I am trying to start this school year off a little better organized than last year, so I decided to print a calendar for all the kids events, especially since I have one starting high school this year, yikes!! Use these free images for your websites, art projects, reports, and Powerpoint presentations! Persons using assistive technology might not be able to fully access information in this file. Reporting Period: This report summarizes surveillance data collected during October 1, 2005-- December 31, 2010.
Description of the System: In 2004, CDC established the Cardiac Arrest Registry to Enhance Survival (CARES) in collaboration with the Department of Emergency Medicine at the Emory University School of Medicine. Results: During October 1, 2005--December 31, 2010, a total of 40,274 OHCA records were submitted to the CARES registry. A subgroup analysis was performed among persons who experienced OHCA events that were not witnessed by EMS personnel to evaluate rates of bystander CPR for these persons. Interpretation: CARES data have helped identify opportunities for improvement in OHCA care. Public Health Actions: Medical directors and public health professionals in participating communities use CARES data to measure and improve the quality of prehospital care for persons experiencing OHCA.
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death among adults in the United States.
In the first few minutes following OHCA, swift implementation of five critical actions by bystanders or emergency medical services (EMS) providers comprising a framework known as the "chain of survival" (Figure 1) can substantially increase the chances of survival from OHCA. Since the mid-1990s, the need for widespread, uniform EMS data reporting has been well understood; both the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration (HRSA) have highlighted the need for EMS data as a necessary foundation for evaluating the effectiveness of EMS care and called for the adoption of standardized data collection strategies and linking prehospital patient care information with outcomes (12,13).
CARES is a simple but robust registry of cardiac arrest events that allows participating sites to enter OHCA-related data, generate summary reports, and compare local data with similar EMS systems elsewhere.
CARES is funded by CDC through a cooperative agreement with the Association of American Medical Colleges (AAMC), which supports the academic medical community's participation in CDC's efforts to promote the prevention and control of disease, injury, and disability. CARES was first implemented in October of 2005 in Atlanta, Georgia, a city in Fulton County served by a single advanced life-support EMS, one first-responding fire department, a single 911 computer-aided dispatch center, and 13 hospitals. Three sources of data are linked to describe each OHCA adequately: 1) 911 call center data (to provide incident address and dispatch and arrival times), 2) EMS data (to describe initially recorded cardiac rhythm and treatment methods), and 3) hospital data. If a community uses a unique identifier number, CARES uses that number to link 911 call center, EMS, and hospital datasets to form a complete record for each event.
The number of mandatory data elements is limited to the minimum required to characterize an OHCA event and document its outcome. CARES data are compiled by using a Health Insurance Portability and Accountability Act (HIPAA)--compliant, web-based system developed by Sansio, Inc (Duluth, Minnesota) and managed by CARES staff. Data elements collected from the 911 call centers include incident location, the time that each 911call was received, the time of dispatch for both first responder and EMS providers, and arrival time at the scene. The initial cardiac telemetry that is documented can identify a shockable rhythm (one that is responsive to defibrillation, including ventricular fibrillation and pulseless ventricular tachycardia).
The data can be submitted in two ways: 1) online by using a data-entry template on the CARES website, and 2) a daily upload of records from EMS services that use an electronic patient-care record system. If EMS providers document ongoing resuscitation in the emergency department, the CARES software automatically sends the respective hospital contact a reminder via e-mail that prompts the contact to log in to the CARES website and provide the needed outcomes to expedite the data-collection process. Often, the primary obstacle to obtaining hospital participation in CARES has been concerns about federal patient privacy laws (14,20). For agencies that utilize an electronic patient-care record system, an electronic query algorithm is used to identify a cardiac arrest by searching patient records for data fields most likely to identify the event.
All participating EMS agencies ensure that all OHCA events are reported to CARES by responding to a routine data audit from CARES that requests confirmation that the number of cases reported represents all of the cases in the agency's medical records. A CARES data analyst provides data validation and reviews every record for completeness and accuracy. After a record has been audited and is considered complete, the patient-specific unique identifiers are permanently stripped from the record. CARES data are used to help communities benchmark and improve their performance for OHCA care. EMS agencies have continuous access to their data and can generate survival reports by date ranges. CARES convenes a regular users-group conference call to discuss data and quality improvement efforts.
An Utstein survival report divides arrests into three categories: unwitnessed, witnessed by bystander, and witnessed by EMS personnel (Figure 9). A subgroup analysis was performed among patients with OHCA events that were not witnessed by EMS providers to evaluate rates of bystander CPR. Two communities (Columbus, Ohio and San Diego, California) are using CARES data to identify local health disparities in both the provision of bystander CPR and AED use. Data collected during the initial phase of the CARES program (2005--2010) have helped participating communities identify opportunities to improve care for persons who experience an OHCA event. Tracking performance longitudinally will help communities better understand which elements of the response system are working well and which elements need improvement. CARES data can be used to evaluate new interventions and treatments in OHCA care and can guide targeted training efforts within communities. Starting in 2011, CARES is expanding to statewide participation in Arizona, Hawaii, Minnesota, North Carolina, Pennsylvania, and Washington. Despite these limitations, which reflect the fact that public health surveillance serves different goals than clinical research, participation in CARES is provided at no cost to participants, and the registry is easy to adopt and maintain.
The data provided in this report indicate the need for prompt and effective resuscitation efforts. With expansion to state-level surveillance, CARES will enable local and state public health departments and EMS agencies to better coordinate their efforts.
Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System.
Alternate Text: The figure above shows a map of the United States indicating the cities in which emergency medical services agencies participate in the Cardiac Arrest Registry to Enhance Survival. Alternate Text: The figure above shows a data entry form used to collect information on out-of-hospital cardiac arrests for the Cardiac Arrest Registry to Enhance Survival.
Alternate Text: The figure above shows site-specific and cumulative overall survival rates for out-of-hospital cardiac arrest events by participating emergency medical services agency for October 1, 2005- December 31, 2010.
Alternate Text: The figure above shows site-specific and aggregate Utstein survival rates for out-of-hospital cardiac arrest events by participating emergency medical services agency for October 1, 2005- December 31, 2010. Alternate Text: The figure above shows site-specific and aggregate bystander CPR rates for out-of-hospital cardiac arrest events by participating emergency medical services agency for October 1, 2005- December 31, 2010. American Heart Month is in February, a perfect time to focus on the prevalence of heart disease, America’s No. If you’re new here make sure to subscribe or join us on Facebook and Pinterest to keep up with our new creative ideas! If you are pinning or sharing this page, please share from this page only and not the direct download. Jamielyn aspires to reach women, get their creative juices flowing, and to genuinely inspire. I also want to start planning our dinner menus and teach my younger ones to start helping with grocery lists, to do lists, etc.
Iam trying to make a pllanner for my daughter in law, who is expecting, and i dont have a clue where to start, but i thought your stuff was pretty! You need to subscribe and it will send you an email, click on the confirmation link and it will send you another email with the printable. An OHCA is defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and is confirmed by the absence of signs of circulation. Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates should focus on timely and effective delivery of interventions by bystanders and emergency medical services (EMS) personnel.
This registry evaluates only OHCA events of presumed cardiac etiology that involve persons who received resuscitative efforts, including CPR or defibrillation.
After exclusion of 3,400 OHCA events that occurred after the arrival of EMS providers, bystander CPR information was analyzed for 28,289 events.
The registry is being used continually to monitor prehospital performance and selected aspects of hospital care to improve quality of care and increase rates of survival following OHCA.
Tracking performance longitudinally allows communities to better understand which elements of their care are working well and which elements need improvement. These actions should be undertaken regardless of the cause of the OHCA and include 1) rapid activation of EMS by calling 911, 2) rapid initiation of cardiopulmonary resuscitation (CPR), 3) prompt application and use of an automated external defibrillator (AED), 4) rapid delivery of advanced life support by EMS providers, and 5) early postresuscitative care (7,8). The American Heart Association (AHA) and other international organizations have called for integrated methods of data collection from EMS agencies, hospitals, and communities to improve care and compare performance across systems (7). The Utstein guidelines were first published in 1991 and later updated in 2004 by the International Liaison Committee on Resuscitation (ILCOR) to provide a uniform reporting template to describe OHCA events (2,16).
The ultimate goal of CARES is to help local EMS administrators and medical directors identify when and where OHCA events occur, who is affected, which elements of the response system are functioning properly and which are not, and what changes can be made to improve cardiac arrest outcomes (17). Since 2004, AAMC has provided funding for the Department of Emergency Medicine at the Emory University School of Medicine to implement CARES. Approximately 600 cases were entered during an initial 12-month period of pilot testing and refinement before the program was expanded to the rest of Fulton County and the surrounding seven counties in the metropolitan Atlanta area, an area encompassing 2,000 square miles with a population of approximately 3 million persons. Initially, several communities were invited to participate on the basis of their ability or history of collecting data regarding OHCA.

In communities for which multiple EMS providers service one catchment area, all providers must participate to ensure capture of all OHCA events within the respective service area. The catchment area of an EMS agency is defined as the regular area of response that is determined locally and might be consistent with a county, township, or municipal border.
Hospital data (emergency department and hospital outcome, hypothermia treatment, and neurologic status at discharge) are requested only when the data are not available already in the EMS record. When a unique number does not exist, the files are linked by matching the patient name and age with the event time, date, and location.
The data can be entered directly online or uploaded in batched files from a computer-aided dispatch center (CAD).
Such patients are more likely to survive than those patients whose rhythm is not shockable. Data entry checks have been embedded in the software to help minimize errors and enhance the accuracy of the data collection process. This scale is provided to hospital users who indicate the cerebral performance of the patient as good (CPC 1), moderate (CPC 2), severe (CPC 3), or in a coma or vegetative state (CPC 4). A hospital contact who logs in to the secure CARES website is able to determine the patient's name, date of birth, and date of admission as entered by the EMS provider.
In an effort to alleviate this concern, CARES provides documentation to hospitals about rules related to sharing information for public health purposes (17) and emphasizes the security of the HIPAA-compliant process used to collect and store the data. The software algorithm searches for records in which the provider impression is documented as cardiac arrest or defibrillation, CPR, or intravenous administration of epinephrine (cardiac dosages) on the EMS report to ensure a sensitive method of capturing all CARES events. Within CARES, the volume of OHCA events per month is compared with historic monthly volumes.
Logic is incorporated into the software for direct online data entry to minimize the number of incomplete fields and implausible data entries. CARES allows participating communities to view their own statistics online confidentially and compare their performance to anonymous aggregated data at the local, regional, or national level. Aggregate de-identified survival reports are shared with all participating sites every 2 months in advance of a regular conference call with EMS medical directors and quality-improvement providers. Topics have included measurement of response time, public access AED programs, dispatcher-assisted CPR training, and geomapping efforts to facilitate targeted community CPR training.
The overall survival rate was calculated for all patients meeting the case definition.In addition, the Utstein survival rate was calculated for a subgroup of patients whose OHCAs were witnessed by a bystander and who had an intial cardiac arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia. After exclusion of 3,400 OHCA events that occurred after the arrival of EMS, bystander CPR information was analyzed for 28,289 events (Table 4). Using GIS mapping techniques, neighborhoods have been identified that have high rates of cardiac arrest and low rates of bystander CPR. The registry can be used to monitor EMS performance and selected aspects of pre-hospital care to improve treatment and increase rates of survival following an OHCA event.
The 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care describe the quality improvement elements of a resuscitation system as 1) systematic evaluation of resuscitation care and outcome, 2) benchmarking with stakeholder feedback, and 3) strategic efforts to address identified deficiencies (8). In 2010, CARES included therapeutic hypothermia as a required data field for both EMS and hospital providers to determine the frequency of this post resuscitation treatment.
Statewide participation allows enrollment of additional communities of different sizes and population densities to be included in the registry. First, although as part of the audit process, participating agencies are asked to confirm that all cardiac arrest cases are included in the CARES registry, some cardiac arrests in a community might be missed, resulting in selection or reporting bias. Personnel costs related to data entry must be absorbed by participating agencies; however, data-collection activity is limited to a small number of high-impact parameters, which decreases the data-entry burden.
Such coordination can improve the quality of EMS care and thus increase the proportion of persons who survive an OHCA event. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Prehospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest.
These cities are located in 20 states: Alaska, California, Colorado, Connecticut, Delaware, Georgia, Kansas, Massachusetts, Michigan, Minnesota, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, and Virginia. Utstein survival refers to survival to hospital discharge of persons whose cardiac arrest events were witnessed by a bystander and had an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia. You’ll want to come back tomorrow too because I’ll be sharing a family planner chock-full of free printables!
When she’s not creating, Jamielyn loves to chase her two little monkeys and snuggle up on the couch with her man. I love the calendar, but I’m having trouble opening the family planner, what am I doing wrong? Once you subscribe it will send you an email, then you will need to confirm the email and it will send you another email with the link to the printable planner! You need to subscribe first, then confirm the email it sends you, then it will send you another email with the link! This is the first report to provide summary data from an OHCA surveillance registry in the United States.
Participating sites collect data from three sources that define the continuum of emergency cardiac care: 911 dispatch centers, EMS providers, and receiving hospitals.
CARES data confirm that patients who receive CPR from bystanders have a greater chance of surviving OHCA than those who do not.
Education of public officials and community members about the importance of increasing rates of bystander CPR and promoting the use of early defibrillation by lay and professional rescuers is critical to increasing survival rates. An OHCA is defined as cessation of cardiac mechanical activity that is confirmed by the absence of signs of circulation and that occurs outside of a hospital setting (1,2). In 2006, the Institute of Medicine (IOM) noted that the majority of EMS agencies cannot document their impact on the communities they serve and recommended that the EMS community collect, analyze, and use performance improvement data (14). The Utstein style was adopted by researchers and clinicians as a standard to use for research and registry databases for the purposes of tracking cardiac arrest in both in-hospital and out-of-hospital settings.
This report, the first to present OHCA surveillance data, summarizes CARES data for October 1, 2005--December 31, 2010 from 46 EMS agencies in 36 communities in 20 states (Table 1; Figure 2). This phase helped in understanding how to work in a complicated and multijurisdictional environment. Communities need to establish contacts at their local hospitals to provide emergency room and hospital data. Regardless of how an EMS agency's area of response is defined geographically, it must allow for capture of all OHCA resuscitation events in its area. If the resuscitation ends in the emergency department before EMS providers leave the hospital, this is documented in the CARES EMS report, and no additional data are needed from the hospital. To preserve patient confidentiality, individual identifiers are stripped from each record after a CARES analyst confirms the completeness and accuracy of each event.
Each variable was vetted by CARES staff, with input from an ad hoc panel assembled at the National Association of EMS Physicians Annual Meeting in 2004 (17). Sites can readily access their data and compare it with aggregate output of the entire registry.
Wide variation in how response time elements are defined in each community prevents aggregation of response time data on a national level. Because a shockable rhythm can deteriorate over time into a nonshockable rhythm, the time of the initially documented rhythm also can be considered as a surrogate marker for the time from collapse in those patients who are believed to have had a cardiac etiology event, emphasizing the importance of minimizing delay until defibrillation.
Each EMS agency also has a method to make sure that all of its resuscitation efforts are reported, which involves either an electronic query of its e-PCR or a manual review of its paper charts. Obtaining neurologic outcome is required to measure the overall clinical outcome of each OHCA patient.
The hospital contact is then able to review a discharge summary or hospital emergency room log and determine quickly the survival status and neurologic outcomes requested. Records that are identified are matched against the CARES database to ensure that all events were captured in CARES.
When a missing case is identified or incomplete data are discovered during the ongoing data audit process, the EMS providers who cared for the patient are asked to complete the record or clarify the missing data elements. A confidential report that compares 1) overall survival rates, 2) survival rates of witnessed arrests with an initial shockable rhythm, and 3) bystander CPR rates by community is provided to each site in a bar chart format (Figures 4--6). An in-person meeting with site medical directors and registry staff takes place annually and corresponds with a national EMS medical directors conference. CARES data are used to analyze neighborhood disparities regarding incidence of cardiac arrest and low rates of bystander CPR. These neighborhoods are now being targeted using culturally sensitive CPR interventions developed with the help of citizens from within these communities (David Keseg, MD, Jim Dunford, MD, personal communications, 2011). CARES data confirm that patients who are helped by bystanders and who are treated promptly by EMS providers in the field are most likely to survive.

A pilot AED registry to track device usage and map existing locations of devices at public sites is in the planning stage. In addition, state-level participation allows better communication and collaboration between state and local EMS providers.
EMS field providers might fail to return patient care documentation, and records with incorrect or missing name and date of birth information make it difficult for hospitals to locate the patient and provide a hospital outcome.
In addition, the data CARES collects focuses attention on the performance metrics that matter most to EMS medical directors, agency directors, and quality-assurance personnel.
If a pulse is not restored before EMS transport, additional efforts at the receiving hospital almost invariably fail (23). 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. OHCA is defined in CARES as a cardiac arrest that occurred in the prehospital setting, had a presumed cardiac etiology, and involved a person who received resuscitative efforts, including CPR or defibrillation. Reporting at the state and local levels can enable state and local public health and EMS agencies to coordinate their efforts to target improving emergency response for OHCA events, regardless of etiology, which can lead to improvement in OHCA survival rates.
In 2008, AHA renewed its call for widespread data surveillance and for making OHCA a reportable condition (3).
This template has been used in many published studies of cardiac arrest and has contributed to a greater understanding of resuscitation science and resuscitation guidelines (2).
Other medical directors learned about the registry through word-of-mouth at conferences and meetings and contacted program staff to request participation. Participating agencies also must ensure through routine audits of paper or electronic records that all of their OHCA events are being reported.
The event must have occurred as the result of a presumed cardiac etiology on the basis of the clinical judgment of the care providers. This helps to decrease the data-reporting burden required of hospitals and promotes and sustains participation in the program because the majority of patients transported to the hospital die in the emergency department.
Four criteria were used to determine which data elements to include in CARES: 1) whether the variable is necessary to characterize an OHCA event, 2) whether it can be defined clearly, 3) whether it can be measured objectively and reported reliably, and 4) whether it can affect or measure the outcome.
Access to the site is restricted to authorized users, who are prohibited from viewing data from another agency or hospital. Instead, these data are used routinely for local benchmarking purposes with historic data used for purposes of comparison. Because anoxic brain injury can occur within 4--6 minutes of collapse, communities with more favorable outcomes (CPC 1 or CPC 2) would likely be more effective might their bystander CPR rates and have shorter 911 response times given the time-sensitive nature of this condition. Tracking regular volumes by EMS and hospital providers also has encouraged compliance with the monthly schedule of data entry. CARES uses a restricted-access Internet database that uses secure socket layer encryption technology in transmitting protected health information to its servers to ensure the integrity and privacy of the data.
An annual report is provided to all participating communities that summarizes local results in comparison to regional and national benchmarks. Starting in 2009, cumulative (beginning October 1, 2005) and annual (calendar year) reports have been generated.
Retention of incident location allows geographic information systems (GIS) to be used to map events, so local EMS services can examine neighborhood characteristics as well as individual factors and system issues that might influence the likelihood of survival following an OHCA event. CARES is a voluntary registry, and agencies that choose to participate might have more resources to dedicate to quality improvement initiatives and thus might have greater survival rates than other agencies. An analysis of CARES data from Fulton County, Georgia, identified 14 census tracts with a high incidence of OHCA and low rate of bystander CPR that had more black residents, lower household income, and lower education levels than other census tracts in the rest of Fulton County (22). CARES records the address of a cardiac arrest event, enabling the use of GIS technology to identify community-level disparities related to bystander CPR and AED usage. CARES cannot capture OHCA events when 911 or EMS are not notified, resulting in lack of detection of some OHCA events.
As statewide CARES registries become available, the data will be used for state-specific OHCA surveillance efforts. I printed a copy for myself as well as each of my teenage daughters {the LOVED it, too!}!!! The Utstein template can be used within hospitals, EMS systems, or communities and enables identification of areas that need improvement and comparisons across systems. These detailed reports include patient demographics, arrest information, and hospital outcomes. Initial cardiac arrest rhythm and neurologic status among survivors are stratified by age group (Figures 7 and 8). No significant difference was noted in receiving bystander CPR between male and female patients (p = 0.821). However, these low survival rates for an OHCA event are of public health concern because, despite advances in technology and resuscitation science, these rates have remained virtually unchanged for >3 decades (10). As communities work to increase training in bystander CPR, improve awareness of AED availability, and use more effective CPR techniques, CARES data can be analyzed to evaluate the success of these interventions and contribute to improved survival on a local, regional, statewide, or national level. Second, EMS providers work in high-stress environments and are commonly collecting information after the event.
We didn’t have any fancy parties or plans but it was nice to enjoy a relaxing night with my favorite people. Without a reliable method to collect data in a uniform fashion, the effectiveness of different EMS systems and interventions cannot be compared. HDS-18) called for increasing the proportion of OHCA events that receive appropriate bystander and EMS care (15). It consists of 29 core data elements that allow for standardized resuscitation terminology. At present the program has grown to encompass more than 40 communities in 23 states, representing 73 EMS agencies and more than 340 hospitals. In addition, EMS agencies and hospitals are able to query the database for any combination of local outcomes. An initial shockable rhythm occurred most frequently among persons aged 35--49 years old and those aged 50--64 years. CARES data reinforce previous research indicating increased survival benefit when bystander CPR occurred. Recall bias among EMS providers, as well as bystanders, might affect the quality of the data. Participation in an OHCA registry enables medical providers and EMS systems to compare patient populations, interventions, and outcomes and identifies opportunities to improve quality of care and ascertain whether resuscitation is provided according to evidence-based guidelines (2). In 2004, to develop a model national registry that could measure outcomes and progress in the treatment of OHCA, CDC collaborated with the Emory University School of Medicine to establish the Cardiac Arrest Registry to Enhance Survival (CARES), which collects data to improve the quality of care and outcomes of patients who experience an OHCA. The proportion of survivors who achieved a good CPC scale (CPC = 1) declined progressively by age group, beginning with those aged 18--34 years through those aged ?80 years. Utstein survival is defined as the rate of survival among persons whose arrests were witnessed by a bystander and who had an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia.
A systematic review and meta-analysis of predictors of survival determined that, for bystander CPR, the number of persons needed to receive treatment to save one life was 24 patients in communities with high baseline survival rates and 36 in communities with low rates of survival; this study suggested that efforts to increase survival rates from OHCA include targeted CPR training (10,22). Utstein survival refers to survival to hospital discharge of those cardiac patients whose arrest events were witnessed by a bystander and that involved persons who had an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia. These patients have the greatest survival potential and are the most likely to respond to CPR or defibrillation. These patients are the most likely to respond to CPR or defibrillation and are thus more likely to survive an OHCA event. Utstein suvival provides a better measurement tool for determining the effectiveness of an intervention, such as increased CPR training within a community.
This could potentially create a selection bias for denser populations, more infrastructure, greater resources, and more established EMS systems, limiting generalizability of CARES results. Since Utstein survival is determined for a subset of the overall dataset and represents patients who are most likely to survive, Utstein survival rates are consistently higher than overall survival rates. Expansion at the state level allows CARES to be more inclusive and include communities of varied size and population densities. Participants are asked to classify an arrest as having a cardiac etiology, unless it is known or likely to have been caused by a noncardiac cause. Improving community bystander CPR rates is an important step towards improving OHCA survival. The presumption of cardiac etiology could potentially cause misclassification of the event.
Fifth, since CARES is designed as a registry system rather than a research database, it does not capture highly detailed information on episodes of OHCA or detailed treatment information. CARES does not measure the rate, depth, or influence of interruptions in chest compressions, which would help to understand better the effectiveness and quality of CPR.
Response time by EMS providers and first responders is measured, but aggregate reports are not generated for benchmarking purposes because of concerns regarding variation in how these times are measured. Finally, the data- collection process protects the confidentiality of subjects by de-identifying records once they have been deemed accurate and complete. This prevents researchers from identifying and contacting survivors or the next-of-kin of those who died, which can limit understanding of patient outcomes after hospitalization or the influence of community members' efforts during an OHCA event before the arrival of 911 responders.

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