Chain of Survival – what does it mean?

The Chain of Survival is widely discussed within the world of resuscitation. The Chain of Survival is a sequence of four key, linked events which, if followed quickly and efficiently, can help save lives of victims of sudden cardiac arrest, which occur outside of hospital. The links are as follows:


  • Early recognition and call for help


  1. At the onset of cardiac arrest, early recognition is vital to ensure an ambulance is called straight away. A delay of just a few minutes could prove fatal. Call 999 if the patient is:
  • Unresponsive / unconscious
  • Not breathing (at all or normally).
  • Early Bystander CPR  


    1. When the heart stops beating, as in the case of cardiac arrest, we must do the work for the heart. CPR allows us to keep pumping oxygenated blood around the body to the vital organs, in particular, the brain. Ensuring someone nearby starts CPR early, significantly improves the chance of survival. It is believed that bystander CPR can double or quadruple survival from out of hospital cardiac arrests. Unbelievably, only 40% of patients receive this in the UK. We could make significant improvements to outcomes for our patients, if we can improve the rates of bystander CPR.
  • Early Defibrillation 


    1. When cardiac arrest occurs, the electrical activity of the heart is often disturbed. By delivering an electrical shock to the heart, we can restore the correct electrical activity which can in turn restore normal heart function. This process is called defibrillation. If we can provide this within 3-5 minutes of the onset of cardiac arrest, the survival rate can be between 50-70%. Public Access Defibrillators play a huge role in this step. Each minute of delay to defibrillation reduces the probability of survival to hospital discharge by 10%.
  • Post Resuscitation Care 


  1. This role is primarily done by the ambulance crew in the pre-hospital arena or within the hospital environment. Advanced skills including drug administration and airway management are used both within the resuscitation attempt and during treatment once the heart has been successfully restarted.

These four links are vital in order for us to have a successful outcome for a cardiac arrest. We are reliant on the first three of these links to be undertaken within the community. These skills could be undertaken by a community based healthcare professional, a first aider or simply by someone being in the right place at the right tim