b'CARES Annual Report 2020 | 7A Year in ReviewDear CARES Community, 2020 was a year unlike any other. Its difficult to fully fathom the health impact our country has experienced since we first learned that COVID-19 arrived in the US in early 2020. Its sobering to consider how many Americans have died, been hospitalized and that continue to have lingering health effects physically, psychologically and emotionally. Vulnerable patients were impacted disproportionately but the novelty of the virus left no one immune. Medical providers worked daily often under trying conditions while offering hope to patients isolated from their families. Balancing the loss they experienced with the optimism they provided reminds us of the fragility of life and the power of human resilience.More than 1,000 Americans daily experience a non-traumatic cardiac arrest outside the hospital. Timely and definitive care often determines whether these patients survive and return to their lives and families. This 2020 Annual Report details the three pillars of the CARES program: surveillance, quality improvement and research. It describes how resuscitation practices changed in the US during the pandemic and provides evidence, through the CARES in Action stories, about how to improve outcomes in the future. Overall survival for out-of-hospital cardiac arrest (OHCA) dropped by 14% in 2020 compared with 2019 (10.5% to 9.0%), bystander AED use in public locations decreased by 26% (12.2% to 9.0%), bystander CPR by 2% (41.2% to 40.2%). These metrics and others shared in greater detail within the report emphasize the surveillance mission of the program. The quality improvement mission is described in the report with regional and state level efforts to improve OHCA care in Minnesota, Texas and North Carolina. The research mission during the early months of the pandemic found that communities with both high and low COVID mortality were impacted with decreased return of spontaneous circulation (ROSC), decreased survival, increased termination of resuscitation (TOR) rates and increased incidence of OHCA.As we begin to emerge from this pandemic, it is important to recognize the value of surveillance data in guiding our public health decision making, including performing quality improvement activities locally to increase survival. 2020 was a year unlike any other but one that ideally prompts us to make necessary changes in our communities to be better prepared for the next cardiac arrest event.Thank you to all of the CARES participants for their continued efforts in contributing to the registry during this year. We recognize that many of you were overextended both personally and professionally. We are truly grateful for your persistence and appreciation for how valuable this data is locally, regionally and nationally. Thank you for all that you do.Respectfully, Bryan McNally, MD, MPH Executive Director CARES Professor of Emergency Medicine Emory University School of Medicine Rollins School of Public Health Atlanta, Georgia USAGrady EMS Superheroes pose for a picture outside their ambulance after a shift.'