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Heart Attack Throughout the United States, and especially in big cities and rural areas, tens of thousands of people with hearts that should be good to keep them alive die each year for lack of adequate first aid. In New York City, for example, a new study has shown that only one person in 100 outside of hospitals -- after the heart suddenly stops pumping . In contrast, in Seattle, the survival -- after such heart attacks is one in five. The difference can be traced __ the effectiveness of the chain of survival, Dr. Joseph P. Ornato said. Each link in the __ must be strong enough for many lives to be . The chain begins with an immediate telephone __ for emergency help and the start within four minutes of the process needed for restarting the __ working, by a family member or bystander . It continues with the prompt arrival-within eight __ ten minutes of a rescuer equipped with a special instrument that can shock the heart back to a normal rhythm. And it ends with the administration of advanced emergency care by nurses to maintain the hearts ability to survive until the doctors at the hospitals can take . When one or more links in this chain fail or function too slowly, the __ of a victim surviving heart attack falls rapidly. Because of widespread weaknesses in the chain of __ , experts in emergency heart care estimate that 20,000 to 80,000 people __ needlessly of heart attack each year, a number comparable to the 55,000 killed annually in automobile . | 
