b'HAWAII: BUILDING AN ISLAND-WIDE SAFETY NET Responding to a cardiac arrest in Hawaii presents unique challenges compared to the continental US. We are multiple islands in the middle of the Pacific Ocean, and providing comprehensive patient care across the state can get quite complicated, says Star Ventura, ED Clinical Coordinator with the Queens Medical Center (QMC) Emergency Department. The time to transfer a patient to a definitive cardiac care hospital can be longer than in other states, so immediate in-community recognition and response to cardiac arrest is what saves lives.Currently, bystanders perform CPR in only 38% of cardiac arrests in Hawaiia critical gap that the state is working to close. CARES data highlighted the need to increase quality bystander CPR prior to the arrival of first responders, prompting the Hawaii State Department of Education to pilot a program introducing CPR and AED training to students and school personnel statewide. We are reaching both rural and urban schools, says Dr. Elizabeth Char, an emergency physician leading the project with the Hawaii Heart Foundation. Our goal is for every high school student to have the chance to learn the lifesaving skills of understanding how to access 911, performing good quality CPR, and being able to use an AED.To expand the use of high-performance CPR, early-adopter first responder agencies implemented the practice and shared training across all first responder organizationsincluding county fire departments, Ocean Safety Lifeguards, EMS, and some police departments. They also extended this training into hospitals to promote uninterrupted, high-quality CPR throughout the patient care journey, which was quite unusual at that time. "This is something that came out of CARESa real teamwork approach. We worked to socialize high-performance CPR to everyone involved along the chain of survival. This allows for a seamless transition from the fire department and EMS to the hospital and truly gives the patient the best possible chance of survival."Dr. Elizabeth Char, Emergency Physician at the Queen\'s Medical CenterThe impact of this collaborative approach is evident in CARES benchmarking data. In 2023, 39.2% of cardiac arrest patients admitted to U.S. hospitals survived to discharge. At QMC, the survival rate was notably higher at 47.6%. Beyond survival, the quality of life for patients has also significantly improved. While nationally, only 14.3% of patients were discharged home with good or moderate neurological function, QMC doubled that rate at 27.6%. 25'