Early Access

The first link in the Chain of Survival is the emergency care call. When SCA strikes, an immediate 911 call is crucial; a delay of just a few minutes could prove fatal. By quickly recognizing a medical emergency, a bystander can help save a life.

Could you recognize the symptoms of SCA?

• Unresponsiveness
• Loss of consciousness
• Lack of pulse
• Cessation of breathing

SCA is not the same as a heart attack. However, a victim of either condition requires an immediate 911 call.

Your Part in the 911 Call

When fielding a 911 call, the emergency medical services (EMS) dispatcher may ask the caller questions such as these (provided by the American Heart Association):

• "What is your emergency?"
  To answer this question, describe the situation as extensively as possible, with such replies as "A customer had sudden chest pain and has now collapsed." Or "They've lost consciousness and they don't seem to be breathing."
• "What's happening now?"
  Respond: "My friend is giving CPR. We have an automated external defibrillator (AED)." Or, "We're trying to find a medically trained person to assist us."
• "Where is the victim located?"
  Respond: "We are at the Evergreen Company, here at 1234 Fifth Avenue NE, in the back hall."
• "What number are you calling from?"
  Respond: "The number is 978-555-1313."

The dispatcher may give directions such as "Stay on the line until I tell you to hang up. Rescuers are being sent to your location. Please meet them and direct them to the scene." Some dispatchers can provide medical care instructions, such as for CPR and the defibrillation process, over the phone.

A prompt 911 call sets the Chain of Survival in motion, giving the next two links, CPR and early defibrillation, the greatest opportunity for success.

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Early CPR

Prompt CPR can help sustain life during VF. The mouth-to-mouth breathing and chest compressions help oxygenated blood flow to the person's brain and heart, until defibrillation can attempt to restore normal heart pumping.

Your Part in the CPR Link

Once an SCA victim collapses and a bystander calls 911, the next step in the Chain is to perform CPR if you are trained, or to find someone who is. Lay people initiate CPR in more than half of SCA cases in which someone has witnessed the incident. It's important, therefore, to increase the number of trained CPR lay people and the number of training programs in your schools and community.

Although CPR can sustain life for a short time, it must be followed immediately by the third link, early defibrillation. Only when combined with early defibrillation and early advanced care can CPR significantly increase an SCA victim's chance for long-term survival.

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Early Defibrillation

Although it is an important link in the Chain of Survival, CPR alone cannot fully resuscitate a person in SCA. Early defibrillation is the third and perhaps most significant link.

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Early Advanced Care

The fourth link in the Chain of Survival is advanced care. Paramedics and other highly trained EMS personnel provide this care, which can include basic life support, defibrillation, administration of cardiac drugs, and the insertion of endotracheal breathing tubes. This type of advanced care can help the heart in VF respond to defibrillation and maintain a normal rhythm after successful defibrillation.

The trained EMS personnel monitor the patient closely on the way to the hospital, where more definitive diagnostic evaluation can occur.

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