DRSABCD is a systematic protocol providing a standardized sequence of actions for first responders and lay rescuers approaching an unconscious or injured person. This mnemonic device guides immediate assessment and intervention, maximizing the chance of survival in an emergency. Following this procedure ensures the most immediate threats to life are addressed until professional medical assistance arrives.
Safety, Assessment, and Calling for Help
The protocol begins with Danger, ensuring the safety of the rescuer, the casualty, and any bystanders before interaction begins. This requires assessing the scene for immediate hazards, such as electrical wires, traffic, or unstable structures, which must be eliminated or mitigated. Scene safety is the highest priority, as a rescuer who becomes a casualty cannot help the injured person.
Once the environment is safe, the rescuer moves to Response, determining the casualty’s level of consciousness. This is done using gentle physical stimulation, like tapping the shoulder, while asking simple questions such as, “Can you hear me?” A lack of response, or only a groan or slight movement, signals a serious alteration in consciousness, requiring immediate life support.
The next step is to Send for Help, immediately activating the local emergency medical services (EMS) by calling the emergency number or directing a capable bystander. This step is time-sensitive, as professional medical intervention, including paramedic support, is essential for a positive outcome. Rapid notification ensures advanced life support is dispatched without delay while the rescuer continues the protocol.
Managing Airway and Respiration
Following the activation of emergency services, the rescuer addresses the Airway, as an unconscious person’s tongue can relax and fall backward, creating a complete obstruction of the upper respiratory tract. To open the airway, the rescuer performs the head tilt/chin lift maneuver by placing one hand on the forehead and gently lifting the chin with two fingers of the other hand. This action moves the tongue away from the back of the throat and straightens the airway.
If the mouth contains obvious foreign material, such as vomit or blood, the rescuer must clear it quickly. Clearing the airway may involve turning the casualty onto their side for drainage and then sweeping the mouth to remove the obstruction. Once the airway is open and clear, the rescuer proceeds to assess Breathing.
Assessing breathing involves looking for chest movement, listening for breath sounds, and feeling for air movement against the cheek for a maximum duration of 10 seconds. The rescuer must distinguish normal, effortless breathing from abnormal, shallow, or gasping breaths (agonal breathing), which are not effective. If the casualty is not breathing normally, the rescuer must immediately prepare to start chest compressions and rescue breaths.
Circulation and Advanced Support
If the casualty is unresponsive and not breathing normally, the next step is Circulation, supported artificially through Cardiopulmonary Resuscitation (CPR). High-quality chest compressions are performed by placing the heel of one hand in the center of the chest with the other hand interlaced on top, keeping the arms straight and using body weight. The compressions must be delivered at a rate of 100 to 120 beats per minute, pushing down 5 to 6 centimeters (2 inches).
Effective compressions function by manually squeezing the heart between the sternum and the spine to circulate oxygenated blood to the brain and vital organs. Current guidelines recommend a cycle of 30 compressions followed by two rescue breaths, aiming to minimize interruptions to the chest compressions. Minimizing pauses is paramount to maintaining the artificial blood flow created by the rescuer.
The final step is Defibrillation, using an Automated External Defibrillator (AED) as soon as one is available. Defibrillation delivers a controlled electrical shock to interrupt a life-threatening, chaotic electrical rhythm, such as ventricular fibrillation, allowing the heart’s natural pacemaker to restart a normal rhythm. The rescuer must turn on the AED, attach the pads to the bare chest (one below the right collarbone, the other below the left armpit), and follow the device’s prompts.
The AED analyzes the heart’s electrical activity and advises whether a shock is necessary, instructing the rescuer to stand clear during delivery. Whether a shock is delivered or not, the rescuer must immediately resume CPR. The cycle of compressions and rescue breaths continues until EMS takes over or the casualty shows signs of recovery. Immediate defibrillation combined with high-quality CPR provides the best chance for survival from sudden cardiac arrest.
Why Sequence Matters in Emergency Response
The precise sequence of the DRSABCD protocol addresses immediate life threats in a logical order, prioritizing actions based on survival impact. Beginning with Danger secures the rescuer’s safety, preventing a second victim. The immediate assessment of Response determines the need for intervention, and Send for Help activates the professional resources required.
The subsequent steps, Airway and Breathing, focus on restoring the supply of oxygen, which is critical for brain survival. Only after verifying the absence of normal breathing does the protocol move to Circulation, as performing CPR on a person who is breathing may cause more harm than good. This structured, step-by-step framework eliminates guesswork under stress, providing a standardized and reliable method that increases the efficiency and effectiveness of emergency response.