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The chain of survival is a concept just to show your role as a first aider in life support and also see what actually happens in the case of a sudden cardiac arrest. The chain of survival has got four levels to it. The first one is early access to the emergency services, the second part is early CPR, third early AED and the fourth early advanced life support. If we look at the first one to start with, early access to the emergency services. What this means is that you need to be calling emergency services as soon as possible, so as soon as you find out that this person is not breathing, you need to make sure that either the emergency services have been called or you're going to make that call yourself right now before delivering the CPR. There's no point in carrying on CPR if the emergency services aren't on their way. The second part is the CPR side. Now it's vital that the first aider delivers effective CPR so that when the emergency services do arrive they've actually got a patient which they can do something with. If CPR hasn't been carried out it's highly probable that the further links of the chains are not going to work. Now, often in first aid, this is where you'll stop. If you've got AED training as well, you could well be involved in the third link, which is early AED. An AED is an automatic external defibrillator. Now, the AED unit is something that may well be in your workplace, it may well be that the paramedics, ambulance service or a community responder have, it may be that you've got an AED unit in your community, so it's vital that this unit arrives as soon as possible. And what is does is it interrupts the abnormal twitching of the heart and hopefully resets the heart to beating normally again. The final link of the chain of survival is advanced care. This will be given by the emergency services themselves. This could be in addition to delivering the AED, they may well be using drugs, they've got oxygen or other treatments that they can give. This is far beyond first aid. As first aiders, we're dealing with the first two links of the chain of survival. The second two links are primarily done by the emergency services unless you do have AED available, in which case you could help on that third link. If anyone of the links of the chain of the survival are broken, then the chance of survival of the person is massively reduced. So if you call the emergency services and don't do CPR, then the effectiveness of the AED unit and also advanced care is going to be reduced, or if you just start straightaway with CPR but don't make the call, then the ambulance service are not going to arrive. For every minute of delay between when the person goes into sudden cardiac arrest to the time where the AED arrives, the chance of survival is dropped by 10%. This would mean if the ambulance is going to get there within the target time of eight minutes this person's chance of survival is only around about 20%, so what we need to is to make sure that all the links of the chain of survival are followed, we call that emergency services straight away, effective CPR until the AED unit arrives and the person's chance of survival is improved.
Understanding the Chain of Survival in First Aid
The chain of survival is a concept that illustrates a first aider's role in life support and the steps taken in sudden cardiac arrest cases. The chain of survival comprises four levels:
- Early access to emergency services
- Early CPR
- Early AED
- Early advanced life support
1. Early Access to Emergency Services
Call emergency services as soon as possible upon discovering a non-breathing person. Initiating CPR is crucial, but ensuring emergency services are on their way is vital.
2. Early CPR
First aiders must deliver effective CPR, ensuring that when emergency services arrive, they have a viable patient to treat. Without CPR, the remaining links in the chain may be ineffective.
3. Early AED
If you have AED (automatic external defibrillator) training, you may be involved in the third link. AEDs can be found in workplaces, with paramedics or community responders, or within communities. AEDs interrupt abnormal heart twitching, potentially resetting the heart to a normal rhythm.
4. Early Advanced Life Support
Emergency services provide advanced care, which may include AED, drugs, oxygen, or other treatments. This level of care goes beyond first aid. As first aiders, you primarily address the first two links, while emergency services handle the latter two, unless you have access to an AED.
Importance of the Chain of Survival
If any link in the chain of survival is broken, the patient's chance of survival drastically decreases. For every minute of delay between sudden cardiac arrest and AED arrival, survival chances drop by 10%. If an ambulance arrives within the target time of eight minutes, the patient's survival chance is about 20%. Ensuring all links in the chain of survival are followed improves the patient's chance of survival.