A primary assessment in first aid is the immediate, systematic evaluation of an injured or suddenly ill person upon first contact. This initial check serves as the foundation of all subsequent care, guiding the first responder’s actions in an emergency. It is a rapid, structured process designed to quickly uncover immediate threats to life that require intervention within the first few minutes. By focusing only on the most severe problems, this assessment ensures time is not wasted on less urgent issues when seconds count toward survival.
Defining the Primary Assessment and its Goal
The sole purpose of the primary assessment is to identify and manage conditions that could cause immediate death (e.g., a blocked airway, absence of breathing, or severe, uncontrolled bleeding). This focused approach means that other injuries, like a broken arm or minor cuts, are temporarily ignored until life-threatening problems are addressed. The entire evaluation should ideally be completed within 60 seconds, reinforcing the need for speed and efficiency.
It is performed before any other detailed examination, regardless of how the injury occurred or how minor the person’s condition may appear. A core principle is that treatment is interwoven with the evaluation: if a life threat is found, the responder must immediately begin treating it before moving on to the next step. For example, if severe bleeding is discovered, direct pressure is applied immediately to control the hemorrhage before checking for breathing or circulation.
The Systematic Steps of Rapid Evaluation
The primary assessment follows a strict, standardized sequence to ensure no life-threatening condition is missed, often summarized by the mnemonic C-A-B for laypersons. The initial action is to control catastrophic external hemorrhage, as uncontrolled bleeding can lead to death far faster than issues with breathing or circulation. This step involves visually scanning for large volumes of blood and applying direct pressure to any actively spurting or pooling wounds.
Following the control of severe bleeding, the sequence moves to the Airway, where the responder checks for obstructions that prevent air from reaching the lungs. If the person is speaking clearly, the airway is likely open; if unresponsive, the head-tilt/chin-lift maneuver can be used to manually clear the tongue from the back of the throat. Next is Breathing, where the responder looks for the rise and fall of the chest to confirm the person is moving air normally. If the person is unresponsive and not breathing normally, rescue breaths or cardiopulmonary resuscitation (CPR) must be started immediately.
The final element of the C-A-B sequence is Circulation, which involves checking for a pulse and looking for signs of shock (e.g., pale, cool, or clammy skin). If no pulse is present, the responder must begin chest compressions as part of CPR, combining this with rescue breathing if necessary. The person’s Level of Consciousness is often assessed early, typically by asking a simple question like, “Are you okay?” to gauge responsiveness. A rapid check for other life-threatening issues, such as signs of internal injury or environmental exposure, may also be included before concluding the assessment.
When the Primary Assessment Ends
The primary assessment concludes when all immediate, life-threatening conditions have been identified and either treated or stabilized. This means the person is breathing, any catastrophic bleeding is controlled, and basic measures have been taken to support circulation and level of consciousness. The person may not be fully recovered, but the immediate danger of death has been mitigated.
Once this initial phase is complete, the first responder transitions to the secondary assessment, a slower, more detailed, head-to-toe examination. The secondary phase involves gathering a detailed medical history and looking for less immediate, though still serious, injuries like fractures or internal injuries. The boundary between the two is distinct: the primary assessment focuses on immediate survival, while the secondary assessment focuses on comprehensive care and preparation for the arrival of advanced medical personnel.