Primary survey

When you find a casualty it is important to perform a primary survey- this is a rapid assessment to safely assess whether someone has life-threatening injuries.

The order of the primary survey is intentional; it allows you to consider each body system in order of priority, assessing first those injuries that will cause fatality the quickest i.e. Airway and Breathing. The contents and order of the primary survey can be easily remembered by using the mnemonic DR.ABC:

Danger:

• Before you approach the casualty you MUST check for danger

• YOUR safety is the number one priority

Examples of danger to be aware of:

1. Moving vehicles
2. Broken glass
3. Live electricity – Do not touch patient. Switch off source or disconnect using wood/plastic
4. Fire and smoke

Is the area safe?

YES: Proceed to help casualty

NO: Can you make the area safe?

YES: Make it safe and help casualty

NO: Stay back and call for help!

Response:

Ask the patient simple questions in BOTH ears- “Can you hear me?” and “Can you open your eyes?”

• YES: If there is any response then proceed to check airway

• NO: Gently hold shoulders and shake – Still no response? Proceed to check airway…

Airway:

Is the airway open and clear of blockages?

• YES: If patient can talk then the airway is open and clear. Proceed to assess breathing…

• NO:

o Responsive: Do not put your fingers in a conscious casualty’s mouth, encourage them to try and remove an obvious blockage with their hands or by coughing

o Unresponsive: Finger sweep to remove obvious blockages and open airway by tilting head back whilst lifting chin (N.B. Head tilt chin lift manoeuvre will be covered in a later video)

Proceed to assess breathing…

Breathing:

Place your ear to the casualty’s mouth and look towards their chest, is the casualty breathing normally?

• YES: You can hear normal breath sounds, feel breath on your cheek and see chest rising and falling – Proceed to assess circulation…

• NO: Shout for help and get them to call 999 for emergency services (if alone call yourself) and immediately begin cardiopulmonary resuscitation (N.B. CPR will be covered in a later video)

Proceed to circulation ONLY if the casualty starts to breathe independently.

Circulation:

Is the casualty bleeding severely from anywhere?

• YES: Control excessive bleeding and call 999 for emergency help (N.B. Treating bleeding will be addressed in a later article)

• NO: If A-C have been successfully dealt with then reassure the patient and wait with them for emergency services to arrive