Early Access:
Call 9-1-1 (or the EMS system in your area) and get an AED!

Recognize an Emergency.
First, you or other witnesses must recognize the emergency. You must recognize the warning signs of a heart attack, cardiac arrest, stroke or choking. Anyone who is unresponsive should receive emergency care. Heart attack, cardiac arrest, stroke and choking can each cause unresponsiveness. Although many conditions — not just cardiac arrest — can cause unresponsiveness, all unresponsive victims will benefit from activating the Chain of Survival.

Call 9-1-1 (or the EMS system in your area).
As soon as an emergency is recognized, call 9-1-1. When you or another rescuer calls 9-1-1, let the dispatcher ask you questions. While the dispatcher interviews you, he or she will enter the data on a computer. The information you give will be relayed to a response team. Answer in short, specific replies, giving only the requested information. The dispatcher will probably ask:

• "What is your emergency?"
  You might answer, "A customer had sudden chest pain and has now collapsed."
  
  
• "What's happening now?"
  "My friend is giving cardiopulmonary resuscitation. We have an automated external defibrillator."
  
  
• "Where is the patient located?"
  "We are at the Evergreen Company, here at 1234 Fifth Avenue NE, in the back hall."
  
  
• "What number are you calling from?"
  "The number is 555-1313."

At this point the dispatcher may give you directions such as "Stay on the line until I tell you to hang up. Rescuers are being sent to your location. Please meet them and direct them to the scene."

Remember, though, if you are alone, you must immediately begin performing CPR, the next link in the chain.

Early CPR:
"Pump and Blow"

Begin Cardiopulmonary Resuscitation (CPR).
CPR is the critical link that buys time between the first link (call 9-1-1) and the third link (use the AED). The earlier you give CPR to a person in cardiac or respiratory arrest, the greater their chance of survival. CPR keeps oxygenated blood flowing to the brain and heart until defibrillation or other advanced care can restore normal heart action.

Dispatcher-Assisted CPR and Defibrillation and Enhanced 9-1-1. In many areas of the country emergency dispatchers are taught how to help callers give emergency care. With help from the dispatcher, callers can give CPR (and use an AED). The instructions are basic and simple, but they will help the victim until EMS personnel arrive. Remember, CPR needs to be started immediately!

Using a prepared list of instructions, the dispatcher can coach you through the basic steps of CPR. At a worksite you will usually have help.

Use this approach:

• Repeat the dispatcher's instructions loudly to the other rescuers and confirm that they are following that step.
• If the patient vomits or other complications arise, tell the dispatcher. Do not expect that you will perform perfectly in such a crisis.
• Be sure that rescuers follow each instruction, even if it takes extra seconds.
• Ensure rescuer safety at all times.
• When EMS personnel arrive at the victim's side, the dispatcher will tell you that he or she is hanging up.
• You hang up last.

Find Out if Your Community Has Enhanced 9-1-1.
In enhanced 9-1-1 a computer automatically confirms the caller's address. Also ask if your 9-1-1 dispatchers are trained to offer prearrival instructions to rescuers. This means that they can give instructions for immediate care based on the clinical criteria of the emergency. If not, become a vocal advocate for such services in your community. Enhanced 9-1-1 can save precious seconds, minutes and even lives.

Early Defibrillation: Use the AED!

Use the Automated External Defibrillator (AED) to Treat Ventricular Fibrillation.
Many sudden cardiac arrest victims are in ventricular fibrillation (VF). VF is an abnormal, chaotic heart rhythm that prevents the heart from pumping blood.

You must defibrillate a victim immediately to stop VF and allow a normal heart rhythm to resume. The sooner you provide defibrillation with the AED, the better the victim's chances of survival. Several studies have documented the effects of time to defibrillation and the effects of bystander CPR on survival from SCA. For every minute that passes between collapse and defibrillation, survival rates from witnessed VF SCA decrease 7 to 10 percent if no CPR is provided. When bystander CPR is provided, the decrease in survival rates is more gradual and averages 3 to 4 percent per minute from collapse to defibrillation. CPR can double or triple survival from witnessed SCA at most intervals to defibrillation.

Community Lay Rescuer AED Programs.
The American Heart Association promotes community lay rescuer AED programs and has identified four key elements: 1) planned and practiced response, 2) training of anticipated rescuers in CPR and the use of the AED, 3) link to the local EMS system, and 4) a process of continuous quality improvement. 

Community lay rescuer AED programs and AED manufacturers should work with local EMS systems. Program authorities or manufacturers should notify EMS directors of AEDs placed in homes, businesses or other public areas.

The AHA has published a statement that provides additional details about community lay rescuer AED programs.

Heartsaver AED.
The American Heart Association has developed the Heartsaver AED Course to support the CPR and AED training components of community lay rescuer AED programs. For more information about CPR and AED courses available in your area click here .

Early Advanced Care

Transfer to Advanced Care.
The fourth link in the Chain of Survival is advanced care. This link is provided by highly trained EMS personnel called paramedics. Paramedics give basic life support and defibrillation as well as more advanced care that can help the heart respond to defibrillation and maintain a normal rhythm after a successful defibrillation.

reviewed/updated 04/21/2008