DRABC is a primary assessment and action plan for a first aid situation. This post will explain how to carry out each step in the First Aid DRABC assessment. It also covers AVPU, the emergency roll, rescue breathing, CPR, and more. By performing DRABC you can determine urgent problems in the body’s critical systems. The human body’s critical systems are circulatory, nervous, and respiratory.
The information in this post is from the book “Wilderness and Travel Medicine” by Sam Fury.
Wilderness and Travel Medicine is a comprehensive handbook with a minimalist approach. It contains prevention, diagnoses, and treatments for a wide range of ailments using modern and “survival” medicines.
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- Overall advice
- Response (AVPU)
- How to do the first aid emergency roll
- How to do the first aid chin lift
- How to do the first aid finger sweep
- How to do first aid rescue breathing
- How to do first aid abdominal compressions
- Breathing (PROP)
- How to check a patient’s pulse
- How to do CPR (cardiopulmonary resuscitation)
- How to do CPR chest compressions
- When not to give CPR
- How to do check perfusion
- First Aid DRABC Summary
First Aid DRABC Overview
IMPORTANT: No amount of reading can compare to a medical course with a professional trainer. A standard first aid course is good. A Remote Area First Aid Course or higher is best.
DRABC in first aid means:
- Danger. Assessing the situation and ensuring the safety of everyone involved.
- Response. Using AVPU to check the patient’s level of consciousness. Includes the emergency roll.
- Airway. Checking if air is moving in and out. Includes the chin lift, rescue breathing, and abdominal compressions.
- Breathing. Ensuring the patient’s breathing is adequate. Includes PROP.
- Circulation. Checking the patient’s heart is beating and the flow of blood is in tact.
Nowadays there is DRABCD. The last D stands for Defibrillation. This refers to applying a defibrillator to the patient. In SFP Remote Area First Aid we do not consider this step. If there is a defibrillator around then there is also someone qualified to use it close-by. In any case, defibrillators are very easy to use. The machine tells you what to do! So if you do need to use one I am sure you’ll figure it out.
There is also DRABCDE, which is more suited to Remote Area First Aid than DRABCD. In DRABCDE the last two letters D and E stand for preventing Disability and minimizing Exposure.. These two steps are important but are not immediately life-threatening. You can “take a breather” and think a few minutes before attending to them. We deal with them in the Diagnoses and Treatments section of SFP Remote Area First Aid Training.
If possible, the first thing to do in all first aid situations is to call emergency medical services. Know what the emergency services number is in whatever country you visit.
Stop and fix problems as you find them. Some may be obvious, others will need further investigation.
DRABC is in a “do this, then this” format. In real life, it is unlikely that you will be able to follow the steps smoothly. You have to be flexible.
Whoever is the most qualified ‘medic’ on the scene is the one in charge. If someone comes along that is more qualified, that new person takes charge.
After assessing critical systems and treating critical problems continue onto the secondary exam.
“Danger” refers to situational assessment. Its primary use is to ensure there is no further danger to anyone involved in the situation. Also, use it to gather information.
When you come across any situation it is important to not rush in.
To ensure the safety of you and everyone around you must first assess the entire situation. Ensure the surroundings are safe for you, your rescue partners, the public, and then the patient(s). In that order.
Next try to determine what may have caused the situation and if there may be spinal damage to the patient. Knowing the cause will help you to determine likely injuries. It will also help you predict further complications and avoid injury by the same thing.
Finally, assess the number of patients, the need for more rescuers, and what resources you have or need.
All this may seem overwhelming but your brain is awesome. Depending on the situation you can gather all this information within seconds.
“Response” is when you assess your patients level of consciousness, i.e., his level of response. It is your first contact with the casualty and is necessary to determine your next step. Use the first aid acronym AVPU.
Approach the victim and check his mental status using AVPU.
Gently shake the individual and ask in a clear voice “Hello, can you hear me? Are you okay?”
- Alert: Patient is alert.
- Verbal: Patient responds to verbal stimulus.
- Pain: Patient responds to pain stimulus.
- Unresponsive: Patient is unresponsive.
Anything below “Alert” may be the result of other critical system injuries, or could also give rise to them. If you need to and are able, put on gloves and call for help.
Use the emergency roll to get the patient on his back and check his critical systems at the same time.
How to do the First Aid Emergency Roll
Vice lock the patient’s spine.
- Support the head and spinal column.
- Grasp the jaw and the back of the head and squeeze the center line of the torso between your forearms.
Roll the patient onto his back. For larger patients use the heel of your foot to nudge his pelvis so it rolls with the upper body.
Move to the back of the patient. Hover your closer hand over the mouth to check for breath.
At the same time, with your other hand, check the radial pulse. The radial pulse is below the wrist at the base of the thumb.
Note: Do not use your thumb to check pulse, as the thumb has a light pulse of its own.
Also, check for and treat any severe bleeding.
If you suspect a spine injury or are unsure, do not move the patient unless absolutely necessary. Protect and stabilize the spine.
Check if air is moving in and out. If the patient is breathing, air is moving. Put your ear close to the patients face so that you are looking down his torso. Place your hand on his abdomen and look, listen, and feel for signs of breathing.
How to do the First Aid Chin Lift
If the airway is not open, use the chin lift. Lift up the chin gently with one hand while pushing down on the forehead with the other to tilt the head back.
When you suspect a neck injury, open the airway using the chin-lift without tilting the head back.
If the airway remains blocked, carefully tilt the head until the airway is open.
With infants (under 1-year-old) be careful not to tilt the head back too far. Doing so may block the breathing passage instead of opening it.
How to do the First Aid Finger Sweep
If the airway is still not open check for a blockage. You can use the finger sweep to remove a blockage. Sweep your finger into the patient’s mouth. Be careful of his teeth.
If there is any fluid (blood, water, vomit) use gravity to help drain it.
Support the patient’s head and neck with one hand and reach around to the center of his back with the other.
Roll the patient onto your thighs and clear the airway using the finger sweep if needed.
If the airway is being blocked due to swelling, e.g., trauma, burns, anaphylaxis, treat the cause (if possible).
How to do First Aid Rescue Breathing
Next, give two rescue breaths.
Transmission of infection between rescuer and patient is rare. As far as we know, no one has ever caught HIV or AIDS via rescue breathing. If it worries you, improvise a barrier slitting a small hole in some sort of material, e.g., glove, plastic bag.
Pinch the person’s nose shut using your thumb and forefinger. Your hand stays on the patient’s forehead to maintain the head tilt. Your other hand also remains to lift up under his chin. Take a normal breath (not deep), and then form a tight seal between yours and the patient’s mouths.
With your mouth sealed tight on the patient’s, breathe into him for one second. Do a steady breath. Not fast. Do two of these breaths.
If the patient’s chest does not rise after the first breath it means the air is not going in. Perform the head tilt again before attempting the second breath.
For small children: The breath into the child lasts for 1.5 seconds. Do chest compressions with these two rescue breaths. Be careful with your force of breath. Only use enough to make the chest rise.
For infants: Cover the nose and mouth with your mouth. The breath into the infant lasts for 1.5 seconds. Be careful with your force of breath. Only use enough to make the chest rise.
How to do First Aid Abdominal Compressions
If the rescue breaths do not go in it means there is still a blockage. Use abdominal compressions.
Straddle over the patient’s legs. Place a fist between the breastbone and belly button. Thrust upwards up to five times to dislodge the obstruction. Attempt the rescue breaths again.
Do five more abdominal compressions if needed, then two more rescue breaths.
Repeat the 5 abdominal compressions and two rescue breaths until your breaths go in.
If his breathing is not adequate, treat the underlying cause (if possible). Use the first aid acronym PROP as a general treatment.
- Position: Put the patient in a position of comfort
- Reassurance: Reassure the patient.
- Oxygen: Provide 100% oxygen if available.
- Positive Pressure Ventilation is artificial respiration by mechanical means. The non-mechanical equivalent is to do rescue breathing. Use one breath every 6 to 8 seconds, which is about 8 to 10 breaths a minute.
Note: If there is no pulse you will do CPR instead of rescue breathing.
How to Check a Patient’s Pulse
If you didn’t check pulse with an emergency roll, do so now.
Lightly press the pads of your index and middle fingers on either the radial or carotid pulse. Do not use your thumb to check pulse since your thumb has a light pulse of its own.
The carotid pulse is on the neck in the hollow between the windpipe and the large muscle.
How to do CPR (Cardiopulmonary Resuscitation)
If there is no pulse start CPR.
Don’t waste time. If you are unsure about whether the heart is beating and you can’t find a pulse within a few seconds, start CPR.
During CPR, consider three things: Airway, breathing, and circulation.
- Open the airway with the chin lift.
- Give two rescue breaths.
- Give 30 chest compressions at the rate of 100 compressions per minute.
Opening the airway and rescue breathing is explained earlier in this article. This section will focus on how to do chest compressions.
How to give CPR Chest Compressions
Kneel at the patient’s side near his chest. Place the heel of your hand on his breastbone (sternum) between the nipples at the bottom of the ribcage. It is where there is a little notch.
Place your other hand on top of the one that is in position. Lock your fingers together pulling them up a little so they are off the chest wall.
Bring your shoulders over his sternum.
A chest compression is two parts:
- Compression (pushing down).
- Relaxation (releasing the chest back up).
Compression and relaxation should go for an equal length of time.
With your hands in position press downward, keeping your arms straight. Push down to about a third of the chest depth then relax to let it return to the normal position. Push hard and fast.
A cracking sound may be due to the ribs or cartilage cracking. Don’t worry about it for now. Keep doing the compressions. Do 30 compressions for every two breaths at a rate of about 100 compressions per minute.
For an infant: Encircle your hands around the chest and use only your thumbs to do the compressions.
For children aged one to eight: Compress at about the nipple line.
If there are 2 rescuers: The person pumping the chest stops while the other gives rescue breaths.
If the victim starts to vomit: Turn the patient’s head to the side and try to sweep out or wipe off the vomit, then continue with CPR.
When not to do CPR
If advanced medical care is not within a few hours away you need to make a decision whether to even start CPR or not.
To make a tough decision a little easier you can follow these points as a standard. In case of one of the following, do not start CPR:
- The patient’s core temperature is below 32 °C (90 °F).
- He/she has been underwater without air for more than 1 hour.
- The patient has an obvious lethal injury, e.g., massive hemorrhaging.
Note: You must treat severe bleeding before giving compressions.
Also, any time that you do start CPR you need to decide for how long you will continue. If advanced help is likely then continuing until it arrives is reasonable.
If you are unsure whether help will arrive, then for how long should you continue? 1 hour? 2 hours? These are decisions you have to make depending on the situation.
How to Check Perfusion
If CPR is not needed check perfusion.
Perfusion is the flow of fluid, e.g., blood, through a certain area of the body. Signs of inadequate perfusion include:
- Cold/clammy skin
- Low mental status
- Slow capillary refill
- Weak pulse in extremities, e.g., radial pulse.
If there is inadequate perfusion, treat the cause (if possible) and use PROP.
Testing Capillary Refill
Apply pressure to the skin and then wait to see how long it takes for blood to flow back into the site. A slow capillary refill means a slow return of blood. This indicates decreased perfusion. Returning from white to pink in less than 2 seconds is normal. 3 or more seconds may mean something is wrong.
Good places to check capillary refill for general perfusion are the fingers and toes.
First Aid DRABC Summary
In this post you have learned all the steps in First Aid DRABC.
- Call emergency services.
- Danger. Ensure it is safe to approach the victim.
- Response. Use AVPU to check the patient’s metal state.
- Airway. Check the victims airway and if needed, clear it using the finger sweep and gravity.
- Breathing. Ensuring the patient’s is breathing. Use PROP to assist him if needed.
- Circulation. Check the patient’s heart is beating. Give CPR if needed.
Something to think about:
The idea of first aid is to keep the patient alive until advanced medical care becomes available. In a survival situation, advanced care may not be available. Nursing a patient takes valuable time and resources. If there is no possibility of advanced medical care you may only be delaying an inevitable death. And in the process, the patient may be taking away resources from other survivors. Is it worth risking everybody? This is a choice you may have to make.
Image Credit: U.S. Air Force graphic
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