What does DRSABCD stand for?

Imagine you are at work and someone falls ill. What should you do? According to the DRS ABC D guide, the answer may be more straightforward than you think. This guide is recognised by many workplace health and safety departments in Australia as the standard for first aiders. In this post, we’ll look at each letter in the acronym and what you should do in life-threatening conditions. Stay safe!

The Australian Resuscitation Council (ARC) recommends using the following 7-step acronym when caring for the casualty – DRSABCD action plan.

1. DANGERS – Check for danger (hazards/risks/safety)
2. RESPONSIVENESS – Check for response (if unresponsive)
3. SEND – Send for help (Call 000) for any medical emergency
4. AIRWAY – Open the airway
5. BREATHING – Check if they have normal breathing (if not breathing / abnormal breathing)
6. CPR ( cardiopulmonary resuscitation )- Start CPR (give 30 chest compressions followed by two breaths)
7. DEFIBRILLATION – Attach an Automated External Defibrillator ( AED ) as soon as available and follow the prompt on delivering an electrical shock

Bondi Rescue – Cardiac Arrest Video

Please watch this video as you will be assessed on CPR in your course. NB. The casualty does survive in this video: Cardiac Arrest Video.

CAUTION! This video may be disturbing to some viewers as it contains footage of real CPR.

Other resources, such as St John, WA, also post informative videos about cardiac arrest on their websites and social media pages.

D – Dangers

This step is the same when caring for a breathing or non-breathing casualty. YOU are the most important person, not the casualty. Ensure your safety (the first aid provider), bystanders’ safety, and the casualty’s safety.

• Checking for potential danger before approaching any situation is critical. Rushing into a situation without adequately assessing the situation can put yourself and others at needless risk
• The amount of hazards dramatically depends on the situation; hence, it is essential to evaluate each scene for possible dangers
• Sometimes, danger can be avoided, or the casualty can be moved away from it

R – Responsiveness

This step is the same when caring for a breathing or non-breathing casualty.

• Check consciousness, speak calmly and positively, identify yourself, and ask if you can help.
• Always approach a casualty with caution, feet first. If there is no response and it is safe, implement C.O.W.S.
• C, can you hear me?
• O open your eyes?
• W, what is your name?
• S squeeze my hand?

Then, grasp and squeeze the shoulders firmly to prompt a response. A casualty who fails to respond or shows only a minor response, such as groaning without eye-opening, should be managed as if unconscious.

S – Send for Help

Once you have determined the casualty requires emergency services, you should immediately send for help.

• Yell out for assistance! If there are any bystanders, instruct them to call 000. If you are alone and can access a phone, call 000 and clearly explain the situation.
• CALL FOR HELP, EMERGENCY NUMBER 000 (landline/mobile) or 112 (mobile) for contact St John Ambulance Australia

Free app available: Emergency +

The following is an excerpt from the Australian Communications and Media Authority ( acma.gov.au ):

Are there advantages to using the Emergency+ smartphone app to call Triple Zero (000)?

The most significant advantage of using the Emergency+ smartphone app to call Triple Zero is that if you do not know your exact location, it uses your smartphone’s existing GPS functionality to enable you to provide emergency call-takers with your location information as determined by your smartphone.

Airway

This step is the same when caring for both a breathing and non-breathing casualty. Airway management is required to provide an open airway when the casualty:

• Is unconscious
• Has an obstructed airway
• Needs rescue breathing

It is reasonable for responsive adults and children to open the person’s airway using the head tilt chin lift manoeuvre. Infants are left in the neutral head position.

B – Breathing

This step is the same when caring for both a breathing or non-breathing casualty.

• LOOK – LISTEN – FEEL FOR BREATHING.
• Get close to the casualty, placing your ear just above their mouth.
• Can you feel breathing on your cheek? Can you hear breathing?
• By looking towards the casualty’s chest, you will be able to check for rise and fall of the chest.
• If the casualty is breathing, they should be turned into the Recovery Position.
• If there is NO SIGN OF BREATHING or the casualty is NOT BREATHING EFFECTIVELY, you will need to proceed immediately to CPR.

Gasping is Not Breathing Normally

More than 50% of casualties in cardiac arrest gasp. Gasping has been described as gurgling, agonal or laboured breathing. Onlookers and even first aiders often misinterpret this as a sign that the casualty is breathing. The abnormal breathing or gasping may last for a few minutes.

Note that if the casualty has not responded to COWS and a firm shoulder squeeze, the gasping should be considered NOT BREATHING EFFECTIVELY; therefore, you will need to proceed immediately to CPR.

C – CPR

Step 1: Compressions

All first aiders should perform chest compressions on all casualties who are unresponsive and not breathing normally.

Compressions are the first part of CPR, used with rescue breathing to circulate the oxygenated blood around the body.

Compressions are performed as follows as taught in CPR Courses:

• Kneel beside the casualty (at the level of the casualty’s shoulders)
• Locate the lower half of the sternum on the casualty
• Place the heel of the dominant hand in the centre of the casualty’s chest with the other hand on top (or two fingers for infants)
• Keeping your arms straight and your wrists and elbows locked, press down vertically to about a third of the casualty’s chest depth, then release pressure.
• Give 30 compressions (about 100 to 120 per minute – around two a second)
• Give two rescue breaths
• Repeat compression/breaths at a 30:2 ratio until help arrives

# A child as one to eighteen years of age (or up to the onset of puberty if the age is unknown).

Quality Chest compressions:

• To optimize the effectiveness of chest compressions, the casualty should be placed on their back on a firm surface
• Interruptions to chest compressions must be minimised
  A casualty should not be routinely rolled onto the side to assess airway and breathing unless regurgitation occurs due to a possibility of spinal injury.
• Allow for complete recoil of the chest after each compression
• Avoid compression beyond the lower limit of the sternum

Fractured ribs – this is a common consequence of CPR; however, this is acceptable given that the alternative to CPR is likely the death of the casualty.

First aider change-over—When possible, it is recommended that first aiders change every 2 minutes (5 cycles) to prevent fatigue and help maintain the depth and speed of compressions. If this is performed, it is essential to minimise interruptions to compressions.

Step 2: Rescue Breath methods

After 30 compressions, perform two rescue breaths using one of the following methods.

Mouth to Mask

This involves using a CPR mask to provide rescue breaths.

• The first aider exhales through a 1-way valve through the mask into the casualty’s mouth.
• Head tilt is still required to open the casualty’s airways. Full head tilts are needed for adults and children, while no head tilts are required for infants.

First aiders need not be discouraged from providing rescue breaths without a barrier device (e.g., a face shield), as the risk of disease transmission in normal non-pandemic circumstances is very low. However, first aiders should consider using a barrier device if one is available.

Mouth to Mouth

This is the recommended form of rescue breathing when a mask is unavailable. The following steps should be taken to provide mouth-to-mouth correctly:

• Head tilt / Chin lift Method: Place one hand onto the forehead or top of the head. The other hand is used in conjunction by holding up the chin using the thumb and forefinger to open the mouth. Place the thumb over the chin below the lip and support the tip of the jaw with the middle finger and the index finger lying along the jaw line. Then gently tilt the casualty’s head back, not the neck, to open the airway.
• Block the casualty’s nose using fingers on one hand
• Take a breath and have an open mouth as widely as possible
• Make a firm seal of your mouth onto the casualty’s mouth
• Exhale into the casualty’s mouth with the required breath size to inflate the casualty’s lungs. Visually view the rise of the chest
• Give a second breath. It should take around one second per breath

Note: Care should be taken not to over-inflate the chest.

In an infant, maximum head tilt should not be used. Instead, the head should be kept neutral. Because of the narrow nasal passages, the upper airway is easily obstructed, so there must be no pressure placed on the neck’s soft tissues. The lower jaw should be supported at the point of the chin while keeping the mouth open. Due to an infant’s head size compared to its body, when laid on its back, the head naturally tips forward towards the chest. A slight backward tilt may be needed to place the head into a neutral position.

Mouth and Nose

This can be used if the first aider prefers it.

• The first aider should cover the infant’s mouth and nose with their mouth instead of attempting to pinch the infant’s nose.
• If providing mouth-to-mouth on adults, the same method is used, except that instead of blocking the nose, the first aider should ensure the casualty’s mouth is closed when exhaling into the casualty’s nose (this involves sealing the mouth by pushing the casualty’s lips together with your thumb).

Blocked Airway:

If the casualty’s chest does not rise during rescue breathing, check that:

• The head is tilted back correctly
• There is no foreign material in the airway
• The seal of your mouth on the casualty’s mouth is firm
• The nose has been blocked
• Enough air is being blown in

D – Defibrillation

An automated External Defibrillator (AED) is a portable computerised device that provides an electrical charge to return the heart to a normal rhythm. It has been known to be very helpful in emergencies and may even be a lifesaving tool.

The portable device has a built-in computer and sensor that checks for the heart rhythm once placed on the casualty’s chest and determines if defibrillation is required. Voice prompts are given to the user to follow and streamline the defibrillation process.

• Access to Early Defibrillation is the most critical step in this cycle.
• Every minute of early defibrillation is delayed, reducing the person’s chances of survival by 10%. This is why it is so important to call 000 / 112 if a cardiac arrest is suspected. A defibrillator is necessary to reverse this process and ‘reboot’ the heart back into its normal cycle.
• An AED can be used effectively with minimal training, as all current models are designed to function only if the unit detects an abnormal “shockable” heart rhythm.
• AED use is not restricted to trained personnel – any first aider can use an AED
• AED units can accurately identify the casualty’s cardiac rhythm as ‘shockable’ or ‘non-shockable.’
• An AED is only to be applied to a non-breathing casualty!

AED for Adults

Once it is determined that the casualty is unconscious and not breathing after having a suspected cardiac arrest and after calling 000, the following steps should be taken to use an AED as soon as one is available correctly:

1. CPR should not be delayed while waiting for the AED to arrive – Start CPR immediately
2. Defibrillation is to be used in conjunction with CPR on casualties who are unconscious and not breathing. The casualty is to be supine (lying on their back)
3. (If possible, have a second person complete the AED aspects while the first person continues with CPR). Turn on the AED and follow the voice or display commands.
4. Move any clothing out of the way of the casualty’s chest
5. If the casualty is wet or sweaty, remove any moisture with something dry before placing the AED pads on the casualty
6. Tear open the AED pad packets and remove the pads
7. If the casualty has a lot of body hair and the pads don’t stick to the chest, you must shave the hair. Attach one pad to the casualty’s upper right chest and the other to the casualty’s lower left chest – these positions will be labelled on the pads (see diagram). Pads must adhere firmly to the chest, so it is essential to roll the pads onto the chest so that there are no air pockets underneath the pads. Press the pads on firmly, including the edges of the pad.
8. Avoid placing pads over any implantable devices – pads should be placed at least 8cm from any such devices
9. Do not place pads over medication patches – remove the patches before continuing, as these can block the current and cause burns to the casualty
10. If not already attached, plug the cables from the pads into the unit (most units already have this ready for use)
11. Do not put or place the electrodes or connected pads together or allow them to touch if the AED is ‘on’. This may complete a circuit and cause an electrocution
12. Move any bystanders out of the way – ensure no one else is touching the casualty
13. AED will analyse casualty. If the AED determines that a shock is needed, move everyone away from the casualty
14. Other first-aiders continue CPR until the AED operator is ready to shock
15. Make sure no one is touching the casualty, press the ‘Shock’ button, and then let the AED re-analyse
16. Follow the instructions of the AED – at this point, you may be instructed to commence CPR, DO NOT remove the pads, or the AED unit may otherwise instruct you that another shock is necessary
17. Continue CPR and AED until medical assistance arrives

AED for children

• Standard adult AED pads are suitable for persons 8 years and older.
• For children under 8 years of age, paediatric pads should be used when available.
• When using paediatric pads on a child, they should be positioned the same way as an adult.
• If these are not available, standard adult AED pads can be used. Ensure the pads do not touch each other on the child’s chest. If the pads are too large, pad-to-pad arcing is dangerous. In this case, the pad placement is different for adult AED. One pad must be placed in the centre of the chest, and the other on the back in the centre. This will be labelled on the pads.

NOTE: Always refer to the manufacturer’s directions/guidelines, as they may vary between brands

AED Availability

Most public places in Australia have an AED available. Manufacturers also sell it for commercial and personal use throughout the country, including Western Australia, New South Wales ( NSW ), Queensland, and others.

AED Safety

An AED, just like any electrical appliance, has safety precautions to prevent injury. The AED operator is responsible for keeping all persons from touching the casualty when a shock is delivered. State a ‘clear’ message. For example, say loudly “don’t touch the casualty” or “stand clear”. Ensure that no one touches the casualty before pressing the shock button. First aid training courses from RTOs, such as CPR First Aid, will teach you how to use this device safely.

The AED should never be connected to anyone other than a casualty in cardiac arrest, nor should an AED be attached to a person for training or demonstration purposes.

Beware of water

Ensure the casualty’s chest area is dry. Do not use an AED if the casualty is in water. Water is an effective electricity transmitter, and the shock may be transmitted to the AED operator.

AED Storage

AEDs require little maintenance. If the AED pads have been used (or opened/tampered with – refer to image), they require immediate replacement. Expired batteries, AED pads, and other consumable items (e.g., shears, towels, and plastic gloves) should be replaced in line with their expiration dates (usually 3-5 years). Proper storage of these items must also be maintained with the help of first aid kits. The manufacturer’s recommendations and updates to its subscribers should be followed in all cases.

All currently available AEDs perform regular self-checks; if a problem is detected, it will be indicated. In most cases, they show this by a warning sign or light visible on the front of the machine or by an audible alert, much the same as a failing smoke detector battery. Those owning or maintaining an AED should have a process in place for it to be checked regularly and frequently (ideally daily) and for appropriate action to be taken when necessary.

Regurgitation:

It should be noted that about one in four casualties will regurgitate whilst having CPR performed on them, especially when drowning is the cause of unconsciousness. This is because the casualty’s muscles relax when unconscious, including the valve that stops regurgitation above the stomach. If the casualty does regurgitate during CPR:

• Turn them into the recovery position with their mouths opened and their heads turned slightly downwards to allow any obvious foreign matter (e.g., food, vomit, blood, and secretions) to drain.
• If required, clear the airways by manually extracting visible items, but don’t apply a blind finger sweep.
• If they are still not breathing once the obstruction is cleared from the airway, place them on their back again and re-commence CPR.

Those who are trained and willing to give breaths do so for all unresponsive and non-breathing persons.

Duration and Cessation of CPR

A first aider should continue to perform CPR on a casualty until:

• The casualty responds or begins to breathe normally
• It is impossible to continue any further due to exhaustion
• Medical professional/s arrive and take over performing CPR
• Medical professional/s have given directions to stop CPR
• The scene/location where CPR is being performed becomes unsafe

How to Perform the Recovery Position

Image Courtesy of European Resuscitation Council

Once you have followed DRS ABCD and established that the casualty is breathing, you need to place them in the recovery position. This is extremely important as it is the best position for an unconscious, breathing casualty. An unconscious casualty lying on their back can very quickly suffocate on their own tongue or stomach contents.

Recovery Position for a Child (1-18 years) or Adult (18+ years)

• Follow DRS ABCD and ensure the casualty is breathing effectively.
• Place both of the casualty’s arms pointing away from you (the closest arm will be across the casualty’s chest).
• Raise the casualty’s knee closest to you and bend it.
• Place one hand under the raised knee and the other arm behind the casualty’s shoulders, and remember to support the neck as best as possible.
• Hold the casualty’s hip to control the roll and prevent it from falling onto its front.
• Gently turn the casualty onto their side facing away from you and bend up the raised knee further to the front of the casualty to ensure they don’t roll onto their front.
• Please make sure the casualty’s mouth is at the lowest point so the stomach contents can drain from the mouth.
• Lift the chin forward in an open airway position and adjust the hand under the cheek as necessary.
• Continue monitoring DRS ABCD until an ambulance arrives – never leave an unconscious casualty unattended.
• If injuries allow, turn the casualty to the other side after 30 minutes.

REMEMBER – WHEN MOVING THE PERSON ONTO THEIR SIDE, MAKE SURE THEIR NECK AND BACK DO NOT MOVE. MAKE SURE YOU ARE ROLLING THE BODY, NOT TWISTING THE SPINE

Recovery Position for an infant (Under 1 year old)

For a baby less than a year old, a modified Recovery Position must be adopted:

• Cradle the infant in your arms, with their head tilted downwards on their side to prevent them from suffocating on their tongue or inhaling stomach contents.
• Monitor and record vital signs, such as level of response and breathing, until medical help arrives.
• 1-handed recovery position can be used by placing your fingers supporting the baby’s neck and jaw.
• The baby should be facing toward the ground so that any vomit or regurgitation will not obstruct their airways.
• This position also leaves your other hand free to make phone calls (e.g., 000 / 112), open doors, perform back blows for choking, etc.
• If you need to walk around with the infant, be careful not to trip. You can easily cause injury by dropping or falling onto the child.

CONCLUSION

So, what do all those letters stand for? The answer is simple: it’s an easy way to remember the order of first aid steps when someone is injured. If you need a refresher on first-aid skills, need CPR training, or want to become certified in first-aid, we offer a variety of courses that can fit your needs. Check out our available first aid courses near you today!