University of Iowa Health Science Relations and
Richard Kerber, MD
Professor of Internal Medicine
First Published: 2000
Last Revised: January 2004
Peer Review Status: Internally Peer Reviewed
What's the first thing to do when you witness someone collapse
from cardiac arrest? If the victim is unresponsive, call 911, then
start CPR, says the American Heart Association.
"Experts agree that early defibrillation--an electric shock that
returns the heartbeat to normal--is vital for survival." says Dr.
Richard Kerber, professor of internal medicine at the University of
Iowa College of Medicine and staff physician with UI Hospitals and
Clinics. "But CPR continues to be key in emergency treatment of
patients who have cardiac arrest.", and new findings suggest that 1-2
minutes of CPR prior to defibrillation enhances the likelyhood of
resumption of circulation and survival.
Kerber was chairman of the Heart Association Emergency Cardiac
Care Committee that developed a "chain of survival" designed to
improve the survival rates of people who experience heart attacks.
The links in the chain are: 1-early activation of the emergency
medical system, which means calling 911 immediately; 2-early CPR;
3-early defibrillation; and 4-advanced cardiac life support.
When those four activities are carried out efficiently, the
survival rate for patients can be as high as 30 percent to 40
percent. However, many U.S. communities do not have a 911 emergency
phone system, and some ambulances do not carry a portable
"When those problems exist, the survival rate drops to below 2
percent," Kerber says. "Every community should ask these questions:
Do we have a 911 system? Can we dispatch rescue units within one
minute of receiving calls? Does the ambulance carry a defibrillator?
Are ambulance personnel qualified and permitted to use a
defibrillator? If the answer to any of these questions is 'No' the
community needs to improve its approach to emergency cardiac care,"
The average citizen remains an important link in the survival
chain, Kerber adds. If you want to be a strong link, enroll in a CPR
class. Call your local American Heart Association affiliate or the
Red Cross for details.