DANGER

Check for DANGER.

If someone appears to be unconscious or seriously injured first observe the immediate area and check for possible risk to the injured person, yourself, or anyone else. 

For example:

• If someone appears to have been electrocuted, are they clear of the source of electricity?

• If the injured person is in a damaged vehicle, is there a risk of it catching fire or moving unpredictably?

• If a sports person has fallen in rugged terrain e.g. skiing or mountain biking, is he or she on a dangerous slope or otherwise at risk of falling further so sustaining more injuries or complicating existing injuries?

Can immediate steps be taken to minimise on-going risks e.g. by stopping play (if on a sports field)?

RESPONSE

Ask the injured person ('the casualty") to respond to you. The first purpose of this is to find out if he or she is conscious.

To establish if someone is conscious, check if he or she can:

• Speak to you

• Hear your voice

• Move (at all) e.g. open and close his/her eyes

• Respond to being touched

Caution: Care must be taken if checking for a response to touch. Shaking him/her may cause further injury.

If the casualty is conscious and able to talk it may be possible to ask about the situation, e.g. if he or she has any pain, what happened, and so on. In that case the remaining steps ABC would not be necessary because someone who can talk can also breathe etc.. Depending on the situation he or she may, or may not, require medical attention. For example, someone who had fallen asleep on a park bench so might have appeared to be unconscious - yet awoke easily when spoken to, may not need any help.

AIRWAY

If a casualty does not respond and so appears to be unconscious, check if his or her airway is clear i.e. that his/her throat is not blocked (which could prevent him/her from breathing).

Blockages in the throat area could be due to:

• Swallowed tongue

• Food or vomit

• Objects e.g. mouth guard (if he/she was using one for protection), or false teeth

Check that the person's head is in a suitable position to allow breathing.

(It may be sufficient just to tilt the head back gently to clear the person's tongue from his/her airway - but move the casualty as little as possible - just as much as needed to allow breathing while help is on the way.)

BREATHING

Check if the casualty is breathing.

• If the casualty does not respond (suggesting that he or she is unconscious) and he or she is not breathing even though his or her airway is clear, send for urgent medical help.

• If the casualty is unconscious but breathing, also send for medical help.It may be appropriate to put a casualty who is unconscious yet breathing into the recovery position while help is on the way. This is not recommended in all cases and especially not if the person has or may have injuries, e.g. broken bones - in which case moving him or her may cause further damage.

While help is on the way continue with the rest of the DRABC procedure.

The next steps / techniques should be followed by people who are competent to perform them - which usually means people who have completed appropriate training in First Aid and any other necessary skills.

If you don't have these skills and have never learned First Aid, now is the time to look-up the current advice given by organizations such as the Red Cross, St John's Ambulance or your local First Aid Charity. Also consider doing a First Aid course yourself because you never know when your help might be needed.

If the casualty is not breathing even though his/her airway is clear, a trained First Aider *might attempt to "breath for" the casualty by blowing air into his/her mouth using a technique called "mouth-to-mouth ventilation" or "mouth-to-mouth resuscitation".

Caution: The "mouth-to-mouth resuscitation" technique requires training that was*, but is no-longer always, included in short courses in First Aid, e.g. for "First Aid in the Workplace".

(During this training delegates practice on manikins - which are sometimes also called "dummies". This technique must not be practised on real people because it must not be applied to people who are breathing.)

Also, mouth-to-mouth ventilation alone is not helpful if there is no circulation, i.e. if the heart has stopped beating. This is because oxygen received into the lungs only reaches tissues in other parts of the body as a result of being transported around the body in blood circulated by the heart. First Aiders and others qualified in these techniques therefore also check and keep checking the casualty's circulation (the "C" of DRABC, as outlined below). The way in which people deal with this ("step B") of the DRABC procedure may vary:

• Some people have been taught to start chest compressions (see below) before applying mouth-to-mouth breaths e.g. British Red Cross Training video November 2009 on the page about CPR.

• Some people have been taught to use masks or ventilators rather than apply direct mouth-to-mouth.

• Details of techniques used often depend on what equipment, if any, is available when the need arises.

CIRCULATION

Blood circulation is essential for life. Blood is pumped around the body by the heart.

Many first aiders and medical professionals check if blood is circulating around the body by looking for a pulse.

However, guidelines and official First Aid advice changes from time to time. Some introductory First Aid courses no-longer teach lay-people (i.e. non-medics) to find and monitor a casualty's pulse*. This is because some people might find it difficult to develop the necessary skill with just the small amount of training and time for practise on a short First Aid course, so might lose confidence and valuable time in an emergency situation. People who do have the skills to quickly find and check a casualty's pulse are not discouraged from doing so.

One good place to check for a pulse is at the carotid artery in the neck.

If the casualty does not have a pulse (i.e. blood circulation), first aiders, paramedics, and other qualified personnel may begin external chest compressions (which involves applying pressure to the correct part of the chest at appropriate regular intervals - see the videos on the page about CPR).