For years, we have heard about the "Chain of Survival" - the links necessary to save the life of a person in cardiac arrest. The American Heart Association has summarized the most important factors that affect survival of cardiac arrest. The four components of the Chain of Survival include early access, CPR, early defibrillation and early advanced care. An EMS system in which there are strong links in this chain provides a better outcome for a victim of cardiac arrest.

But the Chain of Survival deals only with patients in cardiac arrest. What about patients who have suffered a serious illness or trauma, but are not in cardiac arrest? It is time to create the "Survival Ladder" for those who are not suffering cardiac arrest, but would be if it were not for the progressive and rapid care they receive from aggressive EMS systems and sophisticated hospitals.

Unfortunately, the only tool we use to measure the effectiveness of an EMS system is cardiac arrest survival rates. But usually cardiac arrest patients make up less than 1% of all calls to which an EMS system responds. What about those patients who never went into cardiac arrest because of a quick response by advanced life support (ALS) first responders and ALS transport vehicles and where appropriate intervention took place? With the Survival Ladder, each rung you move up is another step closer to survival. Any "misstep" on a rung or missing a rung breaks the climb and can adversely affect patient outcomes.

One excellent opportunity for using the Survival Ladder is with the introduction of STEMI (ST-segment elevation myocardial infarction) programs around the country. It is estimated that approximately 865,000 heart attacks occur in the United States each year. While many of these heart attacks do not show an ST-elevation on an EKG and are not easy to identify, ST-elevated heart attacks can be quickly recognized and treated to reduce heart damage. The approximately 400,000 STEMI heart attacks that occur each year can be easily recognized by firefighter/paramedics in the field.

The whole idea behind STEMI programs is to open the arteries in the heart of a person suffering a myocardial infarction within 90 minutes from arrival at the hospital. There are two ways of opening the arteries of a STEMI patient: clot-busting drugs (thrombolytics) or angioplasty, where a tiny wire is inserted into the blocked area of an artery and a balloon is inflated to re-open the artery and restore blood flow.