Emory University
Years Available
2006 to present
Mode of Collection
Abstraction of administrative data, claims data, or data from other records.
CARES was developed to help communities determine standard outcome measures for out-of-hospital cardiac arrest (OHCA), allowing for local quality improvement efforts and benchmarking capability to improve care and increase survival. The program seeks to save more lives from OHCA; strengthen collaboration between 911 centers, first responders, emergency medical services (EMS) agencies and hospitals; provide a simple, confidential process for assessing patient outcomes in compliance with HIPAA; offer technical assistance to help community leaders identify and prioritize opportunities to improve EMS performance; and generate annual national and statewide reports for benchmarking capability.
Selected Content
Demographic information, circumstances of cardiac arrest, resuscitation-specific data, emergency department and hospital data, and survival status.
Population Covered
In 2020, CARES included 28 state-based registries, the District of Columbia registry, over 45 community sites in 14 additional states, as well as more than 1,800 EMS agencies and 2,200 hospitals nationwide. The registry represents a catchment area of 145 million people (45% of US population).
CARES is a secure, web-based data management system in which participating communities enter local data and generate their own reports. Communities can compare their EMS system performance to de-identified aggregate statistics at the local, state, or national level and discover promising practices that could improve emergency cardiac care. Data collection is based on the Utstein style definitions for cardiac arrest – a standardized template of uniform reporting guidelines for clinical variables and patient outcomes developed by international resuscitation experts. Patient-level data without personal identifiers can be submitted using a data-entry form on the CARES website or through daily upload from an agency's electronic patient-care record system. The CARES database is geocoded on an annual basis and linked to census-tract variables including: median household income, median age, race, unemployment rate, average household size, population density, and educational attainment.
Response Rates and Sample Size
CARES participants are responsible for entering data on 100% of all EMS-treated out-of-hospital cardiac arrests within their response boundaries. Since CARES is not survey-based, a "response rate" per se doesn't apply.
Interpretation Issues
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. 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. CARES cannot capture OHCA events when 911 or EMS are not notified, resulting in lack of detection of some OHCA events. EMS providers work in high-stress environments and are commonly collecting information after the event. Recall bias among EMS providers, as well as bystanders, might affect the data quality. 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 next-of-kin of those who have died, which can limit understanding of patient outcomes after hospitalization or the influence of community members' efforts during an OCHA event before the arrival of 911 responders.