Use DRSABCD To Save A Non Breathing Casualty

In December 2010 the Australian Resuscitation Council issued its latest amendment to the Basic Life Support (BLS) or CPR protocols, and introduced the DRSABCD acronym making DRABCD a little obsolete.  When we look at the DRSABC, at first glance the only change appears to be the inclusion of ‘S’ but if we break it down the changes go beyond the ‘S’

I must point out that despite the changes to CPR protocols that any attempt at resuscitation is better than none at all. If in the moment you are unable to or you forget what DRSABCD means; do something. Even if it is just compressions or an older protocol, it will be better than doing nothing.

Rob explains DRSABCD to First Aid students

Rob explains DRSABCD to First Aid students

D = Danger

The ‘D’ in DRSABCD refers to danger. As in all first aid situations you need to assess the risk to your personal safety first and foremost, the safety of the casualty secondly and lastly anyone else in the area.

R = Response

Response is the second step in DRSABCD. We check for a response from the casualty by gently touching them on the hand, cheek or shoulders and talking to the casualty e.g. “can you hear me open your eyes, squeeze my hand’. Remember to always be respectful. If we get no response we send for help.

S = Send for help

This is the notable addition to the old DRABCD prompt. This is a very important addition and while I have had many trainees ask why the inclusion, when it seems so obvious that the call for help is needed; I have seen in many situations where the first aider becomes so focused on the patient’s injuries that they overlook the need to call for assistance. In many situations it is not easy to stop treatment to raise the alarm once you have started.

A = Check, Clear and Open the Airway

Look inside the patient’s mouth and Check to see if there is any foreign matter which may cause a choke hazard or block the airway. If there are, we Clear the airway either by sweeping it out by hand, rolling them on their side to allow any fluids to drain away. Once any foreign material has been removed from the airway we gently Open the patient’s airway with one hand on the patient’s forehead and the other supporting their jaw gently tilt their head back and open their mouth. One thing I see a lot in DRSABCD training is trainees opening the airway before they check and clear it. The problem with this is that any foreign matter in the mouth would end up in the airway and potentially compromise the airway.

B = Look, Listen and Feel for Normal Breathing

Previously under the old DRABCD prompt we would have checked for breath sounds. The problem with this was that there are a number of abnormal breath sounds that indicate that the patient needs urgent attention. The provision of first aid is a situation that many of us will feel uncomfortable about. Hearing a breath sound, be they abnormal, can lead us to believe that everything is fine when nothing could be farther from the truth. To check for normal breath sounds we place a hand on the chest of the patient and bring our ear down towards their mouth. We look to see if the patient’s chest rise and fall by watching our hand on the patient’s chest. We listen for normal breath sounds and we see if we can feel their breath against our cheek. If they are breathing normally we place the patient in to the recovery position. If they are not breathing normally we commence Cardio Pulmonary Resuscitation (CPR).

C = Start CPR

Whereas previously in DRABCD we would have given the casualty recovery breaths before starting chest compressions; now under DRSABCD we go straight in to compressions. Our hands are placed over the lower half of the patient’s chest; compressions are to a depth of 1/3 the depth of their chest, at a ratio of 30 compressions to two breaths, and at a rate of 100 compressions / minute, with minimal disruptions for the delivery of breaths. When we give the breaths we gently tilt the head back, pinch the patient’s nose and deliver the breaths, aiming to achieve the normal rise and fall of the patient’s chest.

There is now a greater focus on the compressions, so when delivering breaths if you cannot achieve the rise and fall of the chest, go back conducting your compressions rather than messing around airway and at the end of the cycle try and see if you can quickly correct the airway. If you are unable to get air into the patient’s lungs, the most likely causes are either poor head position or the airway is of clear of debris. If you are unable establish the airway, or if there is some reason that you are reluctant to give ‘mouth to mouth’ resuscitation, stick with compressions only. As mentioned earlier there is now a greater focus on the compressions.   

D = Defibrillation

Defibrilation is the final step in DRSABCD. The introduction of the Automatic External Defibrillator (AED) in to the public arena has been a great step forward in the provision of care of patient who has suffered a heart attack in the pre-hospital setting. AEDs are a lot safer than they once were and are being fitted more often in places where people gather such as airports, shopping centre, etc… These units are designed for use by the average person in the street and make a significant contribution towards the chances of survivability of a heart attack patient. Essentially to use these devices you turn them on, follow the verbal prompts and deliver a shock when advised to.

In the care of a patient who is receiving CPR we do not disrupt the delivery of CPR to attach the AED to the patient if possible. So where there are two (2) first aiders, one first aider works around the other to attach the AED while the other continues to deliver CPR.

Summary Of DRSABCD

The changes to the CPR protocols are:

  • Any attempt at CPR is better than none at all
  • The inclusion of ‘S’ Send for help
  • We now check for normal breath sounds
  • There is a greater focus on compressions than rescue breaths and
  • Greater emphasis on the use of AEDs.

It is the recommendation of the Australian Resuscitation Council that CPR refreshers be conducted annually. The best way to remember your DRSABCD of course is with practice! If you’ve encountered either old or new protocols please share your experience in the comments below. Do you think DRSABCD will actually save more lives or just burden First Aiders with more to remember?