Measurement of results is an essential element of the HeartRescue Project. A system can implement all the best practices in the world, but we won't know it is working unless performance and outcomes including survival rates are measured. We can also gain better perspectives on SCA prevalence. 

• Currently, there are no national standards for SCA performance and outcomes. HeartRescue Partners are utilizing the CARES registry as a common set of data elements used to measure performance and outcomes.  More information on OHCA (out-of-hospital cardiac arrest) data collection can be found here.
• There are an estimated 382,800 OHCA events treated by EMS in the United States each year.¹
• The best survival statistics available today indicate that in communities that measure their survival rates, roughly 10% of OHCA victims survive²; this is known as the “overall” survival rate. 
• Survival in communities that are not measuring is likely half of that rate. Because only a handful of communities currently measure SCA survival^2,3 across most of the United States, the national overall survival rate is likely much less than 10%.
• Survival for EMS treated, bystander witnessed, ventricular fibrillation (VF) OHCA in the US is around 30% in communities that measure.
• Patients who present in ventricular fibrillation, particularly those who are EMS-treated, bystander-witnessed, and in ventricular fibrillation have the best chance of survival among all cardiac arrest victims. Survival rates for this group of SCA victims often serve as a sentinel measure for the effectiveness of a community's system of care.
• There is wide variability in EMS-treated, bystander witnessed, VF OHCA survival rates across the country, ranging from 7.7% to 39.9%³.

While every community has a unique set of circumstances that may not allow for the commitment of resources that top-performing systems may have, similar results can be achieved.
Focusing on best practices does not mean cookie-cutter solutions. Incremental steps can be taken, starting with a number of possibilities including:

• Measuring OHCA at the basic level (e.g. ventricular fibrillation witnessed arrests)
• Improving CPR at the EMS level (e.g., implementing high performance CPR education at the EMT level)
• Implementing public-based CPR/AED education programs
• Providing 911 dispatchers with SCA recognition training and bystander CPR instructions

It should be no surprise that any community SCA response effort needs visionary leaders committed to system improvement. Any efforts should start by gaining buy-in and enthusiasm from top community leaders. Leaders fulfill the following functions:

• Motivate and educate other key leaders
• Set strategic goals for activities to be undertaken
• Align efforts within the organization to achieve those goals
• Provide resources for the creation, spread, and sustainability of effective systems
• Remove obstacles to improvements for clinicians and staff
• Require adherence to known practices that will promote patient safety

There is a correlation between the overall performance of an EMS system and SCA survival rates.

• The attributes of collaboration and measurement which contribute to good SCA outcomes also contribute to better EMS care in general
• Collaboration that’s required to improve SCA survival rates means connections between pre-hospital and hospital are strong, which has positive implications for the entire system
• Undertaking an effort to improve SCA outcomes can have a positive effect on the entire EMS system, in terms of building relationships, cultural changes, and an emphasis on performance and quality improvement