The survival chain consists of the basic links necessary to save the largest number of patients being in cardio-respiratory arrest (CRA) in pre-hospital stage. The power of this chain is directly affected by the weakest of links; therefore in order to save a large number of CRA victims, the links of this chain have to work corectly in the pre-hospital stage.
The components of the survival chain are:
- FAST ACCESS
- VITAL BASIC SUPPORT (VBS)
PRECOCEOUS BASIC FIRST-AID
- PRECOCEOUS DEFIBRILATION
- PRECOCEOUS ADVANCED LIFE-SUPPORT (ALS)
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1. FAST ACCESS
This means triggering the emergency system by the population in case of a CRA. This access has to be fast, easy and unconditional. In the United States the access is made through a sole emergency phone number „911”,and in Europe this system was adopted only in the '90 by introducing a single telephone number for all emergency services “112”. In Romania the number to call in case of a medical emergency is 961. To be remembered that in the present there are other emergency numbers981 - Fire Department, 955 - Police, 956 - Gendarmerie, 982 - Civil Protection.
2. PRECOCEOUS BASIC FIRST-AID
This is of a proven major importance in case of a CRA. The prognosis of the CRA patients on whom the basic cardio-pulmonary resuscitation was correctly performed is much more favourable by comparison to those on whom there were no cardio-pulmonary resuscitation (CPR) manoeuvres applied and were unassisted for a period of time, until the medical unit arrived. The population and the first respondants like the Firemen, the Police, a.s.o., have to be trained in this field and aware of the major importance of this act, while waiting for the arrival of the medical unit.
3.PRECOCEOUS DEFIBRILATION
The majority of cardiac arrest in adults are initially based on a ventriculary fibrilation (VF). The sole efficient treatment of the ventriculary fibrilation is the defibrilation. As time passes, the ventriculary fibrilation becomen more resistant to defibrilation until the asystolia is installed. Therefore, a defibrilation performed immediatly after the occurance of the VF the chances of survival are over 85%, but a defibrilation performed after 5-8 minutes since the VF has variable chances of survival, not greater than 50% and that usually requires multiple high-energy defibrilations.
In order to make the defibrilation procedure accessible to non-medical personnel, a special type of defibrilators were designed, named semi-automatic defibrilators. These defibrilators, in countries such as the US, France, Great Britain, a.o. are in the endowment of the firefighters, the policemen, station masters, stewardesses aboard the passengers airplanes, making possible the precoceous defibrilation, before the arrival of the medical unit.
4. PRECOCEOUS ADVANCED LIFE-SUPPORT
This link is of a great importance in case of the patients being in cardiac arrest and who are in need of intensive care, specific drug administration and special maneouvres during resuscitation. The optimal time of arrival of the medical unit should be below 10 minutes, if the basic CPR is performed immediatly after the event has occured, or at most 5-6 minutes, if the second and third links of the survival chain are missing. The studies performed by SMURD Tg.Mures have shown that the victims resuscitated in pre-hospital and have left the Intensive Care Unit alive are those to whom the medical unit had arrived in less than 5-6 minutes. The pre-hospital resuscitated victims but to whom the medical unit have arrived in more than 6 minutes from the occurance of the CRA have suffered irreversible brain damage. This is valid under the circumstances in which the links 2 and 3 of the survival chain are still missing in Tg. Mures and in România.
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