5.1 The DRABC Protocol and Basic CPR

The DRABC Protocol and Basic CPR

In the State of Qatar, private security guards are designated by the Ministry of Interior (MOI) as crucial first responders in residential, commercial, and industrial facilities. When a medical emergency arises, a security guard is typically the first individual on the scene. The immediate actions taken during the initial minutes before the arrival of professional paramedics from the Hamad Medical Corporation (HMC) Ambulance Service can mean the difference between life and death for a casualty. The primary objectives of first aid are to preserve life, prevent the injury or illness from worsening, and promote recovery. To execute these responsibilities effectively, security guards must follow a standardized, step-by-step approach to assess and manage casualties safely.

The DRABC protocol is a systematic, sequential assessment method used to determine a casualty's status and prioritize life-saving interventions. Each letter represents a critical step that must be completed in order.

The DRABC Steps

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Detailed Breakdown of DRABC

Danger

Before initiating any first aid, the security guard must assess the environment for immediate hazards. Personal safety is the absolute priority. A guard who becomes injured cannot assist others and instead places an additional burden on emergency services. The guard must scan the area for threats such as active traffic, fire, smoke, structural instability, toxic gases, or exposed electrical wires. In Qatar's industrial sites or construction zones, hazards may also include operating heavy machinery, chemical spills, or extreme heat. If the scene is unsafe, the guard must maintain a safe distance, secure the perimeter, and notify emergency services. Approach the casualty only when the scene is secure.

Response

Assess the casualty's level of responsiveness using the "shake and shout" method. Gently shake the casualty's shoulders and ask loudly, "Are you okay?" or "Can you hear me?" in English and Arabic ("Inta ok?"), reflecting Qatar's diverse expatriate workforce. If the casualty responds verbally, moves, or opens their eyes, they are responsive. Keep them in the position found (if safe), monitor their condition, and seek appropriate assistance. If they show no reaction, they are unresponsive, indicating a critical, life-threatening emergency.

Airway

For an unresponsive casualty, the muscles of the tongue relax, which can cause the tongue to fall backward and block the windpipe. Open the airway using the head-tilt, chin-lift maneuver: place one hand on the forehead, tilt the head back gently, and use two fingers of the other hand under the chin to lift it. If a spinal or neck injury is suspected—common in falls from heights—avoid tilting the head; instead, use a jaw-thrust maneuver to open the airway without moving the neck. Check the mouth for visible obstructions like food, vomit, or blood, and carefully remove them.

Breathing

Keep the airway open and check for normal breathing for no more than 10 seconds. Place your ear close to the casualty's mouth and nose, looking down at their chest:

• Look for the chest to rise and fall.
• Listen for breathing sounds.
• Feel for air against your cheek.

Distinguish normal breathing from agonal gasps (irregular, noisy gasping sounds occurring after cardiac arrest). If the casualty is not breathing or is only gasping, treat them as not breathing and prepare to start CPR immediately.

Circulation

Evaluate circulation. Check for severe, life-threatening external bleeding and control it. If the casualty is unresponsive and not breathing normally, their heart has stopped, and blood is not circulating. The guard must begin Cardiopulmonary Resitation (CPR) immediately to pump blood to the brain and vital organs.

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Cardiopulmonary Resuscitation (CPR)

CPR is a life-saving technique combining chest compressions and rescue breaths to maintain oxygenation and circulation to the brain and other vital organs.

Chest Compressions

To perform high-quality chest compressions, follow this procedure:

1. Place the heel of one hand in the center of the chest (lower half of the sternum) and the other hand on top, interlocking the fingers.
2. Position shoulders directly over your hands, keep arms straight, and elbows locked.
3. Compress the chest 5 to 6 cm deep (approximately 2 to 2.4 inches) for an adult.
4. Compress at a rate of 100 to 120 compressions per minute.
5. Allow the chest to fully recoil after each compression without losing contact.

Rescue Breaths

After 30 compressions, deliver rescue breaths:

1. Open the airway using head-tilt, chin-lift.
2. Pinch the nose closed, take a normal breath, place your mouth firmly over the casualty's mouth (using a pocket mask or resuscitation face shield), and blow steadily for 1 second, watching the chest rise.
3. Allow the air to escape, then deliver a second breath.

CPR Ratio

The compression-to-ventilation ratio for adult CPR is 30:2 (30 compressions to 2 rescue breaths). Repeat this cycle continuously. Do not interrupt compressions for more than 10 seconds.

Stopping CPR

Continue CPR until:

• HMC paramedics arrive and take over.
• The casualty shows clear signs of life (starts breathing normally, moving, or coughing).
• The guard is too exhausted to continue.
• The scene becomes dangerous.

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Activating Emergency Services

In Qatar, the national emergency number is 999. When calling, remain calm and provide:

• The exact location using Qatar's blue plate address details (building number, street name/number, zone number).
• The nature of the emergency.
• The casualty's status.
• Whether CPR is in progress.

Do not hang up until instructed by the operator.