The primary survey is a quick way to find out how to treat any life-threatening conditions a casualty may have in order of priority. We can use DR ABCDE to do this: Danger, Response, Airway, Breathing, Circulation, Disability and Exposure.
How to do the primary survey (DR ABCDE)
Dr Lynn Thomas, OStJ, BSc, MB.BS, MA, FRCPClinically reviewed: 18/09/2026
Use the primary survey to quickly assess the situation and the casualty.
What is the primary survey?
- 1
Danger. Before approaching the casualty, always make sure the area is safe.
- 2
Response. Check if the casualty is responsive or unresponsive. As you approach them, introduce yourself and ask them questions to see if you can get a response. Kneel next to their chest and gently shake their shoulders, asking, ‘Are you OK?’, ‘Can you open your eyes?’.
If they don't respond, shout for help and ask a helper to call 999 or 112 for an ambulance or put your phone on speaker phone and call yourself.
If there is life-threatening bleeding (massive amounts of blood pouring, gushing, or spurting from a significant injury) it must be dealt with before moving on to the airway.
Treat life-threatening bleeding by applying direct pressure to the wound before managing their airway and if you haven’t already, call 999 or 112 for an ambulance.
- 3
Airway. Next, you need to check that the airway is open and clear. Open the airway by placing one hand on the forehead to tilt the head back and use two fingers from the other hand to lift the chin.
- 4
Breathing. You now need to check if the casualty is breathing normally. Keep the airway held open, place your ear above their mouth and look down at their chest. Listen for sounds of breathing and see if you can feel their breath on your cheek. Watch to see if their chest moves. Do this for 10 seconds.
Please note:
During the first minutes of cardiac arrest, about half of casualties will do something called 'agonal gasping'. They can open their mouths, extend their neck, and take usually slow, sometimes noisy gasps. This is not normal breathing and, in a patient with no other signs of life, is a sign of cardiac arrest.
If they're not breathing normally, start CPR and ask a helper to find and bring a defibrillator (AED), if available.
If they are responsive and breathing normally, move on to circulation.
- 5
Circulation. Once you have established that they are breathing normally, look and check for any signs of severe bleeding.
If they are bleeding severely, you will need to control and treat the bleeding by applying direct pressure to the wound. Call 999 or 112 for emergency help.
If they are unresponsive and breathing normally but with no bleeding, put them in the recovery position and call 999 or 112 for emergency help.
- 6
Disability. This will include looking for signs of neurological problems, including confusion, signs of a stroke (FAST), a head injury, or low blood sugar.
- 7
Exposure. This will include looking for signs of injury which may be obvious or hidden, or medical alerts.
Once you have completed your primary survey and treated any life-threatening conditions, you can move on to the secondary survey (top-to-toe survey).
