Sudden cardiac arrest in the community is still a major cause of death despite significant advances in prevention and therapy over the last 60 years. The visual metaphor for treatment of such cardiac arrests has evolved through advances in medical and educational science into what is called the Chain of Survival. Each circle represents one step in the chain from the bystander’s recognition of the emergency; calling for help and being coached by the dispatcher in applying CPR; high performance CPR and early defibrillation by first responders or Emergency Medical Technicians; further therapy and stabilisation by paramedics; and finally hospital care.
Another version of the Chain of Survival includes a circle before bystander intervention: early prevention. And measures such as exercise, diet, and drug therapy to control cholesterol and blood pressure have been very effective in reducing cardiovascular disease in high-income countries (HICs).
Shelisha and Khalif’s Story
The family had gathered for a barbecue at their London home in the UK. Shelisha was upstairs with her son, Shylio, when she heard a bloodcurdling scream and ran downstairs. Outside, her sister, brother and dad had found her nephew, Khalif, in the pond and pulled him out. The two-year old was lifeless. Having been trained in CPR at work, Shelisha immediately began chest compressions and rescue breathing.
“I was very calm, almost robotic; I knew I had to continue without stopping,” she said later. When the ambulance arrived after 15 minutes and the paramedics took over, they told the family that there was a faint heartbeat – but Khalif was still unconscious. Rushed to hospital, he was transferred to intensive care where he made a full recovery.
Mr. Ha’s Story
Having finished the marathon track of a triathlon event in Seoul, South Korea, Mr. Ha (53), suddenly collapsed.
The emergency team from Hallym University Hospital arrived within 3 minutes. After 1 minute of CPR and a single AED shock, his heart resumed beating. He was still unconscious, but high quality hospital care had him fully recovered after a few hours.
A professional runner for many years, Mr. Ha had attended several CPR courses, and is able to appreciate fully the importance of an effective Chain of Survival. Having resumed running, he is now an enthusiastic CPR supporter on every marathon and all IronMan games.
Muhammad Luqman Abdul Rahman of Singapore is only 18 years old and has already helped save nearly 20 lives. He was just 13 when he made his first save: on the way home from school his My Responder app from the Singapore Civil Defence Force alerted him that a factory worker had suffered a heart attack and collapsed close by. Having sprinted to the scene, Luqman performed CPR until the ambulance arrived – and later recalled that he had felt daunted because “actual doing was very, very different from practising.”
At first, Luqman’s parents were against his responding, fearing that the boy would be blamed if something went wrong. Asking them to come along the next time the alert sounded, he won them over – and by now they must be the proudest parents in Singapore.
Tim Hillier is Deputy Chief, Professional Standards at Medavie Health Services West, Saskatoon, Canada.
With 200 firefighters, primary care paramedics and EMTs, Tim and his team have fully embraced the need for high-quality CPR and real-time feedback.
“The way I look at it, I know that there are six more people alive in Saskatoon each year that wouldn’t have been if we hadn’t done this.”