The primary survey

Danger

Are you or the casualty in any danger? If you have not already done so, make the situation safe and then assess the casualty.

Response

If the casualty appears unconscious check this by shouting

Can you hear me?’, ‘Open your eyes
and gently shaking their shoulders.

If there is a response:

  • If there is no further danger, leave the casualty in the position found and summon help if needed.
  • Treat any condition found and monitor vital signs - breathing, level of response and pulse.
  • Continue monitoring the casualty either until help arrives or he recovers.

If there is no response:

  • Shout for help.
  • If possible, leave the casualty in the position found and open the airway.
  • If this is not possible, turn the casualty onto their back and open the airway.

Airway

Open the airway by placing one hand on the casualty’s forehead and gently tilting the head back, then lift the chin using 2 fingers only.

This will move the casualty's tongue away from the back of the mouth.

Breathing

  • Look, listen and feel for no more than 10 seconds to see if the casualty is breathing normally.
  • Look to see if the chest is rising and falling. Listen for breathing.
  • Feel for breath against your cheek.
If the casualty is breathing normally, treat any life threatening injuries and place them in the recovery position.
  • If their breathing becomes noisy, stop treatment and turn them into the recovery position before continuing.

If the casualty is not breathing normally or if you have any doubt whether breathing is normal begin CPR:

  • CPR for adults
    • If you have someone with you, send them to Dial 999 (or 112) for an ambulance immediately.
    • If you are alone Dial 999 (or 112) for an ambulance immediately and then return to help the casualty.
  • CPR for children (one year to puberty)
    • If you have someone with you, send them to Dial 999 (or 112) for an ambulance immediately.
    • If you are on your own carry out CPR for 1 min before dialling 999 (or 112) for an ambulance.
  • CPR for babies (birth to one year)
    • If you have someone with you, send them to Dial 999 (or 112) for an ambulance immediately.
    • If you are on your own carry out CPR for one min before dialling 999 (or 112) for an ambulance.

Agonal breathing

This is common in the first few minutes after a sudden cardiac arrest. It usually takes the form of sudden irregular gasps for breath. It should not be mistaken for normal breathing and if it is present chest compressions and rescue breaths (together called cardio-pulmonary resuscitation or CPR) should be started without hesitation.

Check for severe bleeding

Injuries or conditions that result in severe bleeding can be life threatening because of the risk of shock. However, only check for severe bleeding once you are sure that the casualty is breathing; do not waste any time in performing CPR.

Related topics

Please note:

These hints are no substitute for thorough knowledge of first aid! St John Ambulance holds first aid courses throughout the country.

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