How to do the primary survey (DR ABC)
1. Danger. Before approaching the casualty, always make sure the area is safe.
2. Response. Check if the casualty is responsive or unresponsive. As you approach them, introduce yourself and ask them questions to see if you can get a response. Kneel next to their chest and gently shake their shoulders, asking, ‘Hello, can you hear me. What has
happened?’, ‘Open your eyes!’.
o If the casualty opens their eyes, or gives another gesture, they are responsive.
o If they do not respond to you in any way they are unresponsive and should be treated as quickly as possible following the below guidance (Check airway & breathing as below)
3. Airway. Next, you need to check that the airway is open and clear. Open the airway by placing one hand on the forehead to tilt the head back and use two fingers from the other hand to lift the chin.
o If they are unresponsive, you need to move on to breathing as quickly as possible.
4. Breathing. You now need to check if the casualty is breathing normally. Place your ear above their mouth, looking down their body. Listen for sounds of breathing and see if you can feel their breath on your cheek. Watch to see if their chest moves. Do this for 10 seconds.
o If they are unresponsive and not breathing, you need to call 999/112 for emergency help and start CPR straight away. Ask a helper to find and bring a defibrillator (AED).
o If they are responsive and breathing move on to secondary survey (see next page)
5. Circulation. Once you have established they are breathing, look and check for any signs of severe bleeding.
o If they are bleeding severely you will need to control and treat the bleeding by applying direct pressure to the wound. Call 999/112 for emergency help.
o If they are unresponsive and breathing but with no bleeding, put them in the recovery position and call 999/112 for emergency help.
Once you have completed your primary survey and have treated any life-threatening conditions you can move on to the secondary survey.
How to do a secondary survey
A focused history and physical exam should be performed after the initial assessment. It is assumed that the life-threatening problems have been found and corrected. If that process involved CPR you may not get to this stage.
Secondary survey includes examination that focuses on specific injury or medical complaints, or it may be a rapid examination of the entire body as follows, which should take no more than 3 minutes. The secondary survey is a systematic approach to identify any bleeding or fractures. This system starts at the head and works down to legs.
Bleeding: Carryout out a head-to-toe check for bleeding.
Head & Neck: Clues to look out for are: bruising, swelling, deformity or bleeding
Shoulders & Chest: Place both hands on opposite shoulders, run them down comparing both sides of the body.
Abdomen & Pelvis: Place palm of hand onto abdomen and gently check area for any injuries or painful responses from patient.
Legs & Arms: Using both your hands compare both arms and legs for fractures, dislocations, look also for medic alerts.
Pockets: Look for clues, ID medical jewellery, such as medic alerts which might indicate any existing medical condition.
Recovery Position: If patient is unconscious place them in the recovery position (see Recovery Position).
Secondary survey also includes obtaining a patient history and vital signs and the acronym used for this is SAMPLE:
S = Signs & symptoms.
A = Allergies.
M = Medications.
P = Pertinent past medical history.
L = Last oral intake.
E = Events leading to the illness or injury.
The emergency services
Phone 999 for an ambulance service first and then start CPR.
Adult CPR
High-quality chest compressions
Start chest compressions as soon as possible.
Deliver compressions on the lower half of the sternum (‘in the centre of the chest’).
Compress to a depth of at least 5 cm but not more than 6 cm.
Compress the chest at a rate of 100–120 min−1 with as few interruptions as possible.
Allow the chest to recoil completely after each compression.
Perform chest compressions on a firm surface whenever feasible.
Rescue breaths
If you are trained to do so, after 30 compressions, provide 2 rescue breaths.
Alternate between providing 30 compressions and 2 rescue breaths.
If you are unable or unwilling to provide ventilations, give continuous chest compressions.
Paediatric CPR modified
Adult sequence with paediatric modifications
Rescuers who have been taught adult CPR, and have no specific knowledge of paediatric resuscitation, should use the adult sequence.
The paediatric modifications to adult CPR should be taught to those who care for children but are unlikely to have to resuscitate them.
o Give 5 initial rescue breaths before starting chest compression.
o If you are on your own, perform CPR for 1 min before going for help.
o Compress the chest by at least one-third of its depth, approximately 4 cm for an infant and approximately 5 cm for an older child. Use both thumbs or two fingers for an infant under 1 year; use one or two hands for a child over 1 year as required to achieve an adequate depth of compression.
o The compression rate should be 100–120 min-1. Alternate between providing 30 compressions and 2 rescue breaths.
AED
When and how to use an AED
Continue CPR until an AED (or other type of defibrillator) arrives on site and is switched on and attached to the person.
Do not delay defibrillation to provide additional CPR once the defibrillator is ready.As soon as the AED arrives, or if one is already available at the site of the cardiac arrest, switch it on.
Attach the electrode pads to the person's (who has sustained cardiac arrest) bare chest according to the position shown on the AED or on the pads.
Continue CPR whilst the pads are being attached.
Follow the spoken (and/or visual) prompts from the AED.
Ensure that nobody is touching the person whilst the AED is analysing the heart rhythm.
If a shock is indicated, ensure that nobody is touching the person. Push the shock button as prompted.
Follow AED instructions and continue with CPR as prompted. There will be a period of CPR (commonly 2 minutes) before the AED prompts for a further pause in CPR for rhythm analysis.
Choking (Adult)
1. If someone is choking, encourage them to cough. If the blockage is severe, they may be holding their chest or neck and won't be able to speak, breathe or cough, and you will need to help them.
2. Bend them forwards and give up to 5 back blows to try and dislodge the blockage. Hit them firmly on their back with the heel of your hand between the shoulder blades.
3. If they are still choking, give up to 5 abdominal thrusts: hold around the waist and pull inwards and upwards above their belly button.
4. If they are still choking call 999 and repeat the steps until they can breathe again or until help arrives. Be prepared to resuscitate should they stop breathing.
Choking Baby (birth to 1 years old)
1. Give up to five back blows: hold the baby face-down along your thigh with their head lower than their bottom. Hit them firmly on their back between the shoulder blades up to five times. If back blows do not dislodge the blockage, move on to step 2.
2. Give up to five chest thrusts: turn the baby over so they are facing upwards. Place two fingers in the middle of their chest just below the nipples. Push sharply downwards up to five times.
3. Call 999 if the blockage does not dislodge. Continue with cycles of back blows and chest thrusts until the blockage dislodges, help arrives or the baby becomes unresponsive. Be prepared to resuscitate
Choking Child (1 year to puberty)
1. Give up to five back blows: hit them firmly on their back between the shoulder blades. If back blows do not dislodge the object, move on to step 2.
2. Give up to five abdominal thrusts: hold the child around the waist and pull inwards and upwards above their belly button.
3. Call 999 if the blockage does not dislodge. Continue with cycles of back blows and abdominal thrusts until the blockage dislodges, help arrives or the child becomes unresponsive. Be prepared to resuscitate.
Bleeding
With open wounds, there’s a risk of infection, so wear protective first aid gloves (if available) to help prevent any infection passing between you both.
Apply direct pressure to the wound using a sterile dressing if possible or a clean non-fluffy cloth, to stop the bleeding.
Elevate the bleed to help slow the bleeding down.
If there’s an object in the wound, don’t pull it out. It may be acting as a plug to reduce the bleeding. Instead apply pressure on either side of the object to push the edges together.
Ask a helper to call 999 or 112 for emergency help and give Ambulance Control details of where the wound is and the extent of the bleeding. 111 for advice if needed for non- emergencies
Firmly secure the dressing with a bandage to maintain pressure on the wound. Make it firm enough to maintain pressure but not so tight that it restricts their circulation.
Check their circulation beyond the bandage. Press one of the nails or the skin beyond the bandage for five seconds until it turns pale, then release the pressure. If the colour does not return within two seconds, the bandage is too tight. If necessary, loosen and reapply the
bandage.
The loss of blood could cause the casualty to develop shock. (Signs and symptoms - Look for: pale skin, which may be cold and clammy, sweating, fast pulse - as shock gets worse, fast, shallow breathing, a weak pulse, grey blue skin, especially inside the lips, nausea and possible vomiting, restlessness and aggressive behaviour, yawning and gasping for air) the casualty could become unresponsive. Treat them for this by helping them to lie down, on a rug or blanket. Raise and support their legs, so they are above the level of their heart. You
should then loosen any tight clothing around their neck, chest and waist and cover the casualty with a blanket to keep them warm.
If blood comes through the dressing, remove it and reapply pressure with a new dressing or pad to control the bleeding. Once the bleed is under control, secure in place with the bandage, tying the knot over the wound to keep the pressure on.
Support the injured part with a sling or bandage.
Keep monitoring their level of response until help arrives. If they become unresponsive at any point, prepare to start CPR.
Burns and scalds
1. Start cooling the burn or scald as quickly as possible. Hold it under cool running water for at least 20 minutes or until the pain feels better.
2. Remove any jewellery or clothing, unless stuck t the burn, before the area begins to swell.
3. When the burn has cooled, cover the area loosely with cling film lengthways or a non-adhesive dressing.
4. Do not wrap the cling film around the burn as the area needs space to swell.
5. If the burn is on a foot or hand you could use a clean plastic bag.
6. Do not use ice, creams or gels. They may cause damage and increase the risk of infection.
7. Do not break any blisters that may appear, as this may cause infection
8. Monitor and seek medical advice, even if the burn appears minor.
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