Out-of-hospital cardiac arrest in three EMS centers in northern and central Thailand: a mixed-methods call for a national data infrastructure

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality in Thailand, yet national response to the issue remains fragmented and under-prioritized. There is no centralized OHCA registry, neurological outcome data are almost entirely absent, and coordination between EMS and hospitals is weak. This limits Thailand's ability to evaluate performance, guide investments, or improve survival. METHODS: We conducted a convergent mixed-methods study combining retrospective analysis of OHCA registry data (n = 2,259) from three hospital sites participating in a regional OHCA registry (2017-2023) with in-depth qualitative interviews across EMS, hospital, and policy stakeholders. Quantitative data were analyzed for trends in bystander CPR, response and scene times, and outcome tracking. Qualitative data were thematically coded to identify structural and operational barriers to data use and system integration. RESULTS: Neurological outcome data were available for only 16.4% of patients who were alive at 30 days. EMS teams had limited access to in-hospital outcome information, and hospitals did not routinely track functional recovery. One suburban-capital hospital showed measurable improvement using internal data to reduce scene times and increase bystander CPR. However, systemic fragmentation undermined scalability. Across sites, EMS and hospital data systems were not interoperable, and OHCA care was inconsistently prioritized. CONCLUSION: Thailand's OHCA system shows both promise and constraint. These findings highlight the need for improved data infrastructure, including standardized outcome tracking, better linkage between EMS and hospital systems, and clearer governance. Local successes can serve as models, but only with political will, shared infrastructure, and clear governance. A national OHCA data strategy is essential to improve survival and achieve equitable care.