Ask ‘what does DR ABC stand for ?’ and the immediate answer from most medical and emergency response professionals is Danger, Response, Airway, Breathing and Circulation. The mnemonic is shorthand for the Primary Survey, the responder’s first rapid assessment of a casualty for conditions that could cause death within minutes. The order is important because each step deals with the most urgent risk before attention moves to the next. At each letter, the responder either finds a threat that needs immediate treatment or confirms that it is safe to continue.

In a noisy or visually complex scene, that discipline keeps an obvious injury, a distressed bystander or an equipment task from drawing attention away from an immediate threat to life. It also gives responders a common sequence or structure to use even when the circumstances around them are changing quickly. Let’s look at each of the checks in turn:

1. Danger: Check For Hazards Before Approaching To Prevent Further Casualties

Danger begins before the responder approaches and continues throughout the contact, as a scene that appears safe can quickly become dangerous again. Traffic may start moving again after a road traffic accident, fire or smoke may spread while a fire is contained, damaged structures may shift, or an apparently settled confrontation may restart.

The responder has to choose a safe approach and deal with hazards they can manage safely. If that cannot be done, police, fire, utility or specialist rescue resources may be needed before treatment can begin. A casualty should be moved urgently if remaining in place presents the greater threat to their safety, or that of the responder or other members of the public.

2. Response: Tells You What The Casualty Can Still Do

A clear verbal response from the casualty provides more than a measure of consciousness. A casualty who can speak has a ‘patent’, or open, airway at that moment, while short phrases, an altered voice or increasing confusion may point towards respiratory or circulatory compromise, as well as emotional distress. If there is no response to voice and a gentle shoulder shake, call for help. At this point, current St John Ambulance guidance directs responders to treat any life-threatening bleeding before opening the airway.

3. Airway: Establishes Whether Air Can Pass

With an unresponsive casualty, open the airway using a head tilt and chin lift and check for an obstruction. If you suspect the casualty may have injured their neck or spine, a responder with the appropriate first-aid training may use a jaw thrust to open the airway while limiting movement of the head and neck. The airway still takes priority, however – preventing neck movement is of little value if the casualty cannot breathe. Continue monitoring the airway as you move through the survey. Any change in the casualty’s position, decrease in conscious level, increasing swelling, or the presence of blood or vomit can obstruct an airway that was clear only moments earlier.

4. Breathing: Means Normal Breathing

Look, listen and feel for no more than ten seconds while keeping the airway open, and do not assume the casualty is breathing normally simply because the chest moves or you can hear a respiratory sound. Agonal gasps are slow, irregular breaths that can occur in the first few minutes of cardiac arrest. They may look like an attempt to breathe, but they do not provide effective ventilation.

If the casualty is unresponsive and not breathing normally, treat the situation as cardiac arrest. Notify control or request the required clinical backup, begin cardiopulmonary resuscitation (CPR) and bring an automated external defibrillator (AED) into use as quickly as possible.

5. Circulation: Brings The Focus Back To Bleeding

Within the St John DR ABC sequence, circulation follows confirmation of normal breathing and includes checking for severe bleeding. Begin with firm direct pressure. Current Resuscitation Council UK guidance then escalates to a standard or haemostatic (clot-promoting) dressing, with a tourniquet for life-threatening extremity bleeding that pressure has not controlled.

Life-threatening bleeding identified during the response check must be treated before the airway assessment. Once normal breathing has been confirmed, the circulation check gives the responder an opportunity to look more systematically for blood loss that was not immediately visible, including bleeding concealed by clothing, underneath the casualty or elsewhere on the body.

What Next? 

Once immediate life threats have been addressed, SmartTriage First Response helps police, fire, security and first-aid teams begin casualty triage and prepare a clearer handover. To find out more about the system, please contact one of the specialists at TSG today by clicking here.