
==== Front
Resusc Plus
Resusc Plus
Resuscitation Plus
2666-5204
Elsevier

S2666-5204(24)00168-1
10.1016/j.resplu.2024.100717
100717
Letter to the Editor
Can the Chain of Survival start with environment safety for special circumstances?
Yilmaz Sarper sarperyilmaz08@gmail.com
⁎
University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
Umac Gülbin Aydoğdu
Emergency Physician, Department of Emergency Medical Service, Manisa Provincial Ambulance Service Chief Physician, Manisa, Turkey
⁎ Corresponding author at: Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, Istanbul, Turkey. sarperyilmaz08@gmail.com
29 8 2024
9 2024
29 8 2024
19 10071728 6 2024
2 7 2024
3 7 2024
© 2024 The Authors
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,

We read with great interest the article by Schnaubelt et al. titled “International facets of the ‘chain of survival’ for out-of-hospital and in-hospital cardiac arrest – A scoping review.”1

Turkey is one of the countries aiming for early cardiopulmonary resuscitation (CPR) and correct application of the Chain of Survival through public awareness campaigns and training, while managing Out-of-hospital cardiac arrests (OHCAs) with Emergency Medical Systems (EMS) teams in cases of disaster, trauma, or other situations. On December 28, 2023, a chain-reaction traffic accident occurred on the Sakarya section of Turkey's Northern Marmara Highway. The accident involved seven vehicles, resulting in 10 fatalities and 61 injuries.2 According to statements from government officials, a significant portion of the fatalities and injuries in the accident were individuals who had left their vehicles to assist other injured persons. Similarly, in a recent incident in Gaziantep, Turkey, a bus struck emergency responders who had arrived at the scene of a car that had veered into a ditch, resulting in 15 fatalities. Additionally, in Mardin's Derik district, another truck hit responders attending to injured individuals from a collision involving a truck and two other vehicles, leading to 20 fatalities.3 In both of these incidents, similarly, due to the lack of adequate environmental safety measures, those assisting the injured also became casualties themselves. In these two accidents, similarly, due to the lack of perimeter security, those who helped the injured were themselves injured or killed when other vehicles became involved in the accident.

In recent years, not only traffic accidents but also many mass casualty incidents caused by CBRN attacks and the COVID-19 pandemic have provided us with crucial insights into the necessity of a unified and controlled approach to all victims.4 Therefore, ensuring the safety of first responders and the security of the scene is a key strategy that protects both the responders and the injured. Implementing a single algorithm that can be used in the event of single or multiple casualties would provide a more comprehensive approach. In a globalized world, in the event of single or multiple injuries, the first people to provide initial aid are often volunteer first responders from the community. Ensuring their own safety while performing these voluntary interventions should be a fundamental principle. We can see through various examples that in incidents such as traffic accidents, terrorist attacks, and natural disasters, the lack of personal safety measures for these responders is among the causes of injury and death.

The Chain of Survival continues to be a metaphor that motivates first responders, raises awareness, and facilitates easy training. The step of ensuring scene safety should be incorporated into the societal awareness created by the Chain of Survival metaphor. The United Nations General Assembly has set an ambitious goal to halve the number of global deaths and injuries from road traffic crashes by 2030 (A/RES/74/299). Within this target, and based on our recent experiences, community first responders remain crucial in OHCA. Therefore, we believe it is essential to discuss the need for the Chain of Survival to start with “Environment Safety” for the protection of first responders themselves, particularly in special circumstances, to enhance their awareness and training.

Meetings

The article has not been presented in any organization

Grant or other financial support

None.

Author contributions

SY and GAU conceived the study, designed the trial. SY and GAU supervised the conduct of the trial and data collection. SY and GAU undertook recruitment of participating centers and patients and managed the data, including quality control. SY and GAU provided statistical advice on study design and analyzed the data. SY and GAU drafted the manuscript, and all authors contributed substantially to its revision. SY and GAU takes responsibility for the paper as a whole.

CRediT authorship contribution statement

Sarper Yilmaz: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Resources, Methodology, Investigation, Data curation, Conceptualization. Gülbin Aydoğdu Umac: Writing – review & editing, Visualization, Supervision, Methodology, Formal analysis, Data curation, Conceptualization.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Sarper Yilmaz reports writing assistance was provided by Kartal Dr Lutfi Kirdar City Hospital. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.].

Acknowledgements

We would like to express my gratitude to OpenAI's ChatGPT-4 for its assistance in refining the English language and clarity of this research.
==== Refs
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 Kuzey Marmara Otoyolu’nda zincirleme kazada 10 kişi öldü, 61 kişi yaralandı, (n.d.). https://www.aa.com.tr/tr/gundem/kuzey-marmara-otoyolunda-zincirleme-kazada-10-kisi-oldu-61-kisi-yaralandi/3094187 (accessed December 28, 2023).
3 Gaziantep ve Mardin’de katliam gibi iki kaza: 35 kişi öldü, (n.d.). https://www.ntv.com.tr/turkiye/gaziantep-ve-mardinde-katliam-gibi-iki-kaza-35-kisi-oldu,ScenstW0tEegJW3aYBoAXw (accessed December 28, 2023).
4 Ramesh A.C. Kumar S. Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents J Pharm Bioallied Sci 2 2010 239 247 10.4103/0975-7406.68506 21829319
