A Position Statement by the Citizen CPR Foundation
Addressing Each Link in the Chain of Survival: A Community Responsibility
The Citizen CPR foundation advocates the Chain of Survival model of emergency cardiac care. The Chain of Survival includes four links: 1) early access, 2) early cardiopulmonary resuscitation, 3) early defibrillation, and 4) early advanced care. The likelihood of surviving sudden cardiac death can be improved when each link in this chain of community response is strengthened.
RATIONALE
- Early Access
Early access of the Emergency Medical Services (EMS) system is critical since it enables CPR and defibrillation trained and equipped personnel to arrive at the victim's side more rapidly and enables trained emergency dispatchers to coach bystanders in the provision of CPR until help arrives.
Bystander action and EMS communications influence early access. The bystander must recognize the emergency, be willing to help and be able to notify the local EMS system. Enhanced 911 telephone systems facilitate the speed and quality of EMS notification.
- Early CPR
Early CPR is critical since it provides blood and oxygen to vital organs for a few extra minutes so that defibrillation and advanced care can be effective.
- Early Defibrillation
Early defibrillation is critical since in most cases of adult cardiac arrest, the heart is in an abnormal rhythm called ventricular fibrillation that can only be reversed by delivering an electrical shock known as defibrillation. Each minute of delay to attempted defibrillation reduces the likelihood of survival.
- Early Advanced Care
Early advanced care (e.g., advanced airways and intravenous medications) is critical since it helps stabilize the victim and prevent recurrence of cardiac arrest.
RESOLUTION
Whereas the Chain of Survival can improve survival from sudden cardiac death when each of the links of early access, early CPR, early defibrillation and early advanced care is addressed, and
Whereas the American College of Emergency Physicians has stated and the Citizen CPR Foundation endorses the position that: Research supports "the efficacy of early defibrillation with the reliable technology of automated external defibrillators;" and
"Widespread implementation of early defibrillation programs with AEDs should be encouraged, but only then these programs are integrated into the EMS system through the four-part 'Chain of Survival': early access, early CPR, early defibrillation and early advanced life support," and
"All four components are critical to ensure that an EMS system can treat victims of cardiac arrest with a maximum potential for survival," and
Whereas the American Heart Association (AHA) has stated and the Citizen CPR Foundation endorses the position that:
"All emergency personnel should be trained and permitted to operate an appropriately maintained defibrillator if their professional activities require that they respond to persons experiencing cardiac arrest," and Emergency personnel includes "all first responding emergency personnel, both hospital and non-hospital (e.g., emergency medical technicians, non-EMT first responders, firefighters, voluntary emergency personnel, physicians, nurses and paramedics)"; and
"All emergency ambulances and other emergency vehicles that respond to or transport cardiac patients should be equipped with a defibrillator, and
Whereas implementation of the Chain of Survival is a cost-effective way to save lives; and
Whereas all communities have a responsibility to provide effective emergency cardiac care to persons in need;
The Citizen CPR Foundation therefore urges all communities to implement and monitor effective emergency cardiac care systems that address each link in the Chain of Survival.
This includes continuous quality improvement of:
- Early access capabilities including implementation of Enhanced 911 communications systems; implementation of Enhanced 911 communications systems; implementation of emergency medical dispatch training and education of the public regarding recognition of cardiac emergencies and the urgent need to call 911 or the local emergency number for help;
- Early CPR capabilities through CPR training for all citizens to ensure effective bystander decision-making and action;
- Early defibrillation capabilities to ensure that personnel trained in CPR are capable of providing defibrillation can arrive at the patient's side within minutes of arrest;
- Early advanced care capabilities.
Resolved October 1993
The Citizen CPR Foundation
Board of Directors
WH Montgomery, MD, NC Chandra, JM Christenson, LL Culley, RO Cummins MD, MPH, MSc. HH Dahll, LD Newell, MM Newman, S O'Connell, JP Ornato and William Thies, Members
(References to be added.) 
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Lenexa, KS 66285-5945
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