Chain of Survival
The chain of survival is the sequence of actions that gives someone in cardiac arrest the best chance of living. It opens every AHA BLS course because it explains why the first few minutes — the BLS minutes — matter so much.
The idea
Survival depends on a chain of linked actions. If one link is weak or missing, the chance of survival falls. The early links — recognition, calling for help, high-quality CPR and early defibrillation — are exactly what BLS teaches.
In hospital, the chain starts earlier, with early recognition and prevention — spotting the deteriorating patient before the arrest — followed by activation of the response, high-quality CPR, defibrillation, post-arrest care and recovery.
The first three links outside hospital, and the early links inside it, are BLS: call, compress, shock. Each minute without CPR and defibrillation reduces the chance of survival, which is why the course drills the BLS algorithm, high-quality compressions and early AED use.
Survivors often need physical, cognitive and emotional rehabilitation. Recovery was added to the chain to recognise that surviving to discharge is not the end of care.
Out of hospital, the first links usually depend on whoever is nearby. That is why workplace training matters: a colleague who recognises cardiac arrest, calls for help and starts compressions before the ambulance arrives strengthens the chain more than anything that happens later. For non-clinical staff, the first aid course teaches the same early links.
This guide summarises what is taught on the course. The American Heart Association CPR and ECC Guidelines, linked below, are the authoritative source.
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The sequence of actions that maximises survival from cardiac arrest: recognition and activation, CPR, defibrillation, advanced care, post-arrest care and recovery.
Six in the current AHA chains, which now include recovery.
Yes, it begins with early recognition and prevention of deterioration.
The early links: recognition, activating help, high-quality CPR and early defibrillation.
For shockable rhythms, every minute without defibrillation reduces the chance of survival.
Reading is not the same as doing. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with classroom, HeartCode and on-site BLS training and a two-year AHA BLS Provider eCard.
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Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.