The acronym DRABC represents a structured framework used in first aid and emergency response to prioritize actions when encountering a person who is injured or suddenly ill. This systematic protocol, often referred to as the primary survey, provides a methodical sequence for assessing and managing immediate life-threatening conditions until professional medical help arrives. By following the steps in order, a first responder can quickly identify and address the most pressing threats to life, ensuring the person receives timely and appropriate initial care.
Initial Assessment: Danger and Response (D and R)
The first step, Danger, demands that the rescuer prioritize their own safety and the safety of any bystanders before approaching the casualty. Hazards in the immediate environment, such as live electrical wires, oncoming traffic, fire, or toxic fumes, must be identified and eliminated or neutralized. If the danger cannot be safely removed, the responder should not approach the person but must immediately activate emergency medical services from a safe distance.
Once the scene is deemed safe, the next step, Response, involves quickly assessing the person’s level of consciousness. A responder should gently tap the person’s shoulders and ask loudly, “Are you okay?” If there is no reaction, the person is considered unresponsive, indicating a serious compromise of their central nervous system function.
The level of consciousness can be further categorized using the AVPU scale, a simplified system for first aid providers. This scale checks if the person is Alert, responsive only to Verbal commands, responsive only to Painful stimuli, or completely Unresponsive. Any score lower than Alert suggests a possible medical emergency, requiring immediate focus on securing the airway. If the person is unresponsive, emergency services should be called immediately.
Securing Immediate Life Support: Airway and Breathing (A and B)
After determining that the person is unresponsive, the priority shifts to Airway, as an unconscious person’s tongue can relax and obstruct the back of the throat. To clear this potential blockage, the head tilt/chin lift maneuver is performed, unless a spinal injury is suspected. This involves placing one hand on the forehead to gently tilt the head back while using two fingers of the other hand to lift the chin, moving the tongue away from the airway.
This mechanical action straightens the airway passage, allowing air to flow more freely into the lungs. By lifting the chin on the bony part of the jaw, the soft tissues are prevented from collapsing and sealing off the throat. A clear airway is a prerequisite for effective breathing.
Following the Airway check, the rescuer must assess for normal Breathing by looking, listening, and feeling for signs of respiration. This check involves placing an ear close to the person’s mouth and nose while observing the chest for movement, looking for the rise and fall of the chest, listening for breath sounds, and feeling for air movement against their cheek.
This assessment must be performed for no more than 10 seconds. Irregular gasps or shallow breaths are not considered normal breathing and should be treated as an absence of respiration. If the person is breathing normally, they should be placed into the recovery position to maintain a clear airway and prevent aspiration while awaiting help.
Final Steps: Circulation and Activating Emergency Services (C)
The final step, Circulation, addresses the body’s need for blood flow, which has two primary interpretations. If the person is breathing normally, the focus is on checking for and controlling severe external bleeding. In a trauma situation, management of significant blood loss takes precedence, as uncontrolled hemorrhage can lead to shock and death.
The rescuer should apply direct, firm pressure to any obvious wounds using a sterile dressing or clean cloth to stem the blood flow. If the person is not breathing normally, the C in DRABC immediately shifts to initiating chest compressions, the first component of cardiopulmonary resuscitation (CPR). This intervention aims to manually pump blood through the body to keep the brain and other organs supplied with oxygen.
The activation of emergency medical services runs parallel to these steps and must be done at the earliest appropriate time. For an unresponsive adult, the call to the local emergency number should be made immediately after determining the lack of response, often during the D and R steps. If the rescuer is alone with a child who is unresponsive and not breathing, guidelines suggest performing one minute of CPR before pausing to call for help.
The entire DRABC process is designed to be completed rapidly, allowing the rescuer to transition from assessment to intervention within seconds. By systematically addressing Danger, Response, Airway, and Breathing, the rescuer can quickly determine the need for life support and initiate Circulation measures, bridging the time gap until professional help arrives.