Primary survey
Primary survey
When arriving at the scene of an accident it is important to ensure it is safe for you to approach and then to prioritise what injuries need dealing with first. The primary survey helps the first aider to recognise life threatening illnesses and injuries.
The human body needs oxygen to survive. In just 4 minutes without oxygen the brain cells will start to die and most people will die within 10 minutes of total oxygen starvation. It is crucial that first aiders recognise and treat conditions where oxygen isn’t getting to the body and do not concern themselves with minor injuries first.
Following the steps of the primary survey will ensure that life threatening illnesses and injuries are dealt with first. It also helps when there are multiple casualties to determine who to help first.
DRCABCDE
Danger
- Make sure you are safe before going to help, do not put yourself at risk. Check that the casualty and bystanders are safe and remove any remains risks if safe to do so.
Response
- Ask the casualty loudly if they are alright. If they do not respond, gently shake or tap their shoulders.
- If there is no response immediately call 999 or 112 and ask for the ambulance service.
- Put your mobile phone on speakerphone so you can continue to talk to the emergency call handler.
Catastrophic Bleeding
- Attempt to control any obvious life-threatening bleeding before continuing your primary survey.
Airway
- If the casualty did not respond you need to open their airway by tilting the head back and lifting the chin. This is called the head tilt/chin lift and will lift the tongue off the back of the throat.
Breathing
- Check for normal breathing for no more than 10 seconds. Look for chest movement, listen for breath sounds and feel for expired air.
- Be aware of Agonal Gasps (gasping, shallow or irregular breathing) which might make you think they are breathing. This is not normal breathing and you must start CPR.
- Agonal gasps in athletes undertaking physical exercise can also present as panting, again this is not normal breathing.
- The 999 call hander can help you identify normal breathing.
Circulation
- Check for any life-threatening circulation problems that need treatment including:
- Severe bleeding
- Heart attack
Disability
Assess the casualty’s overall responsiveness using the ACVPU scale. A decreased response level may suggest life-threatening conditions that impair brain function, including:
- Diabetes
- Stroke
- Head Injury
Exposure
Consider the possibility of problems caused by prolonged exposure to heat or cold that could have altered the core body temperature such as:
- Hypothermia
- Heat Stroke
Exposure also allows progression to a Secondary Survey where you might expose other injuries that were initially hidden.
