Chain of Survival

The five links in out-of-hospital Chain of Survival

In order to help save more lives impacted by sudden cardiac arrest (SCA), the American Heart Association advocates for an effective emergency cardiovascular care response known as the Chain of Survival.

The Five Links Within the Out of Hospital Chain of Survival:

Early Recognition

Early recognition of sudden cardiac arrest and activation of the emergency response system.

Which begs the question, what does a sudden cardiac arrest look like?.

Immediately following the SCA victim’s collapse, bystanders often witness what is reported as seizure-like activity (sporadic jerks, stiffening of muscles, tremors, etc.) This seizure-like phase is caused by oxygen deprivation due to the lack of the heart effectively pumping blood to the body. In addition to the symptoms similar to an epileptic seizure, the victim may exhibit agonal breathing. This is an attempt to breathe without cerebral coordination and diaphragm muscle. These can be seen as gasps – the chest does not rise and fall.

Once SCA is identified, it is imperative to activate the emergency response system by calling for help, calling for an AED, and moving to the next link in the chain of survival. 

Early CPR

Cardiopulmonary resuscitation assists blood flow to the heart, and chest compressions at a rate of 100-120 per minute should begin immediately. To review the latest American Heart Association guidelines, click here.

Early Defibrillation

When a victim is in an abnormal heart rhythm, such as ventricular fibrillation or ventricular tachycardia, the best way to save the person is by utilizing an automated external defibrillation (AED), and delivering a shock to reset the heart into a viable heart rhythm.

How does an AED save someone from SCA?

Electrodes are placed on the victim’s chest which allows the AED to analyze the person’s heart rhythm. Once the analysis is complete, the AED can determine whether a shock is needed to return the heart to a viable rhythm.

Basic and Advanced Emergency Medical Services

This is the point at which highly trained professional and equipped pre-hospital emergency medical services (EMS) paramedics arrive. These individuals can provide for the administration of drugs, advanced airway procedures, and other necessary interventions prior to the patient’s hospital arrival.

There are a multitude of cases where EMS responds rapidly, making the first three links in the Chain of Survival brief. However, as the first on scene, it is important for bystanders to begin CPR in anticipation of EMS arrival.

Advanced Life Support and Post Cardiac Arrest Care

In response to a major medical event such as SCA, an individual will receive further advanced life support and post-cardiac arrest care to ensure as full a recovery as possible.

Often being the first to arrive on scene, we as bystanders share a vital importance in ensuring the best chance of survival. Being able to recognize a sudden cardiac arrest, knowing the chain of survival, and being trained in CPR and AED use is our best opportunity to help save a life. Think of those whose path you cross on a daily basis. These family members, co-workers, friends, and strangers may be the very individual you help to save by taking a proactive stance in educating yourself and others to save a life. You can save a life, and we want to help. Call us today for more information on CPR, AED preparedness, and equipping yourself to save a life. If you or your team would like to be prepared to handle an SCA emergency, check out our on-site CPR/AED certification class.

S. Joanne Dames - MD, MPH

Updated: 1/15/2019

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