The concept of the Chain of Survival has not changed significantly since it was first described even though individual components such as basic life support (BLS) and defibrillation have been refined and redirected.
The need to link the efforts of those responding to an emergency was described as far back as the 1960s. Its genesis was based on the pre-hospital setting to deal with the problem of sudden cardiac death (SCD) in the community. Peter Safar recognised the need to link basic cardiopulmonary resuscitation (CPR), whose aim was to 'buy time', to advanced life support (ALS), whose aim was to restore spontaneous circulation (Newman 1998). This message was developed by Mary Newman of the Citizen Foundation who introduced the Chain of Survival metaphor in 1987 (Newman 1989). By the mid-1980s the importance of early defibrillation had been established and as such became a component of the chain in its own right.
The first Chain of Survival was published in 1989 and had only three links which were:
• early cardiopulmonary resuscitation;
• early defibrillation.
Within a year the fourth link, that of early ALS, had been added (Newman 1989).
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