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    What is the Chain of Survival-and Why Is It Important?

    Dr. Mary Williams, RN, DC

    About the author

    Dr. Mary Williams, RN, DC

    Dr. Mary Williams, R.N., D.C is a Doctor of Chiropractic with an extensive background as a Registered Nurse and experienced Core Instructor for the American Heart Association. She has over 30 years of hands-on medical and instructional experience.

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    The Chain of Survival is a series of actions that has to be taken to improve a patient’s likelihood of surviving cardiac arrest.

    There are five links in the chain, and while it’s important for paramedics and emergency response professionals to know what they are, bystanders have a role as well.

    Whether or not you’re a healthcare professional, knowing the links in the chain—and your place in it—could help you save a life.

    Bystanders play an important role

    Every year, approximately 395,000 cardiac arrests occur outside a hospital—and of those, only 6% of victims survive. However, according to statistics from the American Health Association, approximately 45% of out-of-hospital cardiac arrest victims survive when they get CPR from a bystander.

    The numbers are clear—the survival numbers are low overall because most cardiac arrest victims who experience their attack outside the hospital don’t get help soon enough.

    After cardiac arrest, brain death occurs after just six minutes. CPR can prolong the life of the victim by circulating oxygenated blood throughout the body, buying valuable time for emergency responders to arrive. But only if the victim gets help within minutes.

    Links in the Chain

    The five links in the Chain of Survival, as described by the American Heart Association, are:

    • Recognizing the signs of cardiac arrest, and calling for emergency help
    • Performing CPR—with a focus on chest compressions
    • Performing rapid defibrillation
    • Providing basic and advanced emergency medical services
    • Delivering advanced life support and care post-cardiac arrest

    All of these links in the chain need to be present to improve a patient’s chances of surviving cardiac arrest. We’ll take a more detailed look at each link in the chain below. 

    Calling 911 for someone having cardiac arrest

    Recognizing the signs of cardiac arrest-and calling for help

    A whopping 88% of cardiac arrests occur in the home—not in a hospital. We’ve already shown how important it is for cardiac arrest victims to get help right away, and in non-hospital settings, it’s often inexperienced, non-professional bystanders who provide the very first line of care.

    It’s sometimes difficult to recognize cardiac arrest when you see it, because there is typically just one symptom: loss of consciousness. However, sometimes certain symptoms appear before the victim loses consciousness. These include:

    • Dizziness or lightheadedness
    • Heart palpitations
    • Chest pain
    • Fatigue
    • Shortness of breath
    • Fainting

    People can experience cardiac arrest even if they have no prior history of heart problems.  If someone near you loses consciousness with no warning—even if you know they’re otherwise healthy—this may be a case of cardiac arrest.

    When someone near you is struck by cardiac arrest, the first thing you should do is call 911 or your local emergency services number.

    Person performing chest compressions

    CPR with chest compressions

    It’s crucial to start CPR as soon as possible—preferably immediately—after cardiac arrest has occurred. Getting CPR certified is a great way to be sure you’ll always be confident and ready if you’re ever in a situation to deliver CPR—but 911 operators are also trained to walk people through the process.

    Most laypeople these days are taught “hands-only” CPR—which couldn’t be simpler. There’s really only one step:

    • Push hard and fast in the center of the chest, to the tune of “Stayin’ Alive” by the Bee Gees

    And don’t be afraid to push hard. The recommended depth of compression (for adults, at least) is a minimum of two inches, with the ribcage recoiling completely between compressions.

    Ideally, if it’s possible, you should keep this up until emergency services arrive.

    Using AED for rapid defibrillation on person needing help

    Delivering rapid defibrillation

    “AED” stands for “automated external defibrillator.” This is a device that analyzes the heart’s natural rhythm and delivers an electrical shock that helps a normal rhythm begin again.

    AEDs save lives. Approximately 66% of out-of-hospital cardiac arrest victims who received an AED shock from a bystander survived to the point of hospital discharge. And luckily, they’re simple enough that anyone can use one—even if you’ve never used one before.

    All 50 states have some kind of legislation in place governing which public places are required to have an AED on the premises. This legislation varies at the state level, but many schools, malls, gyms, movie theatres, airports, and other public buildings have an AED on-site.

    To use an AED, all you need to do is turn it on and follow the very clear audio and visual prompts.

    Person going into ambulance

    Providing basic and advanced emergency medical services

    This step is for EMS personnel. It’s crucial, and the steps here depend on the victim’s precise situation. It may include delivering emergency response CPR, administering medications, and delivering other interventions to stabilize the patient and get them to the hospital as quickly as possible.

    However, timely and effective delivery of this kind of care depends on getting the first link in the chain right—it depends on a bystander recognizing a cardiac arrest for what it is, calling 911 immediately, and delivering emergency CPR.

    Advanced life support and post-cardiac-arrest care

    In this stage, the care provided after the patient wakes up can be just as crucial as the care they receive in the early stages. It can ensure the patient survives and recovers as much function as possible after discharge. Cardiac arrest stops the flow of oxygenated blood to the brain and vital organs—so restoring brain function as well as physical health is often a key part of recovery.

    In the days and weeks after a cardiac arrest, patients who survive the initial cardiac arrest will work with cardiologists, nurses, physical therapists, dietitians, and more to recover fully and make the key medical and lifestyle changes needed to protect their health going forward.

    The survival rates for cardiac arrest are abysmally low—but when every link in the Chain of Survival is strong, victims have a much better chance of surviving. You can do your part by learning how to perform CPR. You don’t need training to deliver lifesaving CPR—but if you get it, you’ll have the skill and confidence to step in during a medical emergency and serve as a strong link in the chain. 


    American Heart Association CPR Facts & Stats - https://cpr.heart.org/en/resources/cpr-facts-and-sta

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