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However, registration of cardiac arrests was prospective and uniform, following the standardized Utstein style for reporting out - of - hospital cardiac arrest and revised for data
quality assurance by the RACE -
CARS team.18 Our results support efforts of other communities seeking to improve bystander and first - responder intervention, since they come from a
quality - improvement database of a substantial portion of the state of North Carolina, with stable reporting over a 4 - year period during a broad implementation program that
used a standardized protocol, as recommended by the
American Heart Association.13, 20,40
These changes are possible (the average Western European
uses half as much energy as the average
American while leading a
quality life), but they will take real political leadership on issues ranging from mass transit to sprawl to the size of
cars.