Nowadays there is DRABCD. The last D stands for Defibrillation. This refers to applying a defibrillator to the patient. In SFP Remote Area First Aid we do not consider this step. If there is a defibrillator around then there is also someone qualified to use it close-by. In any case, defibrillators are very easy to use. The machine tells you what to do! So if you do need to use one I am sure you'll figure it out.

There is also DRABCDE, which is more suited to Remote Area First Aid than DRABCD. In DRABCDE the last two letters D and E stand for preventing Disability and minimizing Exposure.. These two steps are important but are not immediately life-threatening. You can "take a breather" and think a few minutes before attending to them. We deal with them in the Diagnoses and Treatments section of SFP Remote Area First Aid Training.

Anything below "Alert" may be the result of other critical system injuries, or could also give rise to them. If you need to and are able, put on gloves and call for help.

Use the emergency roll to get the patient on his back and check his critical systems at the same time.

Roll the patient onto his back. For larger patients use the heel of your foot to nudge his pelvis so it rolls with the upper body.

Move to the back of the patient. Hover your closer hand over the mouth to check for breath.

At the same time, with your other hand, check the radial pulse. The radial pulse is below the wrist at the base of the thumb.

Note: Do not use your thumb to check pulse, as the thumb has a light pulse of its own.

Also, check for and treat any severe bleeding.

When you suspect a neck injury, open the airway using the chin-lift without tilting the head back.

If the airway remains blocked, carefully tilt the head until the airway is open.

With infants (under one-year-old) be careful not to tilt the head back too far. Doing so may block the breathing passage instead of opening it.

If there is any fluid (blood, water, vomit) use gravity to help drain it.

Support the patient’s head and neck with one hand and reach around to the center of his back with the other.

Roll the patient onto your thighs and clear the airway using the finger sweep if needed.

If the airway is being blocked due to swelling, e.g., trauma, burns, anaphylaxis, treat the cause (if possible).

With your mouth sealed tight on the patient’s, breathe into him for one second. Do a steady breath. Not fast. Do two of these breaths.

If the patient's chest does not rise after the first breath it means the air is not going in. Perform the head tilt again before attempting the second breath.

For small children: The breath into the child lasts for 1.5 seconds. Do chest compressions with these two rescue breaths. Be careful with your force of breath. Only use enough to make the chest rise.

For infants: Cover the nose and mouth with your mouth. The breath into the infant lasts for 1.5 seconds. Be careful with your force of breath. Only use enough to make the chest rise.

Repeat the five abdominal compressions and two rescue breaths until your breaths go in.

Note: If there is no pulse you will do CPR instead of rescue breathing.

Opening the airway and rescue breathing is explained earlier in this article. This section will focus on how to do chest compressions.

How to Give CPR Chest Compressions

Kneel at the patient’s side near his chest. Place the heel of your hand on his breastbone (sternum) between the nipples at the bottom of the ribcage. It is where there is a little notch.

Place your other hand on top of the one that is in position. Lock your fingers together pulling them up a little so they are off the chest wall.

Bring your shoulders over his sternum.

A chest compression is two parts:

Compression and relaxation should go for an equal length of time.

With your hands in position press downward, keeping your arms straight. Push down to about a third of the chest depth then relax to let it return to the normal position. Push hard and fast.

A cracking sound may be due to the ribs or cartilage cracking. Don’t worry about it for now. Keep doing the compressions. Do 30 compressions for every two breaths at a rate of about 100 compressions per minute.

For an infant: Encircle your hands around the chest and use only your thumbs to do the compressions.

For children aged one to eight: Compress at about the nipple line.

If there are two rescuers: The person pumping the chest stops while the other gives rescue breaths.

If the victim starts to vomit: Turn the patient’s head to the side and try to sweep out or wipe off the vomit, then continue with CPR.

When not to do CPR

If advanced medical care is not within a few hours away you need to make a decision whether to even start CPR or not.

To make a tough decision a little easier you can follow these points as a standard. In case of one of the following, do not start CPR:

Note: You must treat severe bleeding before giving compressions.

Also, any time that you do start CPR you need to decide for how long you will continue. If advanced help is likely then continuing until it arrives is reasonable.

If you are unsure whether help will arrive, then for how long should you continue? 1 hour? 2 hours? These are decisions you have to make depending on the situation.

How to Check Perfusion

If CPR is not needed check perfusion.

Perfusion is the flow of fluid, e.g., blood, through a certain area of the body. Signs of inadequate perfusion include:

If there is inadequate perfusion, treat the cause (if possible) and use PROP.

Testing Capillary Refill

Apply pressure to the skin and then wait to see how long it takes for blood to flow back into the site. A slow capillary refill means a slow return of blood. This indicates decreased perfusion. Returning from white to pink in less than 2 seconds is normal. 3 or more seconds may mean something is wrong.

Good places to check capillary refill for general perfusion are the fingers and toes.

Something to think about:

The idea of first aid is to keep the patient alive until advanced medical care becomes available.

In a survival situation, advanced care may not be available. Nursing a patient takes valuable time and resources.

If there is no possibility of advanced medical care you may only be delaying an inevitable death. And in the process, the patient may be taking away resources from other survivors.

Is it worth risking everybody?

This is a choice you may have to make.

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