The pediatric chain of survival is different from the adult for some very good reasons. Lets take a look at the first link; prevention. Unintentional injuries are the number one cause of death in children and young people in the United States. Most of these injuries can be prevented with proper education and information. If we can prevent an emergency from happening in the first place, we are that much more effective in saving the lives of our children.
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In an adult, child, and infant CPR First Aid class, it is the responsibility of the BLS instructor to not only teach students how to effectively respond to pediatric emergencies, but also how to prevent them from happening in the first place. It is not enough to just teach CPR. Since most of the students in our class will never actually have to do CPR on an infant or child (some will), it is important that prevention issues that have daily significance are addressed. In this manner instructors and training programs make the most of the time and also are able to effectively deal with emergencies before they even happen.
For example: As I write this article I am at the park with my one and half year old son. A gentleman has just arrived to use the park to run his rather large Pit Bull Rottweiler mix….with no leash, around a park full of kids. Hmm… I have nothing against family pets, but animals by nature can be unpredictable, and in my own personal experience when someone says “he doesn’t bite” he usually does just that. This is why there are city ordinances made to “prevent” issues. That’s like riding in your car with all 5 of your kids, rushing through traffic because you’re late and no one is wearing a seat belt. I have seen my share of animal attacks and certainly am not interested in visiting the ER this morning. So I will take my son far out of any potential harms way. This would be prevention. Prevention in this situation might mean bringing the family pet at a time when there isn’t so many kids. But today, for me and my son it means find a place to play with less of a risk. I like 0 risk factors.
Prevention is a proactive way of dealing with emergencies, whereas CPR, bleeding control, etc., would be reactive. The reactive measures have there place, but the proactive measures give us the much more effective silent victories over emergencies and that is why prevention is the first link in the pediatric chain of survival.
Early CPR
The second link in the pediatric chain of survival is early CPR although a critical skill, its application is not necessary for every pediatric patient in an emergency situation. Those who are providing care should assess the victim to determine the most appropriate course of action. The pediatric chain of survival in not the pediatric “cardiac” chain of survival. Children are less likely to suffer from cardiac arrest due to heart disease and most often are found to require emergency medical assistance due to another type of circumstance that has caused them to stop breathing. In any case what is important to understand is that children cannot survive very long at all without oxygen. For this reason it is important that a lone rescuer who finds a child unresponsive assess the need for rescue breathing or CPR even before spending any time calling 911. Of course when multiple bystanders are present, calling 911 and the assessment of the child’s airway breathing and circulation can be performed simultaneously.
Michael Morales is an EMT paramedic and director of education for Vital Ethics Inc., providing basic and advanced life support training and certification programs.
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