ASHI and MEDIC First Aid Blog

Anyone who has taken a CPR class has heard of the “chain of survival,” a mnemonic device that helps students remember all the steps necessary to help improve the chances for survival for a victim of cardiac arrest. But what about improving outcomes for non-cardiac emergencies? What does the chain metaphor reveal when applied to other types of medical emergencies?

Research has shown that the chain of survival, when used to describe the best approach for treating sud­den cardiac arrest (SCA), has resulted in improved outcomes. We know that each link in the chain is essential for a person suffering SCA to survive, and if a single link is weak or missing, the chances for survival are greatly reduced. The links are:

• Early recognition of car­diac arrest and activa­tion of EMS
• Immediate CPR with high-quality chest compressions
• Rapid defibrillation, or electrical shock, to the heart
• Effective basic and advanced EMS care and transport
• Effective post-cardiac arrest care at a hospital

Because of the importance of each link, there is a significant collection of data from the world of OHCA (out-of-hospital cardiac arrest) research on each aspect of response for improving SCA outcomes.

For applicability to trauma response, the chain must be modified. In these instances, the links include:

• Early first aid
• Early BLS/ALS (Basic Life Support/Advanced Life Support)
• Early advanced therapy (such as surgery)
• Early rehabilitation

Although there is evidence regularly collected regarding the effectiveness of three of those links, a study in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine points towards one link that could benefit from more attention in the research world. They concluded that:

“There is extremely little research on what first aid measures bystanders provide to trauma victims [such as providing an open airway, staunching bleedings or preventing hypothermia] and on what impact such measures have on outcome....The lack of research on bystander first aid makes the first link in the trauma chain of survival the weakest link.”

As the data shows so clearly in cardiac emergencies, early bystander intervention can mean the difference between life and death. When more data is collected and analyzed regarding bystander response in trauma incidents, those findings will, in turn, help researchers develop even more effective emergency care response to make our communities and workplaces safer.

For our first responder readers: 24-7 EMS has added a new course to our continuing education library that illuminates how research drives the methods and procedures of response. The Role of Research in EMS will introduce you to the role research plays in developing evidence-based treatment guidelines for use by EMS providers in medical emergencies. The course reviews what research is and its practical use in EMS; the impact research has on improving patient care, as well as patient and provider safety; and why these developments are important to EMS providers and their patients.