In the event of a medical emergency, the very first thing that needs to be done is an initial evaluation of the situation – referred to as a ‘primary survey’. The primary survey in first aid is used to assess and treat any immediate threats to life quickly and systematically.
There are five steps involved in conducting a primary survey. To help remember what these steps are, the acronym DRABC has been developed.
DRABC stands for:
D – Danger
R – Response
A – Airway
B – Breathing
C – Circulation
The primary survey stands as the foundation of effective medical response in emergencies. Its careful execution, guided by DRABC, helps promptly and proficiently address critical life-threatening situations.
In this article, we will take a look at what each of the elements of this acronym stand for, as well as provide an overview of the primary survey in general.
What is the Primary Survey?
The primary survey in first aid is a technique designed to enable anyone who is not a professional emergency responder to assess and deal with a life-threatening situation before help arrives.
Although designed to be able to be used by non-medical personnel, it is based on the Advanced Trauma Life Support (ATLS) program, which is known under the acronym DR C ABCDEFG. This longer set of steps has been used by hospital staff and paramedics worldwide since the early 1980s.
The intent of the primary survey is to provide people with an easy to remember framework that they can use to assess and treat any risks to the life of a person who is injured or ill. The DRABC steps allow the responder to systematically evaluate and treat all threats to life in order of priority.
Following the DRABC steps of the primary survey correctly could save a person’s life. So, it is crucial that a person who is attempting to provide first aid has an understanding of how to carry out these steps when necessary.
When Should the Primary Survey be Used?
The primary survey should be conducted, when a person encounters someone who has been injured or fallen seriously ill. An emergency medical situation may have an obvious cause, such as a fall or other type of accident, or a person may collapse for no apparent reason because of an underlying health issue, such as a heart condition.
Examples of when the primary survey should be used include, but are not limited to, emergencies involving:
- Cardiac arrest
- Serious blood loss
- Blunt force trauma
Who Can Conduct DRABC?
While anyone can perform a primary survey, if there is a person who is qualified in first aid training available, then they should be the one to carry out the assessment and provide treatment.
Often, a workplace will have an appointed first aid responder. This is usually someone who has completed an appropriate first aid course with at least 18 contact hours of practical training. In the event that the appointed first aid person is unavailable; the primary survey will need to be done by a competent bystander.
The DRABC Steps Explained
So, now, let’s delve into the steps behind DRABC and take a closer look at what they mean.
D – Danger
Before any action is taken, you must first look for danger. This means you must evaluate any risks to yourself as well as anyone else in the immediate vicinity. This includes any potential environmental hazards.
Examples of hazards to look for include:
- Live electrical currents
- Broken glass
- Unsafe structures
If you identify, any such hazards they must be controlled before approaching a casualty. For example, if there is a risk of electrocution, power should be cut at the source, or the casualty must be moved away from the current without touching them directly. This can be done by means of a non-conductive object made of plastic or wood.
If such hazards cannot be eliminated, then you must wait until emergency medical responders arrive.
R – Response
If it is safe to approach the casualty, their level of responsiveness must be evaluated. In simple terms, these means speaking to them, introducting yourself and asking them what happened.
Another simple acronym exists for evaluating responsiveness, called AVPU. The letters of AVPU stand for:
Alert – Ascertain if the casualty is alert. Are they conscious? Are they moving or talking? If not, go on to the next step.
Voice – Ask the casualty if they are OK using a loud, commanding tone of voice. Try and be in their line of sight while doing so. If you get no response, move on to the next stage.
Place – Place your hand on the casualty’s collarbone, arm or shoulder and lightly shake them. This must be done gently so as not to exacerbate any existing back or neck injuries. If they still do not respond, move on to the last step.
Unresponsive – At this stage, the casualty must be classified as unresponsive. If the emergency services have not been alerted, then they must be called immediately. While waiting for help to arrive, responders should move on to the next step in the primary survey.
A – Airway
Step three of the primary survey is to check if the person’s airways are clear of any blockages. If the casualty is responding, ask them to remove any blockages themselves if possible. If they cannot remove the blockage themselves, then you should attempt to do so.
Fingers must not be placed into the casualty’s mouth. Blockages should be attempted to be displaced by slapping the casualty on the back and performing abdominal thrusts.
B – Breathing
Once any choking hazard has been removed, the casualty’s breathing must be assessed. To evaluate a person’s breathing, tilt their head back, then look for chest movements and listen for sounds of breathing. Put your cheek or your fingers near their mouth or nose to see if you can feel their breath. Ensure that you check the pace and rhythm of the breath for at least ten seconds.
If the casualty is not breathing normally and is unresponsive, emergency services must be notified. If the responder has had appropriate CPR training, they can begin CPR with rescue breaths. If not, then hands-only CPR must be used. If one is available, a defibrillator (AED) may need to be used.
The current guidance recommends caution when giving rescue breaths to avoid transmission of Covid-19.
If the casualty is unresponsive but breathing as normal, move them into the recovery position (if it is safe) and wait for emergency services to arrive.
C – Circulation
This step should only be completed if the casualty is breathing on their own accord. If they are breathing independently, a responder should check them for any signs of bleeding. If there is a wound that is bleeding severely, direct pressure to the wound must be applied using a sterile dressing or a clean cloth.
If there is no bleeding and the person is responsive, stay with them and reassure them until help arrives. If they are unresponsive, and it can be done safely, move them into the recovery position and wait with them until emergency services arrive.
What to Do After You’ve Completed DRABC?
Once all the primary survey steps have been completed, a secondary survey can be undertaken. This is done to gather information about how the situation occurred and the casualty themselves.
Ask the casualty to explain what happened to them and how it happened. Have them describe any symptoms or pain they are experiencing and the severity of these sensations.
Perform a thorough physical examination from head to toe, carefully feel over their body to check for broken bones or swelling. If they are responsive, please ask for consent before this step. Try and take note of any other physical issues, such as skin discolourations or if their breath has a strange odour.
If the casualty is unresponsive, perform the physical examination with respect for their personal dignity. Any injuries that are found should be made note of and communicated to emergency service personnel upon their arrival.
Providing First Aid Training
It’s the legal duty of every employer to conduct a first aid needs assessment, and ensure they have enough first aid cover for their work sites. An adequate number of trained first aiders should be available. Whilst practical first aid training must take place in person, it is recognised by the Health and Safety Executive that online training can play an important role in keeping this training up to date.
To learn more about the types of online first aid training Human Focus has to offer.