Primary Survey: Basic First Aid – DRABC

July 23, 2023

The Primary Survey is a rapid assessment of a casualty to determine if there are life threatening injuries or a condition that needs addressing immediately. There are several mnemonics to assist with delivering an effective Primary Survey, but as with any aspect of first aid there is always a desire to cram as much detail as possible. Leading to several variations of the the initialism (for example, DRABC, DRSCABC, and DRCABCDE). In this article we’ll run through the basics of a primary survey only and we will use the basic mnemonic “DRABC”.

It’s important to note however, that there are other mnemonics which might be more beneficial to more advanced first aid situations, such as those involve in Mountain Rescue, Police, or other First Responders. We have a more advanced Primary Survey article that covers the more in depth DRCABCDE. Here we will focus on the basic steps required when coming across a single casualty. Again, we’ll cover more complex scenarios with multiple casualties in another post.

The Primary Survey

The basic Primary Survey has the following steps: Danger, Response, Airway, Breathing Circulation. This is the basis of the “DR ABC” mnemonic. We’ll cover the basic stages of DRABC below, we will cover a more advanced variation in another post.

Danger

Before approaching the casualty, assess the scene for danger. You should look for potential dangers that could present a risk you as a responder. For example, if you come across an unconscious casualty in an office you should consider the risk of electric shock. You may need to cut the power before you can approach the casualty. Whereas out on the hills if someone has fallen, you may need to consider the risk of falling rocks. In the event of a road traffic accident, the risk could be from traffic. You may need to lay out warning lights or a warning triangle.

At this point you should consider PPE. In almost all circumstances this will at least involve putting on nitrile gloves. However, you may require additional personal protective equipment such as a face mask, goggles, or a helmet.  

Response

Check is the casualty is responsive. When approaching the casualty, call out to them and let them know who you are. Expect that the casualty may be in shock or may be confused, so telling them who you are and that you are there to help is important. Ask them what has happened. You must call out to the person before touching them. If there is no response and you are required to touch the casualty, beware of the potential for a c-spine injury. If you have an assistant with you, ask them to control the c-spine until you have chance to clear it as a concern. Place one hand on their forehead to prevent neck movement. Place one hand on their shoulder and shake them gently. Beware that this may cause them to become alert and attempt to sit up. You should warn the casualty not to move until you have established the circumstances and have cleared the c-spine. If the casualty is not immediately alert, does not respond to your voice, and does not respond to you touching their shoulders – they are unresponsive. This will affect how you move through the ABC check below.

Shout for Help

Send for Help

If you are with another person, send for help. If you’re in a group do not just announce that someone should go for help but tell a specific person to go for help. Give direct and short commands: “You, call 999.” or “You, go to reception and tell them to call an ambulance.”

Call for Help

If you are alone, do not leave the casualty. If you have a mobile phone, use the speaker phone option to keep your hands free and call 999. Explain the situation and continue to work through the Primary Survey. Be prepared to give your exact location. Follow their instructions. If you do not have a mobile phone, shout for help. Whilst shouting, continue to work through the Primary Survey.

Airway with C Spine

You need to ensure that the airway is clear, open, and maintained. If the casualty is conscious, remind them frequently to keep their neck and head still until you have cleared them for a c spine injury. Check the airway is clear and free from any obstructions, if obstructions are present then remove with suction or forceps. Open the airway with an airway manoeuvre. If there is a risk of a c-spine injury then perform a jaw-thrust. Otherwise a head tilt-chin lift may be performed.

Breathing

Check for breathing by placing your ear near to the casualty’s nose and mouth and placing your hand on the stomach of the casualty. Listen, Watch, and Feel for breathing. Check for 10 seconds to establish if the casualty is breathing.

If no signs of breathing, start CPR. Do not stop CPR until Emergency Services arrive or you become exhausted. If you have an assistant, tell them to get an AED if there is one available in your area. If you have an assistant available, prepare to take turns giving CPR.

If the casualty is breathing, check for 30 seconds to determine their respiratory rate. A normal rate is 12-20 breaths per minute. If they are breathing, move on to circulation. If the casualty is conscious, consider conditions such as asthma and whether aid can be given with their inhaler.

Circulation

You need to check for severe bleeding. Check for blood pooling on the floor or for blood soaked clothing. Address the bleeding by applying direct pressure to the wound.

Once you have completed your Primary Survey and you have addressed any conditions or injuries likely to present an immediate threat to life, you may continue with the Secondary Survey. Continue communicating with Emergency Services, and prepare the casualty for hand over upon their arrival.

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