The mnemonic DR ABC is a framework used in first aid and basic life support to quickly assess and manage an emergency situation before professional medical help arrives. This structured approach, often referred to as the primary survey, provides a standardized sequence for responders to identify and address life-threatening conditions. By following this sequence, a rescuer can prioritize immediate actions and ensure the most time-sensitive interventions are performed first. The systematic nature of DR ABC helps maintain a calm and methodical response.
Decoding the Acronym
The acronym DR ABC stands for Danger, Response, Airway, Breathing, and Circulation. The “D” for Danger is the initial step, requiring the rescuer to survey the scene for any hazards that could endanger themselves, the victim, or bystanders, such as traffic, fire, or live electricity. If the environment is unsafe, the rescuer must either remove the danger or move the victim to a safe location before proceeding.
The next letter, “R,” stands for Response, which involves determining the victim’s level of consciousness by gently tapping their shoulder and asking, “Are you okay?” If the person is responsive, the rescuer can focus on treating any injuries and monitoring their condition. A lack of response indicates a potential state of unconsciousness, which requires moving immediately to the next steps.
“A” represents Airway, where the rescuer must ensure the air passage is open and clear of obstruction. This is typically achieved by performing a head tilt-chin lift maneuver to move the tongue away from the back of the throat. Following this, “B” for Breathing is checked by looking for chest movement, listening for breath sounds, and feeling for air movement against the cheek for up to ten seconds.
Finally, “C” stands for Circulation, which involves checking for signs of severe bleeding. If the person is not breathing normally, the C shifts its focus to Compressions, indicating the need to immediately begin cardiopulmonary resuscitation (CPR). The priority is to address any massive external bleeding before starting compressions, as severe blood loss can rapidly lead to shock and death.
The Step-by-Step Assessment Sequence
The process begins with Danger because self-protection must always precede victim care; a rescuer who is injured cannot help the victim. Only once the scene is deemed safe can the rescuer approach to check for a Response.
If the victim is unresponsive, the rescuer must immediately move to the Airway step, as a blocked airway will prevent oxygen from reaching the lungs. Opening the airway is a prerequisite for accurately assessing Breathing. If breathing is absent or abnormal, the rescuer must assume cardiac arrest.
The assessment flow requires moving from one step to the next only after the current one has been addressed or corrected. For instance, if the airway is blocked, it must be cleared before the breathing check is meaningful. If the victim is not breathing, the sequence concludes with Circulation, where the rescuer must immediately activate emergency medical services and initiate chest compressions.
Protocol Differences and Evolving Standards
First aid and resuscitation protocols have led to common variations of the DR ABC sequence. In many regions, particularly the UK and Australia, the standard is often taught as DRSABCD, where the added “S” stands for Send for help and the second “D” stands for Defibrillation. The inclusion of “S” emphasizes calling for emergency services immediately after assessing response, and “D” highlights the use of an automated external defibrillator (AED).
A notable difference exists in the guidance for Cardiopulmonary Resuscitation (CPR). For adult cardiac arrest, the American Heart Association (AHA) shifted its focus from the traditional A-B-C (Airway, Breathing, Circulation) to C-A-B (Compressions, Airway, Breathing) in 2010. This change was implemented because immediate chest compressions to maintain blood flow are the most time-sensitive action, often delayed by rescuers attempting to establish an airway first.
The C-A-B sequence prioritizes compressions to circulate the oxygen already present in the victim’s blood, minimizing the delay in restoring blood flow to the brain and heart. However, many organizations continue to promote the D-R-A-B-C sequence for general first aid assessment, reserving C-A-B specifically for the CPR component of an unresponsive, non-breathing adult.