The Accident Procedure

The universal accident procedure “ABC” is the crux of First Aid Training.  Whichever course you have attended and whichever variant you have been taught (ABC, DRABC, DRSABC…) they all follow the basic concept of treating the most important things first.

The acronym ABC was coined in the 1950's by Peter Safar in his book The ABC of Resuscitation in an attempt to improve and standardize CPR training.   Since then it has been adopted almost universally as the underlying principle of Basic Life Support.

 


ABC in First Aid

The premise is simple;  If you don’t have an open airway, the casualty cannot breathe.  If they are not breathing or they have difficulty breathing, that will kill them next.  Bleeding (Circulation) will then kill them.

In First Aid – rather than a clinical setting -  we front-load the acronym with “DR” for Danger and Response.  When we happen upon a casualty don't want to become a casualty ourselves.  We know nothing about the casualty so it makes sense to find out very quickly if they are conscious or unconscious. 

 

ABCDE in a Clinical Setting

In a clinical setting, professionals would follow current ABCDE protocol of Basic Life support which adds “DE” for Disability and Expose. 

 


 


The Problem

The problem is that on FREC, First Person on Scene and other Advanced courses the DRABC and ABCDE protocols are hastily wedged together.  However, candidates in this hinterland of "quasi-medic" are:

  • Still pre-hospital, so Danger and Response have to be considered before ABC
  • But still not Registered Healthcare Professionals so some elements of "Disability" are above their scope of practice.

So we have a mish-mash of over simplistic DRABC married to a protocol which was designed for a clinical setting.

 

Danger
Standard stuff. I’m happy with that. 

Response
Of course.  Still happy.

Airway.
Goes without saying.  keep going.

Breathing
This all makes sense.

Circulation.
Textbook.   I’m all over this.

Disability.
Now we're into the grown up stuff.  Teach me master!

PEARL – Are their Pupils Equal and Reacting to Light? 
That’s advanced stuff now but that’s why we’re here!

Blood glucose. 
OK…  But I don’t think actually measuring someones blood glucose is on the syllabus?

Reversible drugs.  
This definitely is not on the syllabus!

Check response.   
I’ve just done that.

Evaluate the ABCs.  
I have literally just done that.

Recovery position
Now you’re talking, we’re back to good old First Aid stuff!

Expose
Are you kidding me?  I’ve just flipped them over, and now you want me to look for injuries?

 

It just doesn’t work.

 

Having observed many courses some Instructors, baffled by how they are meant to include Disability into this bastardised DRABCDE, will just include PEARL in "D" because it is the only competent of D they can add to the DRABC, or insist candidates recheck the ABCs which is essentially asking them to do DR-ABC-RABC-E.

 

The Solution

Advanced skills, knowledge and protocols can be brought together in a practical and pragmatic way…with a bit of jiggery pokery.

Accident Procedure

Following the DRABC...

  • Make DAMAGE your next priority.  This is the secondary survey (considered as Expose in the ABCDE).  In this we look for injuries and evidence of medical conditions.   We can also assess for PEARL
     
  • Introduce the EVERYTHING ELSE phase.   This is the Bigger Picture Stuff.   Moving from the micro to the macro.   The long term care type stuff:  You have managed the scene, checked their vital signs, identified injuries now recheck the ABCs, rule out low blood sugar as a possible cause (everyone is affected by low blood sugar, not just diabetics) and think about how the environment is going to affect the casualty.   This almost always means packaging them to prevent hypothermia but can mean preventing heat illness.
     
  • Now FLIP.   Flip is a metaphor for the Safe Airway Position (or Recovery Position or Three Quarter Prone or Drainage Position or whatever else you call it) but it also means any appropriate position for the casualty.   As a rule a conscious casualty will always adopt a comfortable position but some positions can make particular conditions worse.
     
  • Now GET HELP.  Getting help is sometimes best done later rather than sooner, when you have a better idea of what is going on with the casualty, when you have information worth passing on, when you know what help is needed.

*Catastrophic Haemorrhage is a topic for another article. 


What is important to remember is that any Accident Procedure is a model – a simplified, distilled version of reality designed for a ‘best fit’ of any situation.  It is not 100% accurate for every situation but it is tried, tested and works for most situations most of the time.

This model also builds progressively from basic First Aid principles which candidates will be familiar with to clinical standards for those who are following a progressive pathway into Pre-Hospital Care.

Next Article:   5 Basic Vital Signs