b'2021 CARES Annual Report 7 7 A Year in ReviewDear CARES Community, 2022 promises greater relief and more hope in our communities, states and nation. As I write today, nearly 375 COVID-related deaths are being reported daily in the United States, a sobering reminder of the impact the pandemic has had on our lives since early 2020. In comparison, more than 1,000 Americans experience an out-of-hospital cardiac arrest that results in resuscitative efforts every day, but this is not considered a newsworthy statistic.We are thankfully seeing stabilization and early evidence of recovery in resuscitation practice and outcomes in the 2021 CARES data. The 14% reduction in survival that occurred in 2020 compared with 2019 (10.5% to 9.0%), stabilized to 9.1% in 2021. Bystander AED use in public locations also recovered to 10.1% last year, up from 9% in 2020 and closer to a pre-pandemic rate of 12.2%. Bystander CPR has been consistent in consecutive years (41.2%, 40.2%, 40.2%). These metrics and others shared in greater detail within the report emphasize the surveillance mission of the CARES program. The quality improvement mission is highlighted in the report with stories about regional and state-level efforts to improve OHCA care in Montana, Nebraska, and Florida. The research mission has a special section focused on disparities and the local efforts that are attempting to help address health inequities related to OHCA.In 2021 the CAROL Act (HR 1193) passed unanimously in the House of Representatives and is now under review in the Senate. The bill, named after the late Carol Barr, wife of Representative Andy Barr (R-Kentucky), would provide for funding to both the NIH and CDC, including funding to help expand CARES to all 50 states and for dedicated quality improvement activities nationally. These activities would include community and state-based educational activities such as Telephone CPR (T-CPR) and high-performance CPR (HP-CPR), and operationalizing the NHTSA developed CPR Life Links curriculum. Funding would also be used to modernize the CARES Next Generation Software Platform, allowing for new functionality, greater flexibility and interfacing with the latest data tools.Finally, Id like to highlight the CARES video released earlier this year and first shared at the National Association of EMS Physicians (NAEMSP) Annual Conference in San Diego. We are most thankful for everyone who helped make this a reality. As we transition to the next phase of the pandemic its important to recognize the value of surveillance data in guiding our public health decision making and performing quality improvement activities locally to increase survival. Our hope is that the recovery we are witnessing nationally will be further improved upon with passage of the CAROL Act and funding that could begin as early as 2023. We greatly appreciate all the local, state and national support that will help in advocating for this federal legislation. Respectfully, Bryan McNally, MD, MPH Executive Director CARES Professor of Emergency Medicine Rollins School of Public HealthEmory University School of Medicine'