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Introduction
North West Ambulance Service NHS Trust has one of the largest and longest established Community First Responder schemes in the Country. The Trust currently has 1200 Active Community First Responders shared between 134 teams throughout the region. The Trust is also responsible for 200 Public Access Defibrillator (PAD) sites including Airports, Railway Stations, Police Stations, Shopping Malls and Sports Centres; training 1900 of the staff at these sites as Establishment Responders.
NWAS responders attended 13,500 emergencies during 2007-8 and make a significant contribution to patient care. Growing numbers of patient’s owe their lives to these important initiatives.
Why do we need Community First Responders?
Dr Richard Cummins from Seattle, USA, discovered that if a series of events take place in a set sequence, a heart attack victim has a greater chance of survival. These events are known as the “Chain of Survival”.
When put into practice, these events can improve the pre-hospital survival rate by 25% or 30%. The Ambulance Service believes that CFR’s trained to provide links 2, 3 and 4 Can significantly improve the chance of survival.
What is the Chain of Survival all about?
Thirty years ago, it was discovered that if a series of events took place, in a set sequence, a patient suffering from a heart attack stood a greater chance of survival. These events are now known as the 'Chain of Survival'.
The First Link
When Sudden Cardiac Arrest strikes, an immediate 999 call is crucial; a delay of just a few minutes could prove fatal. By quickly recognising a medical emergency, a bystander can help save a life. Could you recognise the symptoms of Sudden Cardiac Arrest?
* Unresponsiveness
* Loss of consciousness
* Lack of pulse
* Cessation of breathing
Sudden Cardiac Arrest is not the same as a heart attack. However, a victim of either condition requires an immediate 999 call.
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The Second Link
CPR or Cardiopulmonary resuscitation is the second link in the Chain of Survival; it is the link that can buy life-saving time between the first link (Early Access to Emergency Care) and the third link (Early Defibrillation). During Sudden Cardiac Arrest, the heart twitches irregularly most often due to ventricular fibrillation (VF) and cannot pump oxygenated blood efficiently to the brain, lungs, and other organs. The victim quickly stops breathing and loses consciousness. However, prompt CPR can help sustain life during VF. The mouth-to-mouth breathing and chest compressions help oxygenated blood flow to the person's brain and heart, until defibrillation can attempt to restore normal heart pumping.
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The Third Link
Although it is an important link in the Chain of Survival, CPR alone cannot fully resuscitate a person in SCA. Early defibrillation is the third and perhaps most significant link. Most SCA victims are in ventricular fibrillation (VF), an electrical malfunction of the heart that causes the heart to twitch irregularly. Defibrillation, the delivery of an electrical shock to the heart muscle, can restore normal heart function if it occurs within minutes of SCA onset. When CPR and defibrillation are provided within eight minutes of an episode, a person's chance of survival increases to 20%. When these steps are provided within four minutes and a paramedic arrives within eight minutes, the likelihood of survival increases to over 40%.
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The Fourth Link
The fourth link in the Chain of Survival is advanced care. Paramedics and other highly trained EMS personnel provide this care, which can include basic life support, defibrillation, administration of cardiac drugs, and the insertion of endotracheal breathing tubes. This type of advanced care can help the heart in VF respond to defibrillation and maintain a normal rhythm after successful defibrillation. The trained EMS personnel monitor the patient closely on the way to the hospital, where more definitive diagnostic evaluation can occur.
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