Cardiac arrest and basic resuscitation in the ambulance

Few tasks are as pure and as merciless as cardiac arrest. The patient has no pulse and is not breathing normally, and from that moment the chance of survival drops for every minute without treatment. As an ambulance technician it is therefore one of the skills you must be able to perform completely automatically, regardless of how unpredictable or chaotic the situation at the scene is.

§The chain that saves lives

Danish Council for Resuscitation and the European ERC guidelines organize resuscitation around a principle known as 'the chain of survival'. The idea is that survival after cardiac arrest depends on a series of steps being performed quickly and in the correct sequence — if one link fails, the chance of survival drops dramatically, no matter how well the other links are executed.

• 01Early detection and alerting — someone recognizes the cardiac arrest and calls 1-1-2 immediately
• 02Early cardiopulmonary resuscitation (CPR) — compressions start before the ambulance arrives
• 03Early defibrillation — a defibrillator (AED) is used as soon as possible
• 04Early advanced treatment — your professional work with airway, oxygen, medicine and transport decision

§Basic resuscitation step by step

When you arrive at a possible cardiac arrest you always start by assessing consciousness and breathing. If the patient does not respond and is breathing abnormally or not at all you treat it as cardiac arrest and start compressions without wasting time on doubt. The exceptions where you first provide a minute of basic first aid before calling are drowning trauma and poisoning – otherwise you call first and then start treatment.

§The defibrillator is part of the team

As soon as a defibrillator is available — either your own from the ambulance or one already put out by bystanders or a volunteer heart-saver — it's switched on and electrodes are applied immediately. Both semi- and fully automatic defibrillators analyse the patient's heart rhythm and guide the user through voice and screen; your job is to ensure that compressions only pause for the brief moment the device requires for analysis and shock.

§Your role as an ambulance technician

At the scene of the accident, you are often the one who structures the intervention: you take over or continue compressions from someone present, distribute tasks between you and your partner or a first aider, ensure a clear airway, give oxygen, and time when the cardiac arrest was detected and when each action was performed. These times are crucial both for further treatment at the hospital and for your documentation in the pre-hospital patient record.

Resuscitation is therefore not just a matter of technique. It is also a matter of calm, clear communication and the ability to maintain systematization even when relatives are in shock and the situation feels chaotic. The more automatic the basic skills are, the more capacity you have for the rest of the effort.

§When you're not alone in the effort

In many cases you do not arrive as the only ones. A resuscitation in progress, a random bystander with a first aid course, or colleagues from fire and police may already be underway when you arrive. Your task then quickly becomes to get an overview: how long has the cardiac arrest lasted? Have shocks been given? When did the compressions start? You must gather that information without unnecessarily interrupting the resuscitation itself, and it must go into the medical record so the further course at the hospital can build on a correct picture of what has already been done.

The decision whether a resuscitation should continue and when it should end rarely lies solely with you as a paramedic — it is often made in consultation with a doctor either on site or by phone via the emergency control center. Regardless of outcome thorough documentation of the process is critical both for relatives who will need answers later and for the professional learning the ambulance service can take forward.