Chain of Survival

In 1990 the American Heart Association established its Chain of Survival guidelines that outline what must take place for sudden cardiac arrest survival rates to improve. Early access, early CPR, early defibrillation, and advanced cardiac life support is the order in which the chain goes.

The Chain of Survival is a tool to help people remember the following critical sequence of events: early activation of the Emergency Medical System (9-1-1) , early CPR, early defibrillation and early advanced care. You may have seen a defibrillator operated by doctors, nurses or paramedics or on TV shows like Third Watch and ER. However, newer devices known as automated external defibrillators are simple to use and are designed for non-medical responders.

We, at The Heart Saver Institute, started work on the early pioneering of AED in 1979. We established a First Responder Program in 1980 at a local country club, where their first save was documented. The AED program has been put to use at this club many times.

Safe, Not Sorry
How a club's emergency readiness paid off
By Juergen H. Schumann, CCM

The budgets for the coming year had been completed and the past year reviewed for member satisfaction. We could be pleased with our operation, initiate thoughts for the off-season, refurbishing, vacation, conference, and then start another season.

This was the situation on a Wednesday I was off. Suddenly the shrillness of a police siren broke into the day intended for my family. A member of the club had fallen victim to a coronary attack.

At Old Westbury Golf and Country Club we had been fortunate in that we had an excellent medical committee chaired by a local physician, Dr. Lawrence Kryle. We also could boast of Oscar Bekoff, a senior cardiopulmonary resuscitation (CPR) instructor, as a member of the committee. Every year, by the end of May, Bekoff had been in the practice of teaching our pool staff water safety and respiratory emergency procedures.

Old Westbury is located in a poor response area for medical emergencies. Response time is a minimum of 20 minutes. We felt obliged to investigate additional methods and treatments available after CPR is properly performed.

We decided on the "Heart Aid," a machine that is a small attaché case-sized, computerized defibrillator (pacemaker). We also were prepared with a medical emergency response procedure which had been worked out in advance.

Assistant manager Tom Jordan had just walked out of the kitchen when he was advised that someone had a medical problem in the TV room. He immediately went into the office to get the "Heart Aid", and went to the scene of the emergency. He identified himself as knowledgeable in CPR and initiated evaluation of the victim. He found no breath or pulse and started CPR.

His procedure was that recommended for one person assisting a victim and included 15 compressions of the heart and two resuscitative breaths. After a minute that seemed like hours Jordan put the "Heart Aid" to use by placing a chest pad on the victim below the rib cage

Next, he inserted an airway (which is part of the pacemaker rig) into the victim's mouth. The "Heart Aid" was turned on and a light went on to indicate there was proper contact. Fifteen second's were taken to evaluate the patient's condition. The evaluation involved checking the patient for pulse, heart action and breathing. Jordan advised all to stay clear and the "Heart Aid" fired a charge.

The patient did not respond. The procedure was repeated two more times. After the third defibrillation, the patient responded with a heart beat. The patient's gag reflexes pushed out the airway and 20 percent oxygen was administered from tanks brought onto the scene. An ambulance arrived about 25 minutes later with medical technicians onboard.

The patient was subsequently discharged from the hospital and recuperated for a period of time at home. The life of the 63-year-old heart patient was saved by a cool head and pre-established guidelines for emergency resuscitation.

This article was published in "Club Manager" in December 1982. Technology since then has made AEDs easier to use and more cost effective.