b'Where the Action Takes PlaceNORTH CAROLINA: TURNING DATA INTO HIGH-LEVEL EVIDENCENorth Carolina is leveraging CARES data to evaluate the RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) trial. The trial is testing whether implementing a customized set of strategically targeted, community-based interventions can improve survival to hospitaldischarge with good neurologic function for OHCA patients, compared to the control or standard of care. As a randomized trial, this will be the highest level of evidence possible, and we will be able to use the results to inform OHCA guidelines,says Chris Granger, professor of medicine and nursing at Duke University and principal investigator of the trial. Sixty-two counties across North Carolinarepresenting 8 of the states 10 million residentswere recruited and randomly assigned to either theCollecting intervention or control group. All counties collect EMS data using CARES,comprehensive state while intervention counties also collect dispatch data. Steve Vandeventer,level cardiac arrest data is important, the NC CARES State Coordinator, ensures high-quality data entry, and thebut how people use RACE-CARS trial team collaborates closely with the intervention counties,that information providing regular feedback drawn from the registry. The interventionlocally is where the includes three core components: community training in CPR and AED use,action takes place.optimizing first responder systems, including equipping them with AEDs,Dr. Bryan McNallyand enhancing dispatch center protocols for early recognition of cardiacExecutive Director of CARESarrest and timely bystander CPR instruction.Our goal is to train an additional 10% of the population in bystander CPR and AED use each year, says Granger. North Carolina already mandates CPR training for public-school students, and were expanding that to include teachers, staff, and eventually broader groups like healthcare systems, county governments, and workplaces. Weve also launched the Heart-Safe Workplace program to recognize organizations that train all employees annually and have a cardiac emergency response plan.However, the states first responders, including fire and law enforcement, lack access to AEDs. Most county governments dont have extra funds to purchase them, says Granger. Were taking a multi-pronged approachengaging county commissions, setting up nonprofits, writing grants, and working with philanthropiststo increase first responder defibrillation by 50% in intervention counties.Another focus is improving 911 dispatch performance, aiming to ensure hands are on chest within three minutes of a call. We are asking 911 leadership to review cardiac arrest protocols with staff and identify areas where time could be saved, says Granger. For example, perhaps too much time is being spent in instructing the bystander on how to evaluate the victims breathing before staring CPR. We have excellent training resources and case review materials available.Finally, RACE-CARS is tracking patient outcomes beyond hospital discharge. CARES provides hospital data up until discharge, but we do not how survivors fare long-term, says Lisa Monk, implementation director for RACE-CARS. We want to gather information about how people do over the next year. We are following up with survivors at three and 12 months to assess their health status and quality of life. Since the start of the trial, we have had over 600 survivors.23'