BERWYN, PA - Berwyn Fire Company EMS has participated in the Emory Woodruff Health Sciences Center 'CARES' Program for the last 15 years. CARES stands for Cardiac Arrest Registry to Enhance Survival. The program uses a secure web database to collect data and track patient progress after a sudden cardiac arrest. It also collects 9-1-1 data to track response times and hospital data to compare benchmarking of key performance indicators. There are 28 states, including Pennsylvania who have 100% compliance as well as dozens of other cities around the country who send their data to CARES. More then 2,200 Hospitals around the country also participate.
CARES exists to help EMS and community leadership evaluate their life saving efforts as it compares to state and national averages. According to the CARES information statement, "CARES was developed to help communities determine standard outcome measures for out-of-hospital cardiac arrest (OHCA) locally allowing for quality improvement efforts and benchmarking capability to improve care and increase survival."
Berwyn EMS recently received our 2020 CARES Survival report. Here are some highlights:
2020 Pre-hospital Sudden Cardiac Arrests: 20
Bystander CPR initiated: 9 out of 20
Bystander AED Use: 0 out of 20
Fire Responder AED Use (Prior to Ambulance): 12
Location: Home: 12; Nursing Home: 1; Public Setting: 7
Clinically, we are able to learn a lot about how we are doing as a response agency. Outcome percentages as compared to state and national numbers represent an outstanding year for Berwyn EMS. Here are some data points with some explanations to understand how we are doing.
AED applied prior to Ambulance arrival by first responder:
Berwyn Fire & EMS First responders, including police officers from Tredyffrin and Easttown often arrive prior to the ambulance and are equipped with Automated External Defibrillators (AEDs). The goal is to get a defibrillator on a patient within minutes to increase survival chances. After 10 minutes, there is almost no chance of an AED being effective.
Shockable Rhythm when AED applied by first responder:
AEDs need a 'Shockable Rhythm' in order to work. In simple terms, the AED resets a poor electrical pulsing of the heart back into a good electrical pulsing to make the heart function properly. When Sudden Cardiac Arrest happens, the electrical pulsing fades away after a short period of time. The longer it takes to get the AED attached, the less chance there is of the AED shocking the patient. Our 30% rate as compared to the state and national means that our first responders are effectively getting AEDs on patients in good time prior to the ambulance arrival.
Sustained ROSC (Return of spontaneous circulation):
Return of spontaneous circulation is achieved after an AED shock and/or CPR. While this does not mean the person will survive, it does mean that shocks, CPR and other Advanced Life Support (ALS) intervention has restarted the heart enough so to where you can feel a pulse on the patient. ROSC is the first step in the lifesaving process during a sudden cardiac arrest event.
Overall Survival with Hospital discharge and good to moderate brain function:
Out of hospital discharge with good to moderate brain function is considered a 'clinical save' and is the pinnacle of what EMS exists to do. In simple terms, these are lives saved after the patient's heart has stopped and they are sent home with good quality of life due to little or no brain damage from lack of oxygen.
Despite the pandemic, which further complicated EMS responses, our providers rose to the occasion and saved several lives in the Tredyffrin/Easttown community. We could not be more proud of our first responders for so far exceeding these state and national averages. The addition of our Quick Response Service Unit and opening of our fire/EMS substation in Tredyffrin Township have played major roles in this community success.