10 components of the life support chain for patient survival
Effective prehospital care restores or maintains adequate oxygenation, perfusion and cellular environment which saves cells, organs and lives
For a patient to survive an emergency condition their organs must survive and continue to function. In order for organs to survive and continue to function, cells must be preserved and continue to function. At the cellular level, there are 10 essential components of the life support chain.
Early in my paramedic education at Youngstown State University I was presented with an article authored by an emergency medicine physician, which explained those 10 components necessary to keep a patient alive. I have searched endlessly for this article to give due credit to the author, however, I have not been successful. This list, compiled from my handwritten notes from 1979, provides a foundation to understanding pathophysiology.
My primary professor and paramedic program director was William E. Brown Jr. If the name sounds familiar to you, it should. Brown went on to become the Advanced Level Coordinator and subsequently the Executive Director of the National Registry of EMTs until his retirement in 2013.
Most important though, is that Brown instilled in me as an incoming paramedic student the necessity to base my education in EMS on a foundation of anatomy, physiology and pathophysiology. Memorizing signs and symptoms was not an option. We were required to understand and explain why the signs and symptoms were occurring in emergency patient conditions.
Likewise, our understanding of treatment was not to regurgitate a set of protocols but to provide the why behind the emergency care we were administering. This was imperative to educating a paramedic who can think and not just react.
A large sign in Brown's office summed up his expectation for paramedic students. It read:
"If you don’t believe in excellence in emergency medicine, then you don’t belong in here."
10 components of life support
I use the 10 components of the life support chain to teach EMT and paramedic students to think about what it really takes to give a patient the best chance to survive a medical emergency or traumatic emergency.
The 10 components of the life support chain necessary to maintain adequate oxygenation, perfusion and cellular environment are:
- Composition of ambient air
- Patency of the airway
- Mechanics of ventilation
- Regulation of respiration
- Ventilation/perfusion ratio
- Transport of gas by the blood
- Blood volume
- Myocardial effectiveness
- Microcirculation and systemic vascular resistance
- Acid base balance
Possessing an understanding of how to assess these components and provide support to maintain normal function, is key to ensuring patient survival in prehospital care.
Treat each cell
Your treatment impacts the ability of a cell to survive. For example, stopping an external hemorrhage should not be thought of as simply as task to perform when you see blood, but as a necessity to keeping the patient’s cells alive.
The patient's blood is a transport medium for oxygen, glucose, other nutrients, carbon dioxide and waste products. Without an adequate amount of oxygen and glucose being delivered to the cells, the cells will shift from aerobic to anaerobic metabolism. If this is not reversed, the toxic byproducts of anaerobic metabolism will cause the cell membranes to eventually fail leading to cell death.
Thus, the emphasis on controlling hemorrhage early and in the most effective manner possible, takes on a new meaning. It is not simply a task, but an intervention to keeping cells alive.
Opening an airway is not something you do simply because it is part of your protocol or expected in your treatment. You are opening the airway so that an adequate amount of oxygen is continually delivered to the cells so that an aerobic metabolic state can be maintained and the cells continue to function. If you don’t open the airway, the lack of oxygen in the blood will eventually cause the patient's cells to shift to an anaerobic state, and if not corrected, will eventually lead to cell death.
Thus, opening an airway or clearing an obstruction is necessary for cell survival. You must identify an occluded airway as early as possible and perform the skill of opening the airway quickly and effectively. If not, cells die. And if cells die, organs die. And if organs die, patients die.
There are three fundamental elements to all emergency care to keep cells alive:
1. Continued adequate oxygenation of cells.
2. Adequate perfusion of cells necessary to continue to deliver oxygen, glucose and other nutrients and eliminate carbon dioxide and other waste products.
3. Maintaining a cellular environment (milieu) that is compatible with cell survival.
As an EMS provider, your goal should be to maintain or return these three elements through your assessment and emergency care.
A disruption in any one of 10 components of the life support chain will lead to either an inadequate delivery of oxygenation or perfusion to cells or create a cellular environment where the cell cannot survive. The most basic and fundamental emergency care can positively impact the 10 components. Ineffective and inefficient emergency care can just as easily negatively impact the 10 components.