Primary Survey: DR C ABCDE
Update to the Primary Survey: DR C ABCDE
Earlier editions of this book refer to the primary survey using DR ABC.
In line with the 2025 Resuscitation Council (UK) Guidelines, the primary survey is now conducted using:
A key change is that emergency services should be contacted as soon as a casualty is found to be unresponsive, before checking for normal breathing. Catastrophic (life-threatening) bleeding is now a priority over airway and breathing. The primary survey now includes D for Disability and E for Exposure.
Updated primary survey sequence
Ensure the area is safe for the casualty, the first aider, and others.
Check whether the casualty is responsive using the AVPU scale.
If the casualty is unresponsive, call 999/112 immediately or instruct a bystander to do so.
If available, place the phone on speaker to receive guidance while continuing first aid.
Identify and control any severe bleeding immediately using direct pressure or a tourniquet if trained to do so.
Open and maintain the airway.
Check for normal breathing for no more than 10 seconds. Begin CPR for a non-breathing casualty.
Look for signs of shock or ongoing bleeding and treat appropriately.
Check the casualty’s level of response and look for signs of neurological impairment or changes in brain function, such as:
- Confusion or altered behaviour
- Unequal or unreactive pupils
- Slurred speech
- Weakness, numbness, or paralysis (especially on one side)
- Seizures
- Signs of stroke or head injury
You should look for any other injuries or conditions that haven’t already been identified, while also preventing heat loss.
- Hidden injuries.
- Bleeding you may have missed.
- Burns, rashes, or swelling.
- Medical alert jewellery or devices.
- Preventing hypothermia by covering them up to keep them warm once checks are complete.