By Dr Wicus Grové — Emergency Medicine
When someone suddenly collapses or is critically injured, everything can change within seconds.
There is rarely time for long discussions. In those first few minutes, survival may depend on recognising danger, calling for help and starting the right action immediately.
Whether the emergency is sudden cardiac arrest, a serious road accident, penetrating injury or catastrophic bleeding, the first minutes matter.
“How in words can you describe this heart without filling a whole book?”
— Leonardo da Vinci, c. 1513
A cardiac arrest occurs when the heart can no longer pump blood effectively around the body. The person becomes unresponsive, stops breathing normally and rapidly loses blood flow to the brain and other vital organs.
This differs from a heart attack, where blood flow to part of the heart muscle is blocked but the heart may still be beating. A heart attack can, however, trigger cardiac arrest.
If someone suddenly collapses, is unresponsive and is not breathing normally, emergency medical help should be called immediately and CPR should begin. For an adult, chest compressions should be performed firmly and quickly in the centre of the chest at around 100 to 120 compressions per minute. Their purpose is to keep blood moving to the heart and brain until circulation can be restored.
An automated external defibrillator, or AED, can make an enormous difference. It guides the user, analyses the heart rhythm and delivers a shock only when required. In certain dangerous rhythms, early defibrillation can improve survival.
“This beats of itself and never stops, except eternally.”
— Leonardo da Vinci, from his anatomical observations of the heart
Trauma, however, changes the picture.
When cardiac arrest follows severe injury, the heart may not have failed because of an electrical problem. The patient may have lost so much blood that there is not enough circulating volume for the heart to pump. Trapped air inside the chest may compress the heart and lungs, or blood may collect around the heart and prevent it from filling.
In these situations, chest compressions alone cannot correct the underlying problem. The trauma team must rapidly identify and treat what can still be reversed.
Catastrophic bleeding is therefore one of the first priorities in modern trauma care. A person can bleed to death within minutes. Severe external bleeding requires immediate direct pressure, while life-threatening bleeding from a limb may require a properly applied tourniquet.
Internal bleeding is harder to recognise. Someone may appear relatively intact while losing blood into the chest, abdomen or pelvis. Weakness, confusion, clammy skin, rapid breathing, severe pain or collapse after significant trauma should raise concern.
Trauma resuscitation has also evolved. Large volumes of clear intravenous fluid were once commonly given. Today, clinicians recognise that these fluids cannot replace the oxygen-carrying cells and clotting components lost during major haemorrhage.
Modern care therefore places greater emphasis on early blood products, limiting unnecessary fluid and controlling the source of bleeding as quickly as possible.
Teams also monitor the body’s ability to clot. Major blood loss can cause hypothermia, abnormal acidity and low calcium levels, each of which can worsen bleeding. Specialised tests such as TEG or ROTEM can help identify clotting problems and guide more targeted treatment.
Occasionally, extraordinary circumstances require extraordinary interventions. In selected patients with penetrating chest trauma and cardiac arrest, doctors may perform a resuscitative thoracotomy—opening the chest to relieve pressure around the heart, control bleeding and attempt to restore circulation.
“Christ, it’s going to work!”
— Dr Christiaan Barnard, reportedly exclaimed as the transplanted heart began beating during the world’s first human-to-human heart transplant, Cape Town, 3 December 1967
Behind these dramatic moments is something patients rarely see: preparation.
Defibrillators must work. Emergency drugs and blood must be available. Tourniquets, pelvic binders and chest equipment must be easy to reach. Doctors, nurses and emergency personnel need clear roles and must practise working together before the real emergency arrives.
For the public, the first response is simpler: recognise the emergency, call for help, begin CPR when someone is unresponsive and not breathing normally, use an AED when available, and control severe external bleeding with firm pressure.
Advanced resuscitation may later involve blood products, ultrasound, surgery and intensive care. But the chain of survival often begins with the person who was there first.
The first few minutes belong to everyone.
Sometimes, those few minutes are enough to restart a heart—or save a life.