Nebraska are two Midwestern states that have received Helmsley grants for the distribution of AEDs to all law enforcement organizations, allowing life-saving technology to be placed into the hands of those who can best utilize it. As CARES participants, both states have been able to track the progress of these programs and measure their impact on out-of-hospital cardiac arrest resuscitation efforts within their communities. The Value of CARES in a Large, Rural State By Janet Trethewey, EdD, EMT, Montana CARES State Coordinator & Emergency Cardiovascular Care Program Manager In a large, rural state, Montana EMS agencies and hospitals are presented with unique challenges when responding to out-of-hospital cardiac arrest. With 147,042 square miles, our Frontier state is roughly the size of California, but has a population equivalent to the city of San Diego, with 1.3 million residents. Only four of fifty-six counties in Montana have a population greater than 100,000, and the three least-populated counties have 0.3 residents per square mile. In addition, Montana is demographically the oldest state west of the Mississippi River, with nearly 20% of residents ages 65 or older. The majority of Montana is served by EMS agencies staffed by volunteers with EMT or AEMT licensure, and the rural nature of the state often prevents even the best emergency services from arriving on scene in time to help cardiac arrest patients. The average time to scene in rural areas is more than 14 minutes, and the corresponding transport time is often greater than 20 minutes. Distances to the nearest hospital of more than 20 miles are not uncommon.4 In 2015, the state began a partnership with the Helmsley Charitable Trust to develop the Montana Emergency Cardiovascular Care (ECVC) System. The grant allowed Montana to become a CARES state, with initial data collection by seven EMS agencies. From 2016-2019, additional agencies were enrolled in CARES to cover approximately 80% of the states population. In 2020 and 2021, the Montana CARES State Coordinator abstracted data from ePCR reports submitted by smaller EMS agencies and manually entered these cases into CARES, allowing for nearly 100% capture of all OHCAs in the state. The ECVC Program is creating a more cohesive emergency cardiovascular system of care in Montana, using CARES data to develop statewide initiatives related to training, community education, and system building. The state has less than 500 non-traumatic cardiac arrests per year, making it difficult to see trends and opportunities for improvement, particularly in low population areas. However, evaluating aggregate, state-level data helps with benchmarking and identifying longitudinal trends. When evaluating CARES data, we found that more than 70% of OHCAs in Montana occur at home and the majority are unwitnessed.5 These circumstances, in addition to long EMS response times, translate to prolonged time from arrest to AED application. In February 2020, the EMS and Trauma Systems Office received another generous grant from the Helmsley Charitable Trust to help address this issue. The grant provided funds to equip every law enforcement vehicle in the state with an AED. Law enforcement officers often reach a patient much faster than EMS, especially in rural communities. Even with aLaw enforcement officers receive training on operating their AEDs. scaled back distribution plan due to COVID,Photo taken by Courtney Perry:The Leona M. and Harry B. Helmsley Charitable Trust.4Montana EMS Annual Report 2021Executive Summary. https://dphhs.mt.gov/assets/publichealth/EMSTS/EMS/EMSannualreport2021.pdf 5CARES Registry DataMontana Reports, 2017-2020.'