It’s not just CPR.

Cardiopulmonary Resuscitation. CPR. Cardio, meaning heart. Pulmonary, meaning lungs and Resuscitation meaning Oh my God, please come back!

To many people the letters CPR represent that annoying couple of hours of First Aid Training you have to do every year to make sure your qualification is maintained. But I disagree! And I guess you would expect me to, but perhaps not for the reasons you think.

I actually think that the course should probably have a different name because there is so much more to it than just pushing up and down on someone’s chest and figuring out how and when to breathe for them.

You see, implicit in the CPR process is the approach to an incident and anyone who has done the course before, even just once, would recognise the mnemonic DRS ABC D. So by way of recap, let’s look at what they stand for;

D – danger. Always assess the area for danger to yourself, any bystanders and the patient. And do it in that order.

R – response. For anyone that has suffered some sort of incident you want to establish their level of responsiveness and indeed if they are responsive at all (will address this in another blog post)

S – send for help. What sort of help is going to be determined by the level of response that you received, but for this purpose were going to assume an unresponsive patient.

A – airway. Is the airway clear? Are there any blockages?

B – breathing. Is the patient breathing? Are they breathing normally? We can look, listen and feel for rise and fall of the chest and any moving air. And if they are not breathing then;

C – compressions. We will begin CPR by pressing on the centre of the patient’s chest, approximately 1/3 chest depth and about two times per second (this is also a topic for a later blog post).

D – defibrillation. If we have access to one we need to get a defibrillator onto this patient as soon as possible for the best chances of ongoing survival.

So there it is. DRS ABC D. This is sometimes referred to as the Basic Life-Support Flowchart. It is also referred to as the Primary Survey. No matter what the incident you need to run through this procedure as part of your approach, always! If you are coming across a patient and you’re not sure what led to the injury or illness and you forget to check for any dangers then you may just be walking into the same situation yourself and become patient number two.

If you speak to the patient and they respond then we can do a mental tick box of the remainder of the survey. Because if they respond they have a clear airway, they are also breathing, and don’t need compressions or defibrillation. Primary Survey done. Okay move on.

So the Primary Survey isn’t just about CPR it’s your full approach to every incident. It’s your system, but it’s also your fallback position. Your last line of defense, as it were. Because if you think about it, anyone who is really sick or really injured and is beyond our first aid care is, sooner or later, going to end up as an unresponsive, unconscious patient for whatever reason. So barring major haemorrhage (which we’ll talk about a later stage) we are back into our Primary Survey and will respond accordingly as we escalate backup the DRS ABC D system and begin running through the process all over again.

It also becomes your priority list. There are many times in first aid where some treatments clash or conflict with other processes. For example, let’s say you come across a car that has rolled many times and is upside down. There is just one occupant, the driver. The driver is yelling and screaming at you to get them out of the car, which is completely understandable. However, the sheer mechanism of that injury/accident would suggest that there is a high potential for spinal damage. And we know the management for spinal damage is immobilisation with no movement whatsoever (unless there is impending danger).

The patient is yelling and screaming at you, so do they have airway, breathing and do they need compressions? No. So we immobilise as much as possible and attempt to reduce the anxiety of the patient by calming talk and providing rest and reassurance.

Now let’s think about that same scenario but change just one thing. The patient is unconscious. They are unresponsive. Is their airway at risk? Absolutely! And this patient cannot be managed effectively whilst hanging upside down in a car. So we look at our list DRS ABC D. Airway is a priority. The management for a patient with an airway at risk is to get them out of the car and on the ground. But this conflicts with what we know about management of a potential spinal injury. But where on this list does it mention spinal? It doesn’t. So whilst we will move the patient as carefully as possible, the higher priority is making sure that the airway is maintained and that breathing continues. After all, what would kill them first? A spinal injury? Or a blocked airway? You got it, Airway blockage.

So the Primary Survey (the CPR course) is about your approach to any incident and/or critical event. It’s your first port of call and your last resort, your backstop as it were. And that’s why I believe that it’s critical to revisit this training every 12 months to make sure that in the most serious event your system is solid and you have the confidence to make a difference, to contribute to a positive outcome.

Take care out there, all the best.

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