Challenges and Solutions Facing EMS in Supporting the IOM Recommendation for a National Cardiac Arrest Registry: A System Perspective

This white paper focuses on the feasibility of the Institute of Medicine’s (IOM) recommendation to support a national cardiac arrest registry. A functional national cardiac arrest registry provides necessary research data to EMS and hospitals for improving cardiac arrest survival rates. This white paper contends the IOM recommendation falls short in considering the issues needed to ensure the success of a national cardiac arrest registry. Challenges facing the successful implementation of a national cardiac arrest registry are framed within systems theory because a) this is the theoretical premise underlying the IOM recommendation, and b) using a systems framework leads to explicit strategy recommendations for addressing the challenges. The challenges noted include a) a lack of shared understanding of the purpose of the national cardiac care registry between the research leadership at the national level and the EMS leadership at the state and local levels, and b) cascading failures caused by unrealistic expectations placed on participating local and state EMS subsystems in trying to support a national research agenda. These challenges bring into serious question the validity of any statistical analysis using EMS/prehospital data. Arguments are augmented by using past evaluations of the Cardiac Arrest Registry for Survival (CARES) and the evaluation findings of six Midwest and Mountain West EMS systems. Using systems theory, several recommended strategies are forwarded which EMS services should consider before making substantive investments in supporting a national cardiac arrest registry. EMS AND A NATIONAL CARDIAC ARREST REGISTRY 3