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EMSWORLD.com | NOVEMBER 2017 19 W hen a group of Michigan clini- cians and researchers set a goal of doubling the state's sudden cardiac arrest (SCA) survival rate over the next three years, they knew it would take a team of dedicated, enthusiastic individuals and the help of others like them around the country who'd already found ways to improve cardiac arrest systems of care. That's why the state recently partnered with the HeartRescue Project, a national collaborative focused on saving more lives from SCA. Coined in 2014 as "SaveMIHeart," Michigan's grassroots effort began with dedicated volunteers and very little fund- ing. Before the state even became a Heart- Rescue partner, SaveMIHeart had brought together a team of leaders and volunteers committed to improving outcomes for vic- tims of cardiac arrest. There is Teri Shields, a nurse who audits the 6,000 or so out-of-hospital sudden cardiac arrests collected by the state of Michigan each year and also serves as SaveMIHeart's executive director. "We stress the importance of the simple things, like hands-only CPR for bystanders," she says. "Calling 9-1-1 and starting hands- only CPR are two simple, lifesaving actions." There is Robert Neumar, MD, cochair of the initiative, who provides vision and direc- tion for the team. "Cardiac arrest is the most critical condi- tion we treat," Neumar says. "In addition, treating cardiac arrest requires the most complex system of care. I like a big chal- lenge." There is Robert Dunne, MD, the emergen- cy physician who oversees the EMS system in Detroit, the state's largest metropolitan area, and who is out on the streets with paramedics and EMTs, teaching them the knowledge and skills necessary to achieve SaveMIHeart's goal. "As a leader, I must provide best practices for training and support for protocol chang- es," says Dunne. "I focus on ways to get the latest knowledge about cardiac arrest out there to the patients who need it." And there are others, such as Brian O'Neil, MD, chair of the emergency department at Wayne State University, and Robert Swor, DO, an emergency medicine physician at Beaumont Health System. These two organizations, along with the University of Michigan, Emergent Health Partners and the Kellogg Family Foundation, have pro- vided much of the funding that supports SaveMIHeart. But the team extends even outside of Michigan's borders, to the dozens of experts around the country who support their fel - low HeartRescue Project members. Like Kim Harkins, program manager of Minnesota's Resuscitation Consortium, who provides guidance to new partner states, like Michi- gan, by drawing on the vast repository of lessons learned by HeartRescue Project partners. "Cardiac arrest," says Harkins, "is a public health crisis screaming for national atten- tion and recognition." Measure and Improve The HeartRescue Project began in 2011 with a five-year grant from the Medtronic Foundation to support six states and one private ambulance partner, all renowned for their resuscitation excellence, in their efforts to measure and improve cardiac arrest outcomes. The partnership emphasized the collec- tion of process and outcome data because only by examining this information could HeartRescue members know whether their efforts were safe and effective. Within a few years the partners saw survival rates increase, thanks largely to improvements in evidence-based actions by bystanders, emergency responders and hospital per- sonnel. Those initial successes led to the expan- sion of the HeartRescue Project and its ef for ts to suppor t measurement and improvement. Overseeing this new phase is one of the project's founding partners, Thomas Rea, MD, who also serves as medi - cal director for King County Medic One and is an associate professor of medicine at the University of Washington. Rea helps coordinate a team of HeartRescue part- ners who continue to collaborate by shar- ing best practices for treatment of cardiac arrest and researching new and innovative approaches. The HeartRescue Project's ultimate goal is simple: to save more lives and improve public health. Their work is cut out for them, as more than 350,000 people experience SCA in the United States every year, and fewer than 10% survive. Creating Systems of Care As a founding member and codirector of SaveMIHeart, Neumar has worked with his team to examine and improve four distinct aspects of cardiac arrest care: bystander CPR, 9-1-1 dispatch, EMS response and postarrest hospital treatment. These four components make up the all-important system of care. Each of these important steps in some way relies on the others; none of them will succeed if they aren't working in concert. Identifying best practices, performing qual- ity improvement (QI) and providing guid- ance for individual communities within the state are ways Michigan can measure and improve outcomes, according to Neumar. "We need to figure out how to best opti- mize the system of care to implement the science we know works," he says. "Even if we design or discover new therapies, if we plug them into a system of care that's not functioning optimally, we will not see improved outcomes." Improving the rate of bystander CPR. Shields uncovered noteworthy data on Michigan's bystander CPR rates: Only about 40% of SCA victims get it, though research indicates it's one of the most critical links in the chain of survival. Michigan wants to raise that rate to 50% or more. Last year the state enacted legislation mandating CPR and AED education in high schools. In addition, SaveMIHeart created an award-winning public ser vice video about hands-only CPR and showed it to more than 100,000 fans at two University of Michigan football games. The lightheart- ed video, which has also been viewed more than 150,000 times on social media, fea- tures a tailgate party where an SCA victim receives bystander CPR while the school's marching band plays the University of Michi- gan fight song—which happens to be at the standard CPR rate of 100 beats a minute. "SCA victims who receive immediate bystander CPR before EMS arrives have an increased chance for survival," Shields says. Within Dunne's Detroit East Medical Con- trol Authority, SCA survival rates had been some of the lowest in the nation. Dunne