The mnemonic DRABC is a standardized, systematic tool used widely in first aid and emergency response to manage a casualty’s initial assessment. This framework is designed to prioritize immediate, life-threatening issues, guiding a rescuer through a rapid sequence of checks and interventions. Following the precise order of the DRABC steps ensures that time-sensitive biological functions, like breathing and circulation, are addressed first. This structured approach serves as the foundation for basic life support until professional medical services arrive on the scene.
Initial Scene Assessment: Danger (D)
The very first consideration in any emergency situation is the safety of the rescuer and any bystanders, which is the ‘D’ for Danger. Before approaching an injured or unconscious person, a first aider must perform a thorough sweep of the environment to identify any potential hazards. This step is non-negotiable because an injured rescuer cannot help the casualty.
Common dangers include live electrical wires, active traffic, unstable structures, fire, smoke, or hazardous materials. If a danger is present, the rescuer’s priority shifts to making the scene safe, perhaps by turning off power or removing the casualty from the immediate threat without personal risk. If the scene cannot be made safe, the first aider must not approach the casualty and should immediately call for professional help.
Checking the Casualty: Response (R)
Once the scene is safe, the next step is to assess the casualty’s level of consciousness, the ‘R’ for Response. This check determines whether the person is conscious, alert, and able to communicate or if they are unresponsive. The common standard used for this quick assessment is the AVPU scale.
The rescuer should first try to elicit a verbal response by speaking loudly and clearly, asking a simple question. If there is no verbal reply, the first aider can try to elicit a physical reaction by gently tapping the person’s shoulders. The AVPU scale assesses if the person is Alert, responding to Voice, responding only to Pain, or completely Unresponsive. An unresponsive casualty indicates a potentially life-threatening situation, requiring an immediate move to the next steps.
Securing Vitals: Airway and Breathing (A & B)
If the casualty is unresponsive, the rescuer must immediately check the ‘A’ for Airway, as a blocked airway can rapidly lead to death. In an unconscious person, the most common obstruction is the tongue, which can fall back and block the windpipe. To quickly open the airway, the rescuer should use the “head tilt/chin lift” technique.
This technique involves placing one hand on the forehead and two fingers under the chin to gently tilt the head back, moving the tongue away from the throat. The rescuer should also quickly check the mouth for any visible foreign objects, such as vomit or food, which should be carefully removed if easily accessible. Once the airway is open, the rescuer proceeds immediately to ‘B’ for Breathing.
The assessment for breathing uses the “Look, Listen, and Feel” method, which must take no more than 10 seconds. The rescuer looks for the rise and fall of the chest, listens for breath sounds, and feels for the flow of air against their cheek. Normal breathing is quiet and regular. Any gasping, gurgling, or labored sound should be considered abnormal, requiring immediate action and a move to the final step.
Final Step: Circulation/Compressions (C)
The final letter, ‘C’, stands for Circulation or Compressions, depending on the casualty’s status. Circulation refers to assessing and managing severe external bleeding, which can be rapidly fatal. If a major, life-threatening bleed is present, it must be controlled immediately with direct, firm pressure applied to the wound, even before starting CPR.
If the casualty is unresponsive and not breathing normally after the Airway and Breathing checks, the ‘C’ transitions immediately to Compressions, meaning the initiation of Cardiopulmonary Resuscitation (CPR). This action is taken because the absence of normal breathing suggests the heart has stopped or is failing. External chest compressions are required to manually circulate oxygenated blood. Emergency medical services must be called before or immediately upon the decision to begin compressions.