Cardiac Arrest Tracking System
Complete an individual form for each treated, non-traumatic, cardiac arrest for whom EMS initiated or continued CPR.
Inclusion Criteria
- Out-of-hospital non-traumatic cardiac arrest
- Patient assessed by organized EMS personnel
- Patient received either:
- External defibrillation by lay responders or EMS personnel
- Chest compressions by EMS personnel
Instructions for coding the cases
Prior to making your coding decisions, review and consider the information from all sources readily available to you: EMS incident report, CAD report, dispatch recording, hospital record, death certificate, medical examiner. For each question, select the best response after considering all available information. Trauma per se does not meet requirement for case inclusion in this data set. However, cases should be included even if the initial mechanism appears to be traumatic, such as an MVA or a fall, if the evidence suggests that the apparent “trauma” was a result of a cardiac arrest and not the cause. Cardiac arrest cases shocked by any external defibrillator with resulting ROSC prior to EMS arrival and no need for EMS CPR are also eligible and should be included.
Database Use: Prior to entering any cases complete the Responding Agency List and Transport Destination List specific to your agency.
CaseNumber
This is the consecutive case ID number automatically generated by the database for each record entered. This is primarily used for database management.
IncidentNumber
Identifying EMS number used within system. This number should be useful to each individual agency and provide a way to track cases and compile information from various data sources.
IncidentDate
Date of cardiac arrest event. Date 911 call came into dispatch center. mm/dd/yyyy
Location
Type code of location where cardiac arrest occurred at the time help as summoned.
CodeCode Value Definition
1 / Home/Residence / Includes: Private Residences, Assisted Living facilities, Adult Family Homes, Retirement Communities, Apartment, Boarding house, sorority house, fraternity house, barracks, dormitory, Farm house, Home premises, House (residential), Non-institutional place of residence, Private: driveway, garage, garden, home or walk, Swimming Pool in private house or garden, Yard of home.Excludes: home under construction but not yet occupied or institutional place of residence
2 / Public indoor / Buildings or adjacent grounds used by the general public or by a particular group of the public, such as: airport, bank, café, casino, church, cinema, clubhouse, courthouse, dance hall, garage building, hotel, market (grocery or other commodity), music hall, night club, office building, post office, public hall, radio broadcasting station, restaurant, shop (commercial), station (bus or rail), store, theater. Educational institutions, schools (private or public) to include university or college, adult education center, pre-schools, daycares.
3 / Public outdoor / Residential streets, highways, parking lots. Amusement park, Baseball field, Basketball court, Beach resort, Cricket ground, Fives court, Football or soccer field, Golf course, Gymnasium, Hockey field, Holiday camp, Ice palace, Lake resort, Mountain resort, Playground, including school playground, Public park, Race course, Resort NOS, Riding school, Rifle range, Seashore resort, Skating rink, Sports ground, Sports palace, Stadium, Swimming pool, public, Tennis court, Vacation resort
Excludes: yard or grounds of private house
4 / Skilled nursing facility or nursing home / Facility that provides 24-hour supervised nursing care, personal care, therapy, supervised nutrition, organized activities, social services, room, board, and laundry. Adult family homes should be coded as this category if 24 hour supervised nursing care is provided.
6 / Medical Care Setting / Any medical care facility. Hospital, Hospices, Medical clinics, clinic-type infirmary, Doctor, dentist or oral surgeon’s office, hemodialysis centers, intermediate care hospitals (24 hr nursing care with a medical director on-site).
9 / Unknown
Use RespondingAgency1, 2, 3 for purposes that make sense for your system. In a two tiered system you can designate one for BLS responders and one for ALS responders. For those who have private ambulance transport, this can be designated RespondingAgency 3. Please document your decision about how to use these variables and maintain consistency in coding.
To create the drop down menu to list your particular agencies, use the Responding Agency List form to populate this drop-down menu.
RespondingAgency1
First responding agency.
RespondingAgency2
Second Responding agency
RespondingAgency3
Third responding agency or Transport agency
Patient FirstName
Patient LastName
Patient name is included for hospital follow up purposes.
Age(Years)
Age in years. If unknown, leave blank. If unknown, approximations are okay to enter. For example, if the responders chart that the patient is about 50 years of age, enter 50 as an estimate, even if exact age is unknown. Age less than 1 year =0, Age greater than 1 but less than 2 = 1, etc.
Date Of Birth
Date of Birth, if known. This is included to facilitate hospital follow up.
Gender
CodeCode Value
1 / Male2 / Female
9 / Unknown, not stated
Arrest Witnessed
If anyone, including EMS, saw or heard the patient collapse, then the arrest is considered witnessed and should be coded ‘yes’. Witnessed means that someone saw or heard the patient collapse, even if there was a delay to call 911. If the patient or someone on their behalf called 911, and the patient was not in cardiac arrest at the time of the 911 call, consider the patient to be witnessed (e.g. cardiac arrest occurred during or after call to 911). If the collapse was not seen or heard,the cardiac arrest is considered to be unwitnessed and should be coded ‘no’, even if the amount of time can be documented to be short (e.g. patient was last seen alive 5 minutes ago).
CodeCode Value
1 / Yes2 / No
9 / Unknown, not stated
Arrest AfterEMS arrival
Did the cardiac arrest occur while EMSwas on-scene? Cardiac arrest is defined as cessation of pulse / blood pressure and respirations. A faint pulse may sometimes be felt even when no blood pressure is obtainable. If a patient has stopped breathing but EMS can still palpate a pulse, even if no blood pressure is obtainable, the patient is not in cardiac arrest yet. Sometimes patients in cardiac arrest can have a persistent respiratory drive or agonal respirations. If EMS cannot obtain a blood pressure or palpate a pulse, but the patient has slow respirations (< 4 - 6 minute), then the patient may be considered in cardiac arrest, particularly if the respirations are described as agonal.
Code 1=yes if the patient has a palpable pulse or obtainable blood pressure on EMS arrival and then loses the pulse and blood pressure while attended by EMS. Code 2 =no if the patient has no palpable pulse or blood pressure upon EMS arrival, even if the patient has agonal respirations (rate < 4-6 minute).
CodeCode Value
1 / Yes, arrest after arrival of EMS2 / No, before EMS arrival
9 / Unknown, not stated
Etiology
The presumed underlying cause of the cardiac arrest. Use all available information to indicate the cause of the cardiac arrest. This is coded by ruling out the non-cardiac etiologies. The basis for the cardiac arrest will be considered to be due to presumed or demonstrable heart disease unless there is evidence to the contrary. In other words, presume the cause to be cardiac unless the documentation supports one of the other choices. For example, a person with end-stage illness can still experience cardiac arrest due to a cardiac etiology, especially if their death is not expected at that time.
CodeCode Value Definition
1 / Presumed Cardiac / Include sudden and non-sudden cardiac etiologies, including persons experiencing an expected death due to heart failure as well as those with a sudden collapse due to presumed heart disease2 / Respiratory - medical / Lung diseases, COPD, emphysema, asthmatic exacerbation. Clinical course implicating asthma. For example: the use of an inhaler or nebulizer at the time of arrest, patient is on O2. Asphyxiation due to hanging is traumatic and should not be included.
3 / Respiratory (toxic-OD) / Respiratory arrest due to intentional or unintentional substance use. To include respiratory suppression due to alcohol, recreational drugs, and unintentional prescription drug interactions and complications.
4 / Drowning / Drowning is the one exception to traumatic etiologies. Cases of drowning are included.
5 / Electrocution
6 / Other medical / Examples include GI Bleed, CVA, aneurysm. End-stage illness: cancer, renal, etc. An individual for whom death is expected, excepting expected cardiac deaths (heart failure) End stage illness such as cancer, etc. An individual whose function is declining and for whom death is expected, excepting expected cardiac deaths (heart failure).).
9 / Unknown Cause / If coding unknown, consider coding as Presumed Cardiac Etiology based on the information available. All cardiac arrest should be considered to be cardiac unless there is evidence otherwise.
Resuscitation Attempted
Didany EMS Responders perform CPR? CPR includes chest compressions, therefore any chest compressions given will be considered CPR. The only time you should answer 2=no for eligible cases is if the patient was shocked first (by PAD or EMS) and had restoration of pulse, blood pressure, and respirations so quickly that EMS did not need to perform CPR. There may be other infrequent situations, such as a combined EMS/medical staff resuscitation at a medical center, where CPR is provided to the patient but not by EMS. Very rarely patients may be resuscitated by a pre-cordial thump if they are being monitored prior to experiencing cardiac arrest. Otherwise, the case should be reconsidered for the this case series. This variable can be used to differentiate those cases that were dead on arrival.
CodeCode Value
1 / Yes2 / No
9 / Unknown
CPRInitiated By
Indicate the first person to provide CPR(compressions and/or ventilations). A treated cardiac arrest requires that CPR or shock be performed. CPR includes compressions and/or ventilations. Note: If you answer 0=No CPR Provided by anyone and there was also no shock (i.e. resuscitation not attempted), then please reconsider whether the case meets the case definition as a treated cardiac arrest patient. The only instance in which you would code 0= No CPR Provided by anyonefor eligible cases is if the patient was shocked first (by PAD or EMS) and had restoration of pulse, blood pressure, and respirations so quickly that no one needed to perform CPR. Very rarely patients may be resuscitated by a pre-cordial thump if they are being monitored prior to experiencing cardiac arrest. Otherwise, the case probably should not be in this data set.
CodeCode Value
1 / EMS / Any level ofEMS responder provided the first CPR. EMT or paramedic.2 / Bystander / Any lay personwho is not described by one of the other provider types.
3 / Police / An on-duty police officer, whether dispatched or not
4 / MD/RN/Off-duty EMS/caregiver / Medical professional, off-duty firefighter, EMT or paramedic; caregiver (paid nursing home staff, aid, home health care worker); other non-EMS but with a duty to respond, e.g. ski patrol, private ambulance, security, etc.
8 / Unknown if CPR before EMS arrival / If you know that EMS did CPR but you don’t know if anyone did CPR prior to EMS arrival
9 / Unknown if any CPR provided / If you don’t know if CPR was done at all
0 / No CPR provided by anyone / The only time you would check this is if the patient was shocked with such quick return of spontaneous circulation and respirations that no CPR was done.
Dispatcher Assisted CPR
Did the 911 caller provide CPR with the aid of dispatcher assistance? The intent of this variable is to determine if CPR was aided or initiated by dispatch. This variable is a measure of dispatcher actions, not the actual actions of the bystander.If the dispatcher offered CPR and it was declined and not done, then code 1=yes because the dispatcher provided, or attempted to provide, assisted CPR.
CodeCode Value
1 / Yes / Instructions were offered or providedto the caller on how to perform chest compression and/or ventilations.2 / No / No instructions were provided.
9 / Unknown
First ECG Rhythm
First monitored ECG rhythm after cardiac arrest has occurred by BLS, ALS, or a public access defibrillator (PAD) that was applied to the patient before EMS arrived. If an automated defibrillator (AED or PAD) was the first defibrillator placed on a patient in cardiac arrest, consider whether the device advised a shock on the first analysis. For example, if a PAD shocked the patient on the first analysis, code 5=unspecified shockable. If the PAD was placed on a patient in cardiac arrest and did not recommend a shock on the first analysis, code 6=unspecified, non-shockable. If a PAD or AED did not shock the patient on the first analysis, also consider whether the patient was really in cardiac arrest at that time. Sometimes bystanders may apply a PAD to an unconscious or unresponsive person who is not yet in cardiac arrest. The identified rhythm codes can be used when the initially monitored ECG rhythm after cardiac arrest is observed by a paramedic or other responder who is trained to recognize ECG rhythm. They may also be coded if your system reviews the PAD or AED download and identifies the first monitored cardiac arrest rhythm as VF, VT, pea, or asystole on the download.
CodeCode Value
1 / Ventricular Fibrillation (VF)2 / Idioventricular/PEA
3 / Ventricular Tachycardia (VT)
4 / Asystole
5 / Unspecified shockable / For AED cases that did receive an analysis and was ‘shock advised’ or manual defibrillation cases where shockable rhythm was not specified or documented
6 / Unspecified, non-shockable / For those case that did receive an AED analysis but was ‘do not shock’ or manual defibrillation where non-shockable rhythm was not specified or documented
9 / Unknown
AED First Applied By
Who applied the first AED pads, regardless of analysis or shock.
CodeCode Value
1 / Responding EMT2 / Responding Paramedic
3 / Bystander / PAD
4 / Police
5 / Other medical personnel
8 / Other, or unknown person
9 / Unknown if patient shocked
Defib First Performed By
Indicate the responder who first shocked the patient after onset of cardiac arrest (do not include cardioversions - shocks delivered to convert a patient who is not in cardiac arrest from atrial fibrillation or ventricular tachycardia)
CodeCode Value
1 / Responding EMT2 / Responding Paramedic
3 / Bystander / PAD
4 / Police
5 / Other medical personnel
8 / Other, or unknown person
9 / Unknown if patient shocked
Time Variables
Times are collected in the 24 hour format hh:mm:ss. Use 0 for the hour between midnight and 1 am, 23 for the hour between 11 pm and midnight. Leave time components blank if unknown or not applicable (e.g. leave seconds blank if unknown). Record the earliest time available for the earliest unit.
Time Dispatch Notified
Time Call Received at first 911 Dispatch Center. Earliest time recorded available at communication center. Leave any unknown time components blank.(hh:mm:ss)
Time Bystander CPR
Time of first bystander CPR, if applicable. Only enter if patient received bystander CPR. Estimations can be used appropriately. For example, “bystanders began CPR just prior to EMS arrival” code CPR onset time prior to EMS arrival according to your best judgment. Leave any unknown time components blank. Recorded to the nearest minute (hh:mm).
Time EMS CPR
Earliest time EMS CPR, first breath or chest compression, administered by EMS. Leave any unknown time components blank. Recorded to the nearest second in (hh:mm:ss).
Time First Shock
Time of first shock. If the patient is shocked by a PAD, you may not know the time. If there is a time estimate, try to convert it to the appropriate hh:mm:ss if possible. For example, the narrative might note that the patient was shocked within one minute of collapse, so you might enter 1 minute after the call to 911 as the hh:mm:ss of the first shock. Leave any unknown time components blank. Recorded to the nearest second in hh:mm:ss.
Time First Unit Notified
Time first unit dispatched. (hh:mm:ss) This is the earliest time for ANY EMS responding unit, not necessarily the first responding agency. If the BLS unit was dispatched first, then enter that time here.
Time First Unit Responds
Time first unit en route or ‘responding’ to scene. Time at which the dispatched unit responded. This allows for measure of ‘roll out’ times. Enter earliest “roll out” time for of all units.
Time First Unit Arrived at Scene
Time first unit arrived at the scene, also known as on-scene time, curb time, or wheelstop time. This is the time for the earliest-arriving EMS unit at the scene. For example, if BLS was dispatched first, but the ALS unit arrived sooner, enter the time that the ALS unit arrived at the scene. The critical interval is how long from the time that the call came in until ANY EMS unit arrived at the scene; it is patient waiting time.