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Perspective

Vol. 4 No. 1 (2026): January/December - 2026

Chain of Prevention versus Chain of Survival: Reframing Hospital Safety from Rescue to Anticipation

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2026.4.1.bjcmr67
Submitted
May 30, 2026
Published
2026-06-29

Abstract

The “Chain of Survival” has become one of the most influential conceptual models in resuscitation medicine, emphasizing early recognition of cardiac arrest, rapid activation of emergency systems, immediate cardiopulmonary resuscitation, defibrillation and advanced post-resuscitation care. Although this approach has contributed substantially to improvements in cardiac arrest outcomes worldwide, evidence suggests that many in-hospital cardiac arrests are preceded by hours of detectable physiological deterioration. Consequently, increasing attention has shifted toward prevention-oriented models, particularly the “Chain of Prevention”, which prioritizes early detection of deterioration before catastrophic events occur. This Perspective argues that the Chain of Prevention and the Chain of Survival should be viewed as complementary components of a unified continuum of care and examines the implications of this integrated perspective for patient safety, resuscitation science and healthcare system design. It further proposes that modern healthcare systems should evolve from predominantly reactive rescue-based paradigms toward integrated anticipatory systems capable of identifying, escalating and treating clinical deterioration at earlier stages. The article further examines the role of Early Warning Systems, rapid response teams, implementation science and health-system organization in operationalizing prevention-based models, particularly in low- and middle-income countries. Finally, the article proposes that the future of resuscitation science depends not only on improving survival after cardiac arrest but increasingly on reducing the incidence of preventable cardiac arrest itself.

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