Early Access:  Call 911 (or the EMS system in your area) and get an AED!

Recognize an Emergency.

First, you or other witnesses must recognize the emergency.  You must recognize the warning signs of a heart attack, cardiac arrest, stroke, or choking.  Anyone who is unresponsive should receive emergency care.  Heart attack, cardiac arrest, stroke, and foreign-body airway obstruction can each cause unresponsiveness.  Although many conditions – not just cardiac arrest – can cause unresponsiveness, all unresponsive victims will benefit from activation of the Chain of Survival.


Call 911 (or the EMS system in your area).

As soon as an emergency is recognized, call 911.  When you or another rescuer calls 911, let the dispatcher ask you questions.  While the dispatcher interviews you, he or she will enter the data on a computer.  The information you give will be relayed to a response team.  Answer in short, specific replies, giving only the requested information.  The dispatcher will probably ask:

  • “What is your emergency?”  You might answer, “A customer had sudden chest pain and has now collapsed.”
  • “What’s happening now?”  “My friend is giving cardiopulmonary resuscitation.  We have an automated external defibrillator.”
  • “Where is the patient located?”  “We are at the Evergreen Company, here at 1234 Fifth Avenue NE, in the back hall.”
  • “What number are you calling from?”  “The number is (412) 555-1313.”

At this point the dispatcher may give you directions such as “Stay on the line until I tell you to hang up.  Rescuers are being sent to your location.  Please meet them and direct them to the scene.”

Remember, though, if you are alone, you must immediately begin performing CPR, the next link in the chain.


Early CPR:  "Pump and Blow"

Begin Cardiopulmonary Resuscitation (CPR).

CPR is the critical link that buys time between the first link (call 911) and the third link (use the AED).  The earlier you give CPR to a person in cardiac or respiratory arrest, the greater their chance of survival.  CPR keeps oxygenated blood flowing to the brain and heart until defibrillation or other advanced care can restore normal heart action.


Dispatcher-Assisted CPR and Defibrillation and Enhanced 911.

In many areas of the country emergency dispatchers are taught how to help callers give emergency care.  With help from the dispatcher, callers can give CPR (and use an AED).  The instructions are basic and simple, but they will help the victim until EMS personnel arrive.  Remember, CPR needs to be started immediately!

Using a prepared list of instructions, the dispatcher can coach you through the basic steps of CPR.  At a worksite you will usually have help.

Use this approach:

  • Repeat the dispatcher’s instructions loudly to the other rescuers and confirm that they are following that step.
  • If the patient vomits or other complications arise, tell the dispatcher.  Do not expect that you will perform perfectly in such a crisis.
  • Be sure that rescuers follow each instruction, even if it takes extra seconds.
  • Ensure rescuer safety at all times.
  • When EMS personnel arrive at the victim’s side, the dispatcher will tell you that he or she is hanging up.
  • You hang up last.

Find out if your community has enhanced 911.

In enhanced 911 a computer automatically confirms the caller’s address.  Also ask if your 911 dispatchers are trained to offer prearrival instructions to rescuers.   This means that they can give instructions for immediate care based on the clinical criteria of the emergency.  If not, become a vocal advocate for such services in your community.  Enhanced 911 can save precious seconds, minutes and even lives.


Early Defibrillation:  Use the AED!

Use the Automated External Defibrillator (AED) to Treat Ventricular Fibrillation.

Most sudden cardiac arrest victims are in ventricular fibrillation (VF).  VF is an abnormal, chaotic heart rhythm that prevents that heart from pumping blood.  VF causes more cardiac arrests than any other rhythm (about 80% to 90% of cases).  You must defibrillate a victim immediately to stop VF and allow a normal heart rhythm to resume.  The sooner you provide defibrillation with the AED, the better the victim’s chances of survival.  If you provide defibrillation within the first 5 minutes of a cardiac arrest, the odds are about 50% that you can save the victim’s life.  But with each passing minute during a cardiac arrest, the chance of successful resuscitation is reduced by 7% to 10%.  After 10 minutes there is very little chance of successful rescue.


Public Access Defibrillation.

The American Heart Association (AHA) promotes the most rapid possible defibrillation of victims of cardiac arrest.  To do this the AHA wants to place AEDs in the hands of trained, nontraditional rescuers.  These include police, security guards, and family members of patients at high risk for cardiac arrest.   Public access defibrillation (PAD) programs place AEDs in homes, police cars, worksites, and public gathering places, under the supervision of licensed physicians.  PAD rescuers must be trained in CPR and the use of an AED.  When AEDs are readily available, rescuers can provide defibrillation within the first few minutes of out-of-hospital cardiac arrest.  This dramatically increases the victim’s chances of survival.


Early Advanced Care

Transfer to Advanced Care.

The fourth link in the Chain of Survival is advanced care.  This link is provided by highly trained EMS personnel called “paramedics.”  Paramedics give basic life support and defibrillation as well as more advanced care.  They can give cardiac drugs and insert endotracheal breathing tubes.  These advanced actions (1) help the heart in VF respond to defibrillation or (2) maintain a normal rhythm after successful defibrillation.


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Material taken from the American Heart Association.