10.2 Primary Survey (ABC)
Key Takeaways
- The primary survey uses ABC: Airway, Breathing, Circulation—as the structured order for life-threatening problems.
- Many courses teach DRSABC: Danger, Response, Send for help, then Airway, Breathing, Circulation.
- Open the airway (head-tilt chin-lift if no suspected spinal injury per training), check breathing, and treat catastrophic bleeding as an urgent circulation priority.
- Approach an unresponsive casualty with scene safety, response check, shout for help, then ABC.
- A simple decision path—safe scene → response → send help → ABC → CPR or recovery position or bleeding control—guides Level 1 exam answers.
10.2 Primary Survey (ABC)
When someone collapses or is seriously injured, random checking wastes time. The primary survey is a fixed order that finds life-threatening problems first. At ISPON HSE Level 1, the core structure you must know is:
A — Airway
B — Breathing
C — Circulation
Many international and Nigerian workplace courses wrap ABC inside a slightly longer memory aid:
DRSABC — Danger, Response, Send for help, then Airway, Breathing, Circulation.
Both ideas work together: make safe and get help, then systematically protect airway, breathing, and circulation.
Why Order Matters
| Priority | Reason |
|---|---|
| Airway first | If the airway is blocked, oxygen cannot reach the lungs—brain injury begins within minutes |
| Breathing next | Even with an open airway, absent or inadequate breathing means oxygen is not being delivered |
| Circulation / severe bleeding | The heart must move oxygenated blood; massive external bleeding can kill as fast as a blocked airway |
Exam trap: spending time on a minor cut while the casualty is not breathing, or starting detailed history-taking before opening the airway of an unresponsive person.
DRSABC — Full Sequence Awareness
| Step | Letter | What you do | Level 1 detail |
|---|---|---|---|
| 1 | D | Danger | Check scene safety for you, bystanders, and the casualty (traffic, electricity, fire, toxic gas, collapse zone). |
| 2 | R | Response | Speak loudly and gently shake the shoulders if safe: “Can you hear me? Open your eyes.” Note any response. |
| 3 | S | Send for help | Shout for help; call site emergency / ambulance / clinic; send someone to fetch the AED and first aid kit if available. |
| 4 | A | Airway | Open and clear the airway as trained. |
| 5 | B | Breathing | Look, listen, and feel for normal breathing (about 10 seconds in many protocols). |
| 6 | C | Circulation | Assess signs of life / severe bleeding; start CPR if indicated and trained; control catastrophic bleeding. |
Some updated teaching also emphasises catastrophic haemorrhage very early (sometimes written as cABC or similar) because massive bleeding can kill before a perfect airway discussion finishes. At Level 1, remember: life-threatening bleeding is a top circulation emergency and must not be ignored while you only stare at the mouth.
Airway — How to Open and Protect
An unresponsive casualty’s tongue can fall back and block the throat. Training commonly teaches:
Head-tilt, chin-lift (no suspected spinal injury)
- Place one hand on the forehead.
- Gently tilt the head back.
- Use two fingers under the bony part of the chin to lift the chin (not soft tissue under the jaw that pushes the tongue back).
Suspected spinal / major trauma awareness
If the mechanism suggests neck or spine injury (fall from height, high-speed vehicle impact, diving injury), many courses teach jaw thrust or minimal movement techniques if you have been trained. At pure awareness level: avoid unnecessary twisting of the neck, keep the head in line when turning is essential, and prioritise airway while calling advanced help. Do not invent complex spinal board procedures you were never taught.
Clear obvious obstruction
- Remove visible loose material from the mouth if you can do so safely (gloves on).
- Do not perform blind finger sweeps deep in the throat that push objects further down.
- For choking in a conscious person, follow the choking sequence you were taught in practical training (encourage coughing; back blows/abdominal thrusts only if trained and indicated).
Breathing — Look, Listen, Feel
With the airway open:
| Sense | What to check |
|---|---|
| Look | Chest and abdomen rise and fall |
| Listen | Breath sounds at the mouth/nose |
| Feel | Air on your cheek |
Decide whether breathing is normal, absent, or not normal (for example only occasional gasps). Occasional irregular gasps after collapse are not reliable normal breathing and are often treated as a need for CPR in current basic life-support teaching—follow the CPR section and your practical course guidance.
If breathing is normal and the casualty is unresponsive: place in the recovery position (section 10.4) if safe, keep monitoring, and await help.
If not breathing normally: begin CPR if you are trained and it is safe (section 10.3), and ensure emergency help is on the way.
Circulation — Signs of Life and Severe Bleeding
“Circulation” in the primary survey means more than feeling a pulse (pulse checks are unreliable for untrained rescuers and many modern courses de-emphasise long pulse hunts for lay responders).
| Circulation focus | Action |
|---|---|
| No normal breathing / no signs of life | Start CPR (if trained) + AED if available |
| Severe external bleeding | Expose wound if needed; apply firm direct pressure with a dressing; add more dressings without removing the first if blood soaks through (as trained); elevate only if it does not worsen injury and you were taught to do so |
| Pale, clammy, weak | Treat for shock (section 10.4); keep warm; urgent help |
| Major trauma | Minimise unnecessary movement; control bleeding; support airway/breathing |
Unresponsive Casualty Approach — Put It Together
- Check danger — do not approach live electricity, unsupported trenches, or toxic atmospheres.
- Check response — shout and tap/shake shoulders if safe.
- Shout for help / send for help — emergency number, site clinic, AED, first-aider backup.
- Open airway.
- Check breathing (look, listen, feel).
- Branch:
- Breathing normally → recovery position (if appropriate), monitor, treat other injuries, await help.
- Not breathing normally → CPR 30:2 (or hands-only if untrained in breaths), AED when available.
- Control catastrophic bleeding as soon as identified without abandoning airway/breathing priorities for a non-breathing casualty—use the logic your practical course teaches for simultaneous threats.
Decision-Tree Style Table
| Finding | Next action |
|---|---|
| Scene unsafe | Make safe or stay out and call specialised help |
| Scene safe; casualty responds and talks | Keep airway clear; history of what happened; treat obvious injuries; decide if emergency services needed |
| No response | Send for help; open airway |
| Airway blocked by position/tongue | Head-tilt chin-lift (or trained alternative); reassess breathing |
| Normal breathing, unresponsive | Recovery position; monitor ABCs; treat bleeding/shock; await help |
| Absent / abnormal breathing | CPR if trained; AED; continue until help takes over or casualty recovers |
| Massive external bleeding | Direct pressure and dressings urgently; call emergency help; treat for shock |
| Electrical / chemical scene | Special precautions first (isolate power; avoid contamination) before full survey |
Common Exam Traps
| Trap | Correct Level 1 view |
|---|---|
| “Check blood pressure first” | Primary survey is ABC / DRSABC, not clinic vitals first |
| “ABC means Always Bring Cotton” | Airway, Breathing, Circulation |
| “Move every casualty to the clinic before assessment” | Assess and protect ABCs on scene when safe; move only if danger demands it |
| “No help needed if a first-aider is present” | First aid is bridge care—send for professional help early for serious cases |
| “Spend two minutes hunting for a pulse before any action” | Prioritise response, airway, normal breathing, and CPR decision per current basic teaching |
Nigerian Site Flavour
- Fabrication yard collapse: Danger from overhead loads; stop crane/work; then response and ABC.
- Generator house casualty: Consider exhaust fumes/CO and heat—ventilate/safe approach before prolonged rescue breaths in a toxic space.
- Road project hit-by-vehicle: Traffic danger first; then ABC; high suspicion of major trauma—gentle handling, early medevac thinking.
- Night camp incident: Lighting and radio for help are part of “Send for help,” not optional extras.
Exam Focus
Be ready to expand ABC and DRSABC, describe head-tilt chin-lift, explain look-listen-feel, prioritise severe bleeding under circulation, and walk through an unresponsive casualty sequence. Prefer answers that start with danger, call for help early, and follow a fixed survey rather than random first aid.
In the primary survey taught for Basic HSE, what does ABC stand for?
What is the correct meaning of the DRSABC sequence used in many first-aid courses?
You find a colleague unresponsive on a clear workshop floor. After confirming danger is low, what is the best next sequence at Basic HSE level?