THE CHALLENGE As the training officer for Buncombe County EMS (BCEMS) in western North Carolina, paramedic Jamie Judd led the implementation of a high-performance, pit-crew CPR program. The agency created new protocols, conducted training, and soon began seeing improvements in their cardiac arrest care. But its leaders also noticed that problems persisted. “When we looked at our CPR quality feedback from our cardiac monitors, we noticed that our compressions were, on average, too shallow, and our rates were erratic, often well over 120 compressions per minute,” Judd said. “So we began looking for a way to provide more consistent compressions at a reasonable cost.” Buncombe County responders also frequently have to work cardiac arrests with only a small number of providers. Severa

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