Dr. Michael Sayre became interested in EMS during residency when he had an EMS month that included riding with ground paramedics and flight nurses. He had to learn EMS medical direction on the job. He wondered how he would know if our service provided excellent care and learned about measuring cardiac arrest survival rates. That led to involvement in international guidelines development for CPR as well as a glimmer of understanding how the design of the system of care influences patient outcome. These concepts form the basis for the Resuscitation Academy project.