b'CARES 2023 Annual ReportChain of SurvivalThe chain of survival refers to a series of actions intended to maximize the chances of survival following cardiac arrest. The six links in the chain of survival are activation of the emergency response system, early CPR, early defibrillation, rapid delivery of EMS care, post-resuscitative care, and recovery. For every minute of cardiac arrest without CPR or defibrillation, a patients chance of survival falls by 7-10%. 2This means that the community and bystander response are integral to survival from OHCA. Activation of the emergency response systemThe first step in the chain of survival is recognition of cardiac arrest and activation of the emergency response system by calling 911. The next crucial time period is the interval between call receipt at the dispatch center to arrival on scene, or response time. The distribution of First Responder and EMS response times are presented in Figure 10.Response and treatment times are supplemental data elements in CARES; however, participants are encouraged to track response times to identify local improvement opportunities. Records with missing response times (14.5%) and those witnessed by a 911 Responder (11.8%) have been excluded from response time analyses.In 2023, median response time by First Responders was 6.2 minutes (interquartile range [IQR]: 4.8 - 8.3 minutes) and median response time by EMS was 7.6 minutes (IQR: 5.6 - 10.4 minutes). First Responders arrived on scene in5 minutes for 29.3% of arrests, while EMS arrived on scene in9 minutes for 63.9% of arrests.20 2% 3%15:01-20 3% 5%14:01-15 1% 2%13:01-14 1% 3%Response Time Interval(minutes)12:01-13 2% 4%11:01-12 3% 5%10:01-11 4% 6%9:01-10 5% 8%8:01-9 8% 10%7:01-8 11% 11%6:01-7 15% 13%5:01-6 16% 12%4:01-5 14% 9%3:01-4 9% 5% 3 6% 4%20% 15% 10% 5% 0% 5% 10% 15% 20%First Responder EMSFigure 10. Distribution of First Responder and EMS response times (time interval from 911 call to arrival on scene).\x1f 2. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann EmergMed. 22:16521658.34 35'