The Chain of Survival

The Chain of Survival metaphor is used across the world to describe the steps required for a successful outcome. The steps are:

  1. Recognition of cardiac arrest and call for help (activation of 999 system)
  2. Early CPR
  3. Early defibrillation (to restart the heart)
  4. Advanced life support (provided by the emergency services)
  5. Post-resuscitation care (mainly but not exclusively in hospital)

In some countries, the guidelines mention four links in the chain, with the fourth link being a combination of emergency services and hospitals.

The most important thing to recognise about the chain of survival is that the first three links can be put in place by any member of the public.

The first three steps are those which are most important and can be done by you:

  • The call for help is often delayed as people are often unsure how to recognise a cardiac arrest
  • In our area, 62% of cardiac arrest victims do not receive CPR until emergency services arrive
  • Only 2% of defibrillator shocks in the North East are delivered prior to arrival of ambulance personnel. This is partly because 82% of cardiac arrests in the North East occur in the home, and there are very few AEDs accessible near our homes. Even if an AED is nearby, most people don’t know where they¬†or are usually afraid to use them

Every minute without CPR and defibrillation reduces survival by 10%. Strengthening the early links in the chain of survival can make a very significant difference.


Call, Push, Restart

CPR stands for cardiopulmonary resuscitation. Many people we have spoken to find it easier to remember it as Call, Push, Restart, as this summarises the first three links in the chain of survival:

Call: dial 999 immediately

Push: perform chest compressions

Restart: use an AED to restart the heart



Automated External Defibrillators

An Automated External Defibrillator (AED) is a device that can safely deliver an electrical shock to restart the heart and it can be used by a lay person with little or no prior training. AEDs are sometimes referred to as defibrillators or defibs. There are various models from a number of manufacturers but they are all designed for use by members of the public. Read more about AEDs here.