One of the greatest challenges of any EMS clinical manager is to find ways to test and improve the efficacy of their system.

   Across the country, we commonly use benchmarks such as dispatch times, as they are one of the few things measured across virtually all U.S. systems, and can be among the most accurately measured and tracked. Within the past decade, however, a trend is emerging to collect data on successful cardiac arrest resuscitations, with many systems publishing their rates. At least one EMS system is promoting rates of resuscitation from bystander-witnessed ventricular fibrillation cardiac arrest as the best benchmark for managing system efficacy.

   "Any witnessed cardiac arrest with VF as the presenting rhythm is a patient you could save," says Mickey Eisenberg, MD, author of the 2009 book Resuscitate! How Your Community Can Improve Survival from Sudden Cardiac Arrest and the medical director of King County EMS in Washington. The work of Eisenberg and fellow MD Michael Copass, medical director for the Seattle Fire Department's Medic One program, has helped produce consistent witnessed VF arrest save rates of better than 45% since 2005. Seattle and King County are perennially among the national leaders in this category.

   These widely publicized statistics have caused a number of administrators from other cities to visit the Seattle-area programs to get a sense of their success. Program administrators from Maryland to Japan have sought to learn from them, and gather information to take back to their own communities. During their time, they have ridden with Medic One staff and observed their culture, ideologies and initiatives.

   Because of a strong belief in their methods of system management (and a consistent stream of visitors from around the world), the Seattle and King County Medic One programs, under the direction of Copass and Eisenberg, created a "Resuscitation Academy"--a weeklong training program for middle managers that presents the basics of resuscitation science and an in-depth overview of the systems in Seattle and King County.