Emergency situations demand a structured, sequential approach to assessment, which is why first aid training relies on standardized acronyms. These mnemonics create a consistent mental checklist, ensuring responders prioritize the most immediate life threats in an organized manner. The acronym DRAB represents the initial, time-sensitive steps required to assess a person who is ill or injured. This systematic method guides the rescuer through the primary survey to quickly determine environmental safety and the victim’s immediate physical status.
Danger and Response
The first step, Danger (D), mandates a thorough safety check of the environment before approaching the person in need of help. A rescuer must ensure the scene is safe from hazards like moving traffic, exposed electrical wires, unstable structures, or chemical exposure, as personal safety is paramount. If a danger cannot be removed or neutralized, the rescuer should not proceed, instead calling for emergency services from a safe distance.
Following scene safety, the rescuer checks for Response (R) to determine the person’s level of consciousness using the AVPU scale. The rescuer first attempts to get an Alert response by speaking clearly, then moves to a Voice response by shouting or giving a verbal command. If the person only responds to a painful stimulus, such as a gentle squeeze of the trapezius muscle, they are classified as Pain responsive. A person who shows no reaction is classified as Unresponsive, indicating an immediate medical emergency.
Airway and Breathing
Once the person is deemed unresponsive, the next concern is the Airway (A), because an unconscious person’s tongue can relax and obstruct the back of the throat. To open the airway, the rescuer performs the head-tilt, chin-lift maneuver. This technique repositions the head and neck, lifting the tongue away from the air passage by tilting the head back and lifting the chin bone.
A suspected neck or spinal injury prevents the use of the head-tilt, chin-lift, requiring the modified jaw-thrust maneuver to open the airway without moving the neck. While opening the airway, the rescuer must also quickly check the mouth for any visible foreign objects that could cause a blockage. The brain can sustain permanent damage after only a few minutes without oxygen.
With the airway open, the rescuer proceeds to check for Breathing (B), using the “Look, Listen, Feel” technique for a maximum of ten seconds. The rescuer should look for the rise and fall of the chest, listen for breath sounds, and feel for air movement. It is important to distinguish between normal breathing and agonal gasps, which are infrequent, weak, or noisy breaths that are not considered effective respiration.
If the person is not breathing normally, this signals an immediate life-threatening emergency, requiring the start of rescue breaths or cardiopulmonary resuscitation (CPR). Acting on the absence of normal breathing is the final step of the DRAB sequence before transitioning to life support interventions.
Integrating DRAB into the Complete First Aid Sequence
The DRAB sequence establishes the safety and immediate needs of the person. After the breathing assessment is complete, the sequence typically expands to include further life-saving steps, often remembered by the acronyms DRABC or DRSABCD. The transition occurs after the ‘B’ for Breathing, where the next focus is on Circulation or Compressions.
If a person is not breathing normally, the rescuer moves directly to providing chest compressions and rescue breaths to support circulation. In the broader DRSABCD protocol, the ‘S’ stands for Send for help, and the final ‘D’ covers Defibrillation. DRAB serves as the foundational assessment that dictates whether the rescuer must immediately begin chest compressions and prepare for the use of an automated external defibrillator (AED).