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Tuesday, August 23, 2011

There are sometimes a few rusty and missing links in the Chain of Survival

There's a nice, tidy guide to maximizing resuscitation success when someone has a sudden cardiac arrest: (1) immediately recognize the arrest for what it is and activate the 911 emergency response network; (2) immediately begin chest compressions; (3) promptly defibrillate the victim; (4) get the victim under Advanced Life Support care; and (5) provide early post-resuscitative care. It's called the Chain of Survival.

In some parts of the real world, however, there are a surprising number of rusty or missing links. What goes wrong?

Calling 911 can be a problem. Don't laugh - this really happens - people sometimes mess up when they try to call 911. They speak too loudly and rapidly, thus needing to repeat themselves to be understood, they forget to tell the 911 operator where they are, sometimes they get involved in an unnecessarily long conversation with the 911 operator, and sometimes they hang up before the 911 system has the information it needs. What needs to be done when the 911 call is answered is to say (for example) "we are at 17 Smithtown Road in office 651. We have a non-responsive forty-five year old female, She is not breathing. We have begun CPR. We need an ambulance. Did you copy that?" And don't hang up!

CPR can be a problem:
• Not enough people are current in their knowledge of CPR.
• Not enough people who are current in their knowledge of CPR will actually use it before the ambulance arrives.
• The quality of CPR performed by both Bystanders and Health Care Providers is not uniformly good. The issues are inadequate compression depth, too many interruptions, interruption(s) that are longer than 10 seconds, too long a period between cessation of chest compressions and delivery of the shock from an AED, and failure to immediately resume chest compressions after shock delivery.

AED's are often a problem: there aren't enough of them where they need to be.

Gaining access to Advanced Life Support can be a problem, because not all EMS responses to cardiac arrest calls can be made by an ALS unit.

Early post-resuscitative care can be a problem in that not all hospitals are staffed 24 x 7 with the professionals required to deal with a resuscitated arrest patient. Not all hospitals have cath labs, let alone one that can be ready for the patient by the time the patient gets there. And not all EMS units and hospitals are equipped to treat a resuscitated comatose SCA victim with therapeutic hypothermia.

The good news is that we have a road map, we can segment the problem and attack it in pieces, and a lot of people are doing just that. Improvements are being made. This is not a bleak picture. "True Bleakness" is when you have a bad situation but no clue as to how to fix it.

The other good news is that you can do some touch-up on your personal chain of survival and those of your family members and friends. Make sure you are current in Bystander CPR, and make sure (for your sake) that your family and friends are, too. Go to and download a 35 minute video that covers Bystander CPR, AED use, resolving choking emergencies and recognizing when someone is having a stroke. It's low budget. It's free. If you are prompted for an access code, use 2020.

There is a one in seven chance that you're going to need the CPR skills at least once in your lifetime, and when you do, it's most likely going to be on a family member or friend. Thirty-five minutes.

Thanks for being part of the solution.