Response, Airway & Breathing

Response, Airway & Breathing

Response, Airway & Breathing - the R-AB of DR-ABC

Response, Airway & Breathing 

Response, Airway & Breathing

Having checked for danger, i.e. made sure it's safe for you to approach the casualty and remain in the area, you can proceed to the next stages of the DR-ABC principle.

This part of the process is to do what's called a primary survey, which is in short to check that the casualty's state of consciousness and whether breathing.


If your casualty is lying down and not obviously conscious, you need to ascertain whether they are asleep (unlikely) or actually unconscious. Do this by moving your head close to the casualty and shouting "can you hear me", "open your eyes" etc. Anything verbal to elicit a response and check whether they are conscious.

A verbal test may not get a response. Tap the casualty on the bony part of the tops of their shoulders, whilst shouting. If you are dealing with someone who has fallen a distance, take care about doing anything that could cause jerky movement, which is why nipping a casualty is not recommended these days, as they may wake in a start. causing dangerous movement.

If that does not get a response, this is a serious situation as you have an unconscious casualty.


Assuming that your casualty is unconscious, you next need to move their body to establish a clear airway and visually check whether their airway is free from obstruction.

To open the airway, place one hand on the casualty's forehead. Tilt their head backwards by placing two fingers on their chin and lifting. Do not lift the underside of the neck, as it could be damaged. Moving the head in this way ensures that the tongue does not fall backwards into the mouth and block the airway.

A quick visual check of the mouth should confirm whether it's free of obstruction.

If there is an obvious obstruction, do what you can to remove it. However, if the casualty has fallen any distance and there could be the possibility of a head injury, you'd be well advised not to turn their head in the process of removing any obstruction.


Plase your ear next to their mouth/nose area and listen/feel for inhale and exhale of air. At the same time, look down the casualty's chest area and check whether you can see it rise as air is inhales, and fall when exhaling. Check for about 10 seconds and make a decision whether the casualty is breathing or not.

There is a condition called agonal breathing, which is where the casualty takes short and infrequent gasping breaths, which sometimes happens after a heart attack. If your casualty is displaying such short and infrequent gasps, treat as though they are not breathing.

Next Steps

Unconscious and not Breathing Casualty

  • call for help immediately
  • start CPR 
  • keep going until more qualified help arrives on scene, the casualty starts breathing/regains consciousness, or you are too exhausted to continue
  • if there is someone else present, switch CPR with them every 1 to 2 minutes to avoid exhaustion
  • if more than one person, conduct a secondary survey as soon as possible, but remembering that CPR is the priority

Unconscious but Breathing Normally

Conscious and Breathing


Spinal Trauma

In the outdoors there is the possibility that the casualty has fallen a distance and sustained head or spinal damage. That damage may not be visible from the outside, with clothing shielding any injury. It could be that any such injury has no external sign, and as such any casualty who has fallen more than a couple of metres, or is known to have hanged their head or fallen awkwardly on their back, should be treated as having potential spinal damage, and thus not moved unless absolutely necessary. Even then, movement will only be possible if there are sufficient people to support the head and next during movement.