Imagine you are at work and someone falls ill. What should you do? Well, the answer may be simpler than you think – according to the DRSABCD guide. This guide is recognised by many workplace health and safety departments as the standard for first aiders. In this post, we’ll take a look at what each letter in the acronym stands for, and what you should do in an emergency situation. Stay safe!
The Australian Resuscitation Council (ARC) recommends using the following 7 step acronym when caring for the casualty – DRSABCD
- DANGERS Check for danger (hazards/risks/safety)
- RESPONSIVENESS Check for response (if unresponsive)
- SEND Send for help (Call 000)
- AIRWAY Open the airway
- BREATHING Check breathing (if not breathing / abnormal breathing)
- CPR Start CPR (give 30 chest compressions followed by two breaths)
- DEFIBRILLATION Attach an Automated External Defibrillator (AED) as soon as available and follow the prompt
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
D – Dangers
This step is the same when caring for both a breathing or non-breathing casualty. YOU are the most important person NOT the casualty. Ensure the safety of yourself (the first aider), bystanders, and the casualty.
- Checking for 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 dangers greatly depends on the situation; hence it is important to assess 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 both caring for a breathing or non-breathing casualty.
- Check the consciousness level, speak in a calm positive manner, 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 to do so, 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 medical assistance, you should next immediately send for help.
- Yell out for assistance! If there are any bystanders, instruct them to call 000. If you are alone and have access to a phone, call 000 and clearly explain the situation.
- CALL FOR HELP, EMERGENCY NUMBER 000 (landline/mobile) or 112 (mobile)
Free app available: Emergency +
The following is an excerpt from 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 the existing GPS functionality of your smartphone to enable you to provide emergency call-takers with your location information as determined by your smartphone.
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
For responsive adults and children, it is reasonable to open the airway using the head tilt chin lift manoeuvre. Infants are left in the head position neutral 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 onto 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. This has often been misinterpreted by onlookers and even first aiders as signs 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 as NOT BREATHING EFFECTIVELY, therefore, you will need to proceed immediately onto 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 in conjunction with rescue breathing to circulate the oxygenated blood around the body.
Compressions are performed as follows:
- 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 2 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 2 a second)
- Give 2 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
o A casualty should not be routinely rolled onto the side to assess airway and breathing unless regurgitation occurs
- 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 also to help ensure that the depth and speed of compressions are maintained. If this is performed, it is important to minimise interruptions to compressions.
Step 2: Rescue Breath methods
After 30 compressions, perform 2 rescue breaths using one of the following methods.
Mouth to Mask
This involves using a CPR mask for providing 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 up the casualty’s airways. Full head tilts for adults and children while no head tilts 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 this is available.
Mouth to Mouth
This is the recommended form of rescue breathing when a mask is not available. The following steps should be taken to correctly provide mouth to mouth:
- 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 open your 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. 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 soft tissues of the neck. The lower jaw should be supported at the point of the chin while keeping the mouth open. Due to the head size of an infant 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 preferred by the first aider.
- For infants, the first aider should cover the infant’s mouth and nose with their own mouth instead of attempting to pinch the infant’s nose.
- If providing mouth to nose on adults, the same method as mouth to mouth 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).
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.
The portable device has a built-in computer and sensor that will check for the heart rhythm once placed on the casualty’s chest and it will determine if defibrillation is required. Voice prompts are given to the user to follow and to streamline the defibrillation process
- Access to Early Defibrillation is the single most important step in this cycle
- Every minute early defibrillation is delayed reduces 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 the current models are designed not to function unless an abnormal “shockable” heart rhythm is detected by the unit
- 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 correctly use an AED as soon as one is available:
- CPR should not be delayed while waiting for the AED to arrive – Start CPR immediately
- 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)
- (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
- Move any clothing out of the way of the casualty’s chest
- If the casualty is wet or sweaty, remove any moisture with something dry before placing the AED pads on the casualty
- Tear open the AED pad packets and remove AED pads
- If the casualty has a lot of body hair and the pads don’t stick to the chest you will need to shave the hair on the chest. 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 important 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.
- Avoid placing pads over any implantable devices – pads should be placed at least 8cm from any such devices
- Do not place pads over medication patches – remove the patches before continuing as these can block the current and cause burns to the casualty
- If not already attached, plug the cables from the pads into the unit (most units already have this ready for use)
- 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
- Move any bystanders out of the way – ensure no one else is touching the casualty
- AED will analyse casualty. If the AED determines that a shock is needed, move everyone away from the casualty
- Other first aider continues CPR until the AED operator is ready to shock
- Make sure no one is touching the casualty and press the ‘Shock’ button, and then let the AED re-analyse
- 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
- Continue CPR and AED until the ambulance 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, there is a danger of pad-to-pad arcing. In this case, the pad placement is not the same as for adult AED. One pad needs to be placed in the centre of the chest, and the other on their 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
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”. Look to ensure that no one is touching the casualty before pressing the shock button.
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 transmitter of electricity and the shock may be transmitted to the AED operator.
AEDs require little maintenance. If the AEDs pads have been used (or opened/tampered with – refer to image), they require immediate replacement. Expired batteries and 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). In all cases, the manufacturer’s recommendations should be followed.
All currently available AEDs perform regular self-checks and 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
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 when unconscious, the casualty’s muscles are totally relaxed, including the valve that stops regurgitation above the stomach. If the casualty does regurgitate during CPR:
- Turn them into the recovery position with the mouth opened and the head 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 persons who are unresponsive and not breathing normally.
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 in performing CPR
- Directions have been given by Medical professional/s to stop CPR
- The scene/location where CPR is being performed becomes unsafe
How to Perform the Recovery Position
Once you have followed DRS ABCD and established the casualty is breathing, you need to place them into 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 easily 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.
- Make sure you are holding the casualty’s hip so that you can control the roll and not let the casualty fall onto their 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.
- Make sure the casualty’s mouth is at the lowest point so that the stomach contents are able to drain from their mouth.
- Lift chin forward in open airway position and adjust 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 – 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 (i.e. 000 / 112), open doors, do back blows for choking etc.
- If you need to walk around with the infant, be very careful not to trip as you can easily cause injury by dropping or falling onto the child.
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 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!