Purpose of the study
Patients who suffer a sudden OHCA have different survival rates through different regions and countries. In Europe, they vary between 6% and 24% (1). The presented study examines the data from nine EMS in Germany and shows the implementation of the Mickey Eisenberg's 10 Steps (2). Afterwards it was analyzed if there is a correlation between the fulfillment of the steps and a better patient survival. 

Materials and methods
In this epidemiological cross-sectional study, data from the German Resuscitation Registry was evaluated. To answer the implementation of the 10 Steps from Mickey Eisenberg also a structured telephone interview with the medical EMS director was performed. Data results and interviews were weighted with points to be able to derive a Scorecard. 

Results
Data sets from EMS in Germany were included who entered complete and plausibility checked data sets in 2016. The 4,115 data sets that were entered were 2,309 resuscitation attempted. The average age was 68,3 years. ROSC was achieved in 46% of the patients and 41% were admitted to the hospital. 14% were discharged alive. In the Scorecard a total of 60 points could be achieved in one EMS when every of the 10 steps was fulfilled. The EMS reached 30 to 36 points and could not show any connection to a better survival rate. 

Conclusions
The fulfillment of the 10 Steps in the preclinical treatment of OHCA played a minor role in the survival rates. Important factors, such as time intervals and the hospital treatment are not considered here. 

Literature
1.	Gräsner J-T, Lefering R et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation 2016; 105:188–95. doi: 10.1016/j.resuscitation.2016.06.004.
2.	Eisenberg MSMD. Resuscitate! 2nd. Univ Of Washington Press; 2015.

4 - It takes a system to save a life - An analysis of selected EMS areas with emphasis to the implementation of the Eisenberg’s steps and the out-of-hospital cardiac arrest outcome