b'The adoption of a statewide CARES registry in Ohio marked a shift from individual EMS agency improvement toward regional and statewide prioritization of cardiac arrest care and patient outcomes. By implementing a statewide subscription model, Ohio experienced rapid adoption of CARES across multiple EMS agencies, expanding the coverage of priority populations in the State from 10% to almost 50% over the first five years. After statewide implementation, Ohio also observed increased rates of return of spontaneous circulation (ROSC) and survival. Although these improvements are not necessarily causal, they have, however, encouraged the continued efforts for statewide involvement in CARES. The statewide infrastructure also addressed previous barriers to EMS agency participation, such as eliminating agency subscription fees and supporting data entry and processing, thereby enhancing the overall effectiveness of the registry. The implementation of statewide CARES in Ohio included several steps. 1STEPS TO IMPLEMENT STATEWIDE CARES IN OHIOEstablishment of a board of directors toStatewide dissemination of information provide leadership and oversight. through EMS agencies and a newly developed centralized website.Definition of the programs mission,Conducting Resuscitation Academies vision, goals, and objectives. through partnerships with the HeartRescue Project and the AHA to Establishment of a legal organizationteach EMS agencies how to leverage capable of receiving and processingCARES data. funding. Fundraising efforts via local hospitals, Hiring a dedicated CARES Stateacademic medical centers, non-profit Coordinator to oversee implementationorganizations, EMS agencies, and and expansion. state government.Conversion from individual EMS agencyActive recruitment and on-boarding subscription to statewide registryof EMS agencies and hospitals into subscription. the registry.Successful implementation has relied heavily on clearly defined goals set by a board of directors, coordination by a paid State Coordinator, and the maintenance of consistent funding sources. While funding has been vital to the implementation and maintenance of the Ohio CARES registry over the past five years, Ohio CARES has not been able to secure sustainable funding, which limits the registrys full potential. Despite these challenges, the success seen in Ohio is a powerful testament to the importance of statewide data in addressing a large public health crisis. For example, by utilizing Ohio statewide data, we observed that bystander CPR rates remained unchanged over the examined periods and were overall poor compared to other states. In response, Ohio CARES is collaborating with state public health officials toward a common goal to improve statewide bystander CPR rates. This partnership has led to the development of public awareness campaigns, such as the Every Minute Counts initiative, and the creation of informational infographics. Identifying the characteristics of high-performing agencies provides invaluable feedback to guide statewide improvement. However, data alone is not enoughit must be coupled with strategic goals, sustained funding, and individual and collective efforts to drive systemwide improvements in cardiac arrest care.291. Nassal, M. M. J., Wang, H. E., Benoit, J. L., Kuhn, A., Powell, J. R., Keseg, D., Sauto, J., & Panchal, A. R. (2023). Statewide implementation of the cardiac arrest registry to enhance survival in Ohio. Resuscitation Plus, 17, 100528. https://doi.org/10.1016/j.resplu.2023.100528'