First aid - assessing a casualty

Doing a primary survey

When faced with the potential need for first aid with a patient or outside of the workplace with a potential casualty, the nurse will require some basic assessment skills, sometimes called undertaking a primary survey, before providing first aid. As ever, nurses should only act within the limits of their knowledge and competence (Nursing and Midwifery Council (NMC), 2018a), although nurses are expected to be able to deliver basic first aid from the point of registration (NMC, 2018b).

The initial first aid assessment of a potential casualty uses the acronym, DRABC (Doctor ABC), where DRABC stands for:

• D – Danger
• R – Response
• A – Airway
• B – Breathing
• C – Circulation (St John’s Ambulance, 2021)

Assessing danger and establishing an initial requirement for first aid is covered in First aid: assessing danger. Once the nurse is assured that they too are not in danger,

Doing a secondary survey

Once the nurse has completed a primary survey and is either excluding or treating any life-threatening injury or illness, they should conduct a secondary survey of the casualty in order to ascertain the need for further first aid. A secondary survey is also useful, especially outside of the workplace, when the nurse may be handing the casualty’s care over to other professionals, e.g. ambulance crew.

As before, nurses are reminded only to act within the boundaries of their knowledge and competence (NMC, 2018a), although nurses should be able to deliver basic first aid from the point of registration (NMC, 2018b).

Away from the clinical setting, the nurse may not have access to the sort of equipment they might ordinarily use to assess a casualty and will need to rely on their ability to gain a history from the casualty, their family or friends and any bystanders/witnesses

References

Mulryan, C. First Aid. In: Delves-Yates (ed.) Essentials of Nursing Practice. Sage; 2015, pp.465-490.

Nursing and Midwifery Council.  The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates.  2018a. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf  (accessed 10 March 2022).

Nursing and Midwifery Council.  Future nurse: Standards of proficiency for registered nurse. 2018b.   https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (accessed 10 March 2022).

Resuscitation Council. Adult basic life support Guidelines. 2021.  Available at: https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines (accessed 09 March 2022).

St John’s Ambulance. How to do the primary survey (DR ABC). 2021.  Available at: https://www.sja.org.uk/get-advice/first-aid-advice/how-to/how-to-do-the-primary-survey/ (accessed 09 March 2022).

St John’s Ambulance. How to do the secondary survey.  2021.  Available at: https://www.sja.org.uk/get-advice/first-aid-advice/how-to/how-to-do-the-secondary-survey/ (accessed 10 March 2022).

Toney-Butler TJ, Unison-Pace WJ. Nursing Admission Assessment and Examination.  2021. https://www.ncbi.nlm.nih.gov/books/NBK493211/ (accessed 10 March 2022).