b'222021 CARES Annual Report procedure, rather, that these agencies are focused on resuscitation on scene, thereby achieving higher rates of ROSC in EMS care, and transporting the resuscitated potential survivors to a higher level of care. The agencies in Quartile 1 are noted to have on average inferior outcomes to those in the other three quartiles, suggesting that an agency with a resuscitation program that includes FTOR in their protocols is unlikely to have inferior outcomes due to this practice. There is likely a limit to this, however, as inspection of Quartile 4 suggests that some agencies who terminate a very large majority of their arrests, a resuscitation culture that might be best described as defeatist, may in fact have worsened outcomes compared to others. In Quartile 4, there does appear to be an inflection point at approximately 50%Figure 1. Unadjusted rates of FTOR and hospital death per arrest by agency. field termination rate as being optimum in a high performing resuscitation program.Scene times were also noted to vary considerably among the study agencies. To complete this analysis, the study population who had undergone field termination of resuscitation was removed, owing to the fact that an on-scene time in this group is not well-defined as being spent on patient care, and the population of OHCA patients were only those who were transported by EMS. Figure 2 depicts the trend between the on-scene-time quartiles. There is a clear trend that agencies who spend more time on scene have improved rates of ROSC, survival to discharge and positive neurologic outcomes. All time spent on scene at a resuscitation is not equal. Besides the resuscitation itself, post ROSC care and extrication times also contribute. A strong resuscitation team may achieve ROSC quickly,Figure 2. Unadjusted outcomes per non-FTOR arrest ordered by on scene time but spend time on scene optimizing physiologyquartile.prior to transport, leading to increased on scene time. This study is unable to account for what this time is being spent on. However, resuscitation while moving the patient as expediently as possible off the scene appears to yield inferior outcomes. This study applying the CARES dataset adds to the growing body of literature that encourages on scene, high-quality resuscitation for the treatment of victims of OHCA prior to transport to yield improved patient outcomes. The intention of the study team is that when reviewing their resuscitation data, agency leadership may be able to apply this study when reviewing their agencys resuscitation program to further optimize care of this patient population. Our team does acknowledge that EMS agencies with prompt access to immediate extracorporeal cardiopulmonary resuscitation (ECPR) need to carefully determine which of their patients qualify for ECPR and should have minimal on-scene time and attention to transport to ECPRunderstanding that the vast majority of OHCA patients are not close to ECPR care and only a small number of an EMS agencys cardiac arrest patients are candidates for ECPR. The existential question of the debate between scoop and run and on scene resuscitation for OHCA appears to, for now, be in favor of treating the patient where they lie.'