Reframing Survival: It’s about Systems not a Chain
The medical standard of care when confronted with sudden cardiac arrest (SCA) is to follow the “Chain of Survival” by engaging in early access, early CPR, early defibrillation and early advanced life support (ALS). Particularly in the occupational setting, each of these actions has been identified as critical to support the patient while awaiting assistance and transportation from the community Emergency Medical Service (EMS). However, I present here a broader argument that restricting one’s thinking to a conception that the “likelihood that a victim will survive cardiac arrest increases if each of the elements is addressed” is inadequate and misleading. Moreover, continuing to focus primarily on these individual elements is unlikely to solve to any significant degree the complex problem of our vulnerability to death from SCA. This paper presents an overview of this argument, offers an alternative conceptualization, and proposes ideas and actions that follow from its logic. While specifically directed at the problem of survival following SCA, the argument presented also addresses wider problems associated with major medical emergencies and other disasters.