When someone suffers a cardiac arrest out of hospital, certain things happening in a certain order can dramatically increase their chances of survival. This order of events is known as the ‘Chain of Survival’.

The elements that make up the Chain of Survival are:

  • Early Intervention: Recognising early on that someone is in cardiac arrest
  • Access: Getting assistance and calling for help from the emergency services
  • CPR: Performing chest compressions until a defibrillator arrives
  • Defibrillation: Administering a controlled electric shock (this can triple the chance of survival)
  • Advanced Cardiac Life Support: Advanced care delivered by paramedics and/or doctors
  • Post-Resuscitation Care: Continued care once resuscitation succeeds

48-year-old Paul, our patient who was featured in episode 1 of More4’s Emergency Helicopter Medics, is a living example of the Chain of Survival in action. In August 2018, golfer Paul was heading out to tee-off on a golf course near Milton Keynes when he started to feel unwell. Paul felt a tight pressure in his back and chest and instinctively knew something was wrong, so he returned to the clubhouse whilst his friends carried on with their round of golf.

At the clubhouse, Paul’s discomfort persisted and he asked the staff to call an ambulance. Without knowing it, Paul had just put himself on the Chain of Survival by realising that something was wrong, making an early intervention by deciding to stop his game of golf, and accessing help by calling 999.

Within 16 minutes of being called-out, Thames Valley Air Ambulance's Critical Care paramedic Jo and doctor Chloe arrived on scene to deliver advanced critical cardiac care to Paul. It was immediately clear to the team that Paul was suffering a catastrophic heart attack and he needed to get to the right hospital with the right facilities to give Paul the very best chance of survival. Suddenly, Paul went into Cardiac arrest. Because he had accessed help early and the critical care team were already present, treatment could be started immediately, with CPR and defibrillation. This treatment was crucial in keeping Paul alive.

Paul’s heart attack was very serious and there was a high probability that he might have another cardiac arrest or suffer other complications which would require further significant medical intervention. Whilst the helicopter could have gotten Paul to the hospital rapidly, there is not as much space to access the patient as there is in an ambulance – space which could be much needed if Paul required further treatment.

The Thames Valley Air Ambulance crew, together with paramedics of the South Central Ambulance Service, continued to treat Paul as they took him by land ambulance to the John Radcliffe Hospital. This decision proved to be the correct one as Paul’s condition deteriorated further, and he suffered several more cardiac arrests on route. Chloe and Jo took over Paul’s breathing by giving him an anaesthetic, placed Paul on a mechanical device which gives continuous chest compressions and delivered regular defibrillation and advanced post-resuscitation drugs to try and get his heart back to a stable rhythm.

Paul had a total of 28 shocks to the heart (13 of these were delivered pre-hospital) and surgery to remove a blood clot found by cardiac surgeons on the left-hand side of his heart. As a result of Paul’s decision to intervene early and place himself on the Chain of Survival, he has defied all odds of survival and is now well on the way to a full and remarkable recovery. He is back at work full-time and running the Reading Half Marathon in March to raise money for Thames Valley Air Ambulance.


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