Atlanta Becomes a Template for Improving Cardiac-Arrest Survival Rates

When Atlanta's emergency medical system needed rescuing, Mayor Shirley Franklin started performing CPR -- in more ways than one.

In 2003, she started issuing orders that have resulted in lifesaving changes to Atlanta's emergency system. She began looking for ways to hold emergency crews more accountable, and last year she ordered all 8,000 city employees -- including herself -- to be trained in cardiopulmonary resuscitation.

"All you need to do is save one life and it's worth it," Franklin says. "It's miraculous."

Thanks to those efforts and a program created in Atlanta by Emory University and the Centers for Disease Control and Prevention, the city is saving more residents who collapse of sudden cardiac arrest. Since September 2005, the survival rate for such patients in Atlanta has jumped from less than 3% to 15%. That's well above the 6% to 10% survival rate for most cities that was identified in a 2003 analysis by USA TODAY.

Atlanta's success has made it, and the program it's following, a template for cities trying to improve cardiac-arrest survival rates, an often murky set of figures complicated by communication problems among government agencies.

Several cities -- including Houston, Anchorage, Austin, Cincinnati, Kansas City, Mo., Raleigh, N.C., and Tucson -- are following in Atlanta's footsteps by signing up for the Emory/CDC program. It allows cities to use its Internet database to combine data from 911 dispatch centers, paramedic run reports and hospital discharge records to reveal more about the performance of EMS units -- widely viewed as a key step in improving cardiac survival rates. Many cities have no system to effectively track such rates.

A few cities in the program or planning to join it were identified in the USA TODAY report four years ago as having particularly good systems for tracking emergency crews' performance. Those include Houston, Kansas City, Tucson, Boston, Nashville and San Francisco. Other cities taking part or planning to -- such as Atlanta, Austin and Columbus, Ohio -- were identified as having less-than-stellar systems for tracking cardiac survival rates.

The program -- known as Cardiac Arrest Registry to Enhance Survival, or CARES -- is a five-year, $1.5 million CDC project launched three years ago. It was partly inspired by the USA TODAY investigation, which found that emergency medical systems in most of the nation's 50 largest cities were fragmented, inconsistent and slow.

Why the focus on cardiac arrest survival rates and not those from something else, such as car accidents or cancer? Cities use cardiac arrest survival rates as a key measure of EMS performance because such victims typically live or die depending on the care they get in the first minutes after collapse, unlike other emergencies in which survival hinges more on hospital care.

"The system has to deliver in order to save a cardiac arrest victim," says Arthur Kellermann, an emergency physician at Emory University School of Medicine. "If it can deliver in a consistent manner for cardiac arrest victims, there is every reason to expect that it will deliver for trauma victims, asthma victims, women in labor."

More than 250,000 people die outside of hospitals each year when their hearts stop beating. Many are reaching the natural end to battles with disease, but others are healthy when struck by an electrical short circuit of the heart called ventricular fibrillation. "V-fib" can be caused by anything from a blocked coronary artery, to a ball striking the chest, to changes in the heart muscle from an infection.

In 2003, USA TODAY found disparities in emergency medical care across the nation, and said cities that carefully track their EMS performance save many more lives. In most cases, such cities also make a point of teaching residents CPR by, among other things, sending firefighters into homes, churches or businesses to train people.