b'Data Informs Dane Countys Pursuit of Improving Sudden Cardiac Arrest Survival By Eric Anderson, NREMT-P, Emergency Management Data Analyst, Dane County, WisconsinIt has long been the goal of Dane County EMS (DCEMS)consistent, and timely case dissemination would be to be a leader in prehospital cardiac arrest resuscitationimportant factors for success. We were able to establish and survival. We support 23 EMS agencies spanningreliable case identification with a daily automated report career, volunteer, urban, rural, ALS, and BLS, and have afrom our ImageTrend platform. Access was then gained to team of three physician medical advisors, Dr. Lohmeier,each agencys cardiac monitor data, and a summary Dr. Kronenfeld, and Dr. VanBendegom. Our County istemplate was developed. The process of annotating, home to 560,000 residents in over 60 cities, villages, andsummarizing, and disseminating case feedback then began. towns across 1,200 square miles. We average 425Each summary includes a snapshot of which metrics were prehospital sudden cardiac arrest (SCA) resuscitationsachieved, a visual representation of the resuscitation data, each year, and entered our first CARES case in August ofand a brief section for feedback on how the cohesive 2016. By the end of 2022 we entered just over 2,400resuscitation went based on the cardiac monitor data and CARES cases cumulatively. context from the dispatch notes and patient care report By 2020, our system had the components to build our(see next page for select summary metrics; full sample SCA improvement process, but lacked a cohesive effortfeedback report available here).to unify them. There was local interest in improving SCAAgency leadership and medical direction receive each survival; cardiac monitors capable of gatheringsummary to share with the involved crews, along with resuscitation data; a reporting platform with timely casequarterly reports on HP-CPR trends and de-identified peer-submission; and an existing relationship with the CARESto-peer benchmarking. Having both case-specific and peer-team to receive year-end outcome reports. As put byto-peer benchmarking allow each agency to perform crew-Carrie Meier, Deputy Director for DCEM, As we lookedspecific training while evaluating their performance against at cardiac arrest, we were able to evaluate ourother departments. At the system level, this information outcomes through the CARES system, but wanted tohelps identify which agencies could benefit from a local push further and look at our quality of care and giveResuscitation Academy to reinforce our resuscitation near-immediate feedback to our providers. This type ofpriorities. Read more about our specific 2023 HP-CPR goals feedback has been done in other areas of the Country,and year-by-year progress in our January 2023 High-but we struggled with making it operational in ourPerformance CPR Summary.system. Through the support of our County ExecutiveThroughout this process, we have seen sustained and and EMS Commission, DCEMS hired a data analystmarked improvements in each of our metrics (see Figure charged with providing timely and non-punitiveto the left). At the time of this reports release, over 970 feedback to EMS crews on their high-performancearrest summaries have been distributed. The quality of resuscitation (HP-CPR) efforts.patient care reports have also become more detailed, Our first step was to implement a model of evidence- giving better context to the review process. I would also based resuscitation by hosting The Resuscitationlike to recognize the efforts of our county-based 911 Academy from King County, WA. From this experience,communications center to improve their T-CPR review we set our performance benchmarks: 1) chestprocess. The impact our telecommunicators have on compression fraction over 90%; 2) zero pauses lastingSCA survival cannot be overstatedtheir improvement longer than 10 seconds; 3) an average compression rateefforts yielded a 62.8% bystander CPR intervention rate between 100 and 120 beats per minute; and 4) post- in 2022 (a marked increase from 40.2% in 2021). ROSC EKG capture on 100% of ROSC patients with fiveOur ability to connect this initiative to outcomes is due to sustained minutes of ROSC without documentation ofpartnerships with local healthcare systems and the CARES conflicting priorities. We also knew actionable, team. Dr. VanBendegom details the importance of these partnerships - Seeing our survivor data and comparing it with national standards is a fantastic measure of how we are doing and gives us the information we need to make informed decisions in our care so we can continue to demonstrate improvement. At the forefront of this process is the impact on neurologically intact survival. Based on preliminary data for 2022, Dane County EMS agencies successfully resuscitated 50 patients (excluding overdose etiology), 49 of whom were discharged with a CPC score of 1 or 2. This represents our highest annual number of survivors.19'