The Development of Emergency Medical Services

Chain of Survival

33. Chain of Survival Motto

1. Early Access: Once a cardiac emergency is recognized, it must be responded to immediately.

Call 9-1-1. This will activate the Emergency Medical System (EMS) so that the necessary pre-hospital care can begin. Anyone can call - it's as simple as 9-1-1.

2. Early Cardiopulmonary Resuscitation (CPR): Some effort to open the airway, ventilate the patient, and begin blood circulation must begin as soon as possible.

CPR should begin immediately; if possible, have one person call 9-1-1 while another begins CPR. DO NOT WAIT; it could be several minutes before the ambulance arrives.

(CPR is not a difficult procedure to learn and almost anyone can get certification. For information, contact the Emergency Medical Services Learning Resource Center (EMSLRC), here at The University of Iowa Hospitals and Clinics.)

3. Early Defibrillation: Identification and treatment of ventricle fibrillation, or irregular contractions of the muscle fibers of the heart, is the single most important intervention. Defibrillation involves temporarily stopping the heart so that it may resume a regular beat.

With the arrival of the ambulance (remember, call 9-1-1), a paramedic can defibrillate the heart to try to get it beating regularly again. This can only be performed by people trained in Advance Cardiac Life Support (ACLS); usually paramedics, physicians, nurses and other qualified health care providers.

34. Defibrillation of a Heart Attack Victim During a heart attack, the muscle fibers of the heart begin to contract irregularly. This is referred to as fibrillation. Defibrillation is the application of brief electroshock to the heart in an effort to counteract these potentially fatal muscle contractions.

4. Early Advanced Cardiac Life Support (ACLS): ACLS includes defibrillation, administration of intravenous (IV) medications which help the heart regain normal function, and assisting the patient to breathe with tools like an endotrachial tube.

REMEMBER, the chain of survival begins with a call to 9-1-1.

The Chain of Survival was devised as a tool to be used by emergency medical personnel to better understand and memorize the steps required when they encounter a person who is having a "cardiac emergency." The concept is symbolized by a series of four interlocking circles. Each circle represents one of the four steps in the chain.

The first two steps can be performed by anyone with a telephone and knowledge of CPR. Steps three and four require professional medical training and appropriate equipment.

35. Ambulance

36. Air Care 1985 Air Care, dispatched out of University of Iowa Hospitals and Clinics, is one of the longest functioning aeromedical units in the nation. This type of unique ambulance service is often staffed by a nurse-paramedic team. Photo courtesy of Donahue, M. P. Nursing: The Finest Art, An Illustrated History, 1985.

37. "The Red Cross of Comfort," by John Morton-Sale Photo courtesy of Donahue, M.P. Nursing: The Finest Art-Master Prints. 1989, plate 27.

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