DR ABC

Danger

Make sure you, the victim and any bystanders are safe.

Response

Gently shake the shoulders and ask loudly “Can you hear me? Can you open your eyes?”
If victim responds:
-leave them in the position you found them provided there is no further danger.
-try to find out what is wrong and get help if needed.
-re-assess regularly
If victim does not respond:
Shout for help, then…

Airway

Turn victim on to their back and open the airway using head tilt and chin lift:
-place your hand on their forehead and gently tilt the head back
-with your fingertips on the point of their chin, lift the chin to open the airway

Breathing

Keeping the airway open look listen and feel for normal breathing. Look listen and feel for no more than 10 seconds. If you have any doubt whether breathing is normal act as if it is not normal.

If victim is breathing normally:

  • put them into the recovery position <link>
  • send or go for help or call an ambulance
  • check for continued breathing.

If victim is not breathing normally:

Circulation

Ask someone to call for an ambulance or, if you are on your own, do this yourself; you may need to leave the victim.
Start chest compression as follows:

  • Kneel by the side of the victim.
  • Place the heel of one hand in the centre of the victim’s chest.
  • Place the heel of your other hand on top of the first hand.
  • Interlock the fingers of your hands and ensure that pressure is not applied over the victim’s ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).
  • Position yourself vertically above the victim’s chest and, with your arms straight, press down on the sternum 4 – 5 cm.
  • After each compression, release all the pressure on the chest without losing contact between your hands and the sternum.
  • Repeat at a rate of about 100 times a minute (a little less than 2 compressions a second).
  • Compression and release should take an equal amount of time.

Combine chest compression with rescue breaths.

  • After 30 compressions open the airway again using head tilt and chin lift.
  • Pinch the soft part of the victim’s nose closed, using the index finger and thumb of your hand on their forehead.
  • Allow their mouth to open, but maintain chin lift.
  • Take a normal breath and place your lips around their mouth, making sure that you have a good seal.
  • Blow steadily into their mouth whilst watching for their chest to rise; take about one second to make the chest rise as in normal breathing; this is an effective rescue breath.
  • Maintaining head tilt and chin lift, take your mouth away from the victim and watch for their chest to fall as air comes out.
  • Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions.
  • Continue with chest compressions and rescue breaths in a ratio of 30:2.

Stop to recheck the victim only if they start breathing normally; otherwise do not interrupt resuscitation.

If your rescue breaths do not make the chest rise as in normal breathing, then before your next attempt:

  • Check the victim’s mouth and remove any visible obstruction.
  • Recheck that there is adequate head tilt and chin lift.
  • Do not attempt more than two breaths each time before returning to chest compressions.

If there is more than one rescuer present, another should take over CPR about every 2 min to prevent fatigue. Ensure the minimum of delay during the changeover of rescuers.

Chest-compression-only CPR.

  • If you are not able, or are unwilling, to give rescue breaths, give chest compressions only.
  • If chest compressions only are given, these should be continuous at a rate of 100 a minute.
  • Stop to recheck the victim only if they start breathing normally; otherwise do not interrupt resuscitation.

Continue resuscitation until:

  • qualified help arrives and takes over,
  • the victim starts breathing normally, or
  • you become exhausted.

Recovery position

There are several variations of the recovery position, each with its own advantages. No single position is perfect for all victims. The position should be stable, near a true lateral position with the head dependent, and with no pressure on the chest to impair breathing.

The Resuscitation Council (UK) recommends this sequence of actions to place a victim in the recovery position:

  • Remove the victim’s spectacles.
  • Kneel beside the victim and make sure that both their legs are straight.
  • Place the arm nearest to you out at right angles to his body, elbow bent with the hand palm uppermost.
  • Bring the far arm across the chest, and hold the back of the hand against the victim’s cheek nearest to you.
  • With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.
  • Keeping their hand pressed against their cheek, pull on the far leg to roll the victim towards you onto their side.
  • Adjust the upper leg so that both the hip and knee are bent at right angles.
  • Tilt the head back to make sure the airway remains open.
  • Adjust the hand under the cheek, if necessary, to keep the head tilted.
  • Check breathing regularly.

If the victim has to be kept in the recovery position for more than 30 minutes turn them to the opposite side to relieve the pressure on the lower arm.