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Resusc Plus
Resusc Plus
Resuscitation Plus
2666-5204
Elsevier

S2666-5204(24)00195-4
10.1016/j.resplu.2024.100744
100744
Letter to the Editor
Author’s response to Letter to the Editor ‘Can the chain of survival start with environment safety for special circumstances’
Schnaubelt Sebastian sebastian.schnaubelt@meduniwien.ac.at
⁎
Department of Emergency Medicine, Medical University of Vienna, Austria
Emergency Medical Service, Vienna, Austria
Eastwood Kathryn
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Greif Robert
University of Bern, Bern, Switzerland
Department of Surgical Sciences, University of Turin, Turin, Italy
⁎ Corresponding author at: Department of Emergency Medicine, Medical University of Vienna, WaehringerGuertel 18-20, 1090 Vienna, Austria. sebastian.schnaubelt@meduniwien.ac.at
10 8 2024
9 2024
10 8 2024
19 10074425 7 2024
28 7 2024
© 2024 The Author(s)
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcDear Editor,

As a response on the scoping review on various facets of the ‘chain of survival’ concept1 under the guidance of the International Liaison Committee on Resuscitation (ILCOR) Education Implementation and Teams Task Force, Yilmaz et al. (citation of the letter by Yilmaz et al.) proposed rescuer safety at the scene as an additional first link of the chain of survival – “environment safety”. In the light of recent major car accidents and mass casualty events, the letter focusses on prevention and the protection of first responders. (citation of the letter by Yilmaz et al.).

While Yilmaz et al. describe general first aid measures helping accident victims rather than cardiopulmonary resuscitation (CPR), which is the focus of the ILCOR Task Forces and the Chain of Survival, scene safety is undoubtedly the first and foremost step before tending to any victim, regardless of the kind of emergency. Therefore, safety of the rescuer is an integrated part of Basic Life Support and first aid courses worldwide, and assessing scene safety is part of standard operating procedures in professional emergency medical systems (EMS).2 Self-protection and situational awareness have seen an additional boost in popularity during the recent COVID-19 pandemic3, and rightly so. As suggested before, first responders embedded in a system should be professionally cared for4, including education in scene safety.

Further tangible impact on rescuer safety could be achieved through mandatory first aid and CPR training in driving schools as promoted by the European Resuscitation Council on a European level,5 mandatory CPR education for school children as promoted by ILCOR and the “Kids Save Lives” program,6 or mandatory workplace CPR trainings for employees. Currently, first responders educated and alerted by EMS systems are trained in scene safety and self-protection, but mandatory first aid and CPR training can ensure a larger proportion of the population are trained in scene safety before responding.

The recently proposed concept of a ‘chainmail of survival’ offers an opportunity to add such important links as rescuer scene safety.1, 7 However, there is a need to ensure messaging for first responders to cardiac arrest is succinct, concise and to-the-point. To reach consensus on enlarged chains of survival would be the task of international organizations such as ILCOR or regional resuscitation councils to deliver uniform suggestions in the upcoming 2025 guidelines updates.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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References

1 Schnaubelt S. Monsieurs K.G. Fijacko N. International facets of the ‘chain of survival’ for out-of-hospital and in-hospital cardiac arrest – A scoping review Resusc Plus 19 2024 100689 10.1016/j.resplu.2024.100689
2 Jenkins W.A. Scene safety situational: awareness saves lives JEMS 36 2011 32 33 10.1016/S0197-2510(11)70116-4
3 Sen-Crowe B. Sutherland M. McKenney M. Elkbuli A. Cardiopulmonary resuscitation during the COVID-19 pandemic: maintaining provider and patient safety Am J Emerg Med 46 2021 714 716 10.1016/j.ajem.2020.10.021 33082062
4 Schnaubelt S. Orlob S. Veigl C. Out of sight – Out of mind? The need for a professional and standardized peri-mission first responder support model Resusc Plus 15 2023 100449 10.1016/j.resplu.2023.100449
5 Semeraro F. Picardi M. Monsieurs K.G. European Resuscitation Council of the European Driving Schools Association “Learn to Drive. Learn CPR”: a lifesaving initiative for the next generation of drivers Resuscitation 188 2023 109835 10.1016/j.resuscitation.2023.109835
6 Schroeder D.C. Semeraro F. Greif R. KIDS SAVE LIVES: Basic life support education for schoolchildren: a narrative review and scientific statement from the International Liaison Committee on Resuscitation Resuscitation 2023 109772 10.1016/j.resuscitation.2023.109772
7 Schnaubelt S. Greif R. Monsieurs K. The chainmail of survival: a modern concept of an adaptive approach towards cardiopulmonary resuscitation Resuscitation 184 2023 109707 10.1016/j.resuscitation.2023.109707
