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A practical exampleBelow is a practical example of how first aiders can use DRSABCD.You are walking through the park when you see an elderly man stumble and fall.When you go to help you notice he is trying to get up and has blood comingfrom a wound on his hand. You decide to act.DANGERSCheck for dangers. Ensure safety for self, casualty andbystanders.You check the scene for obvious hazards and risks and notethe presence of blood. You put on gloves.RESPONSE(AVPU)(See AVPU, p7)You ask him if he is OK.He speaks to you. He is alert.You introduce yourself and ask if you can help him.SEND FOR HELPSend or shout for help.You ask bystander for help. Consider AED.AIRWAYThe casualty talks easily and has no obvious airway problem.BREATHINGYou ask if he is OK. Breathing is rapid.USING DRSABCDUsing DRSABCDCIRCULATION/CPR Casualty appears pale and says he feels light headed.You send bystander to call for an ambulance immediately,because of the signs of shock.DEFIBRILLATIONConsider AED.– If needed, attach and follow prompts.SPECIFIC CAREYou lie the casualty in the shock position.You treat the hand wound.You check that the ambulance is on the way.You ask if the casualty has a history of heart-relatedproblems, they say yes.You check for other injuries and cannot find any.GENERAL CAREYou keep the casualty warm and reassure him.You stay until the ambulance arrives.5

DANGERSDangersEnsure scene safetyMovement from dangersMovement can worsen the casualty’scondition by increasing pain, injury,blood loss or shock. Only move acasualty if there is a clear reason todo so (to ensure safety; in extremeweather or on difficult terrain wheremovement is essential; to makepossible the care of ABCs (Airway,Breathing, Circulation), perform CPRor control of severe bleeding).HOW TO HELP The one person dragStay with the casualty and sendothers to get help.The one-person drag is the bestway for the lone rescuer tomove the casualty from danger.A blanket may also be used.6

Levels of consciousnessThe casualty’s response is a measure of their Level of Consciousness. An initialcheck of consciousness is performed in the Primary Assessment using the Shoutand Tap method. More detailed assessment of a casualty’s level of consciousnessshould be made as part of the Secondary Assessment.RESPONSEResponseThe check should be repeated at regular intervals and medical personnel should beadvised of any patterns. Patterns may show changes in the casualty’s condition.LEVELS OFCONSCIOUSNESSAALERT andresponsiveRESPONSETalks and responds to questionsappropriately. For example:ɠ What time of the day is it?ɠ What sport were you playing?ɠ What town are you in?Talks, but may be anxious, irritable orconfused.May repeat questions several times,forgetting that answers have beenprovided.May start to become drowsy.VConsidercalling anambulanceDrowsy butObeys instructions such as,responds to VOICE ɠ move your armsɠ open your eyesor responds to instructions by grunting,groaning, moving the head or similarattempts to acknowledge.Considercalling anambulancePUnconscious, doesnot respond tovoice but respondsto PAINDoes not speak or respond toinstructions. Moves away from painfulstimuli. Moves head away or grimaceswhen tapped on the shoulder.Considercalling anambulanceUUNRESPONSIVEUnconsciousDoes not speak. Does not respond inany way to pain or voice.Send or shoutfor help – callan ambulanceimmediately7

AIRWAY BREATHINGAirwayBreathingIf a casualty is unconsciousthey will be unable tomaintain an open airway toallow air to enter the lungs.Opening the airway of anon-breathing unconsciouscasualty may be the only steprequired to save their life.When we breathe, the bodyuses only part of the oxygenwe breathe in, so there is stilloxygen in the air when webreathe out. This is why thefirst aider’s breath can beused to provide a casualty’soxygen needs.Open their airway using Head tilt/Chin lift as follows:Look, listen and feel for breathing forup to 10 seconds.HOW TO HELP Head tilt/Chin liftIf a casualty is breathing normally,position the casualty on their side.See Stable Side Position, p11.The normal adult breathing rate is12-20 breaths per minute (about 2-3breaths in 10 seconds). Children andinfants breathe at a faster rate.Place one hand on the foreheadand two fingers of the other handon the bony part of the chin. Tiltthe head back using the hand onthe forehead, and at the sametime lift the jaw upwards withthe fingers of the other hand.8

SIGNS AND SYMPTOMS OF BREATHING DIFFICULTIES:ɠ difficulty breathingɠ difficulty speakingɠ anxietyɠ inappropriate or lack of speechɠ noisy breathing, wheezing,coughingHOW TO HELP MANAGE BREATHINGDIFFICULTIES:ɠ Call an ambulance immediately.ɠ Monitor ABCs.ɠ Make as comfortable as possible.ɠ Encourage casualty to take theirmedication.ɠ Rest and reassure casualty.ɠ If the casualty is unresponsiveposition them on their side.Circulation /CardiopulmonaryResuscitation (CPR)The heart beats to pumpblood around the body.Breathing is a sign ofcirculation. If there isno circulation, normalbody activity will cease.Commence CPR.Unresponsive and notbreathing normally CPR attach AED ASAP.BREATHING DIFFICULTIES CIRCULATION/CPRBreathingdifficultiesUnresponsive and breathingnormally stable sideposition.In both situations send forhelp immediately.Major bleeding must be managedearly to prevent shock developingas the blood volume lowers.Use direct pressure to controlbleeding.See Bleeding and Wounds, pp32–35.Minimise shock by laying the casualtydown, keeping them warm andreassuring them.Pale, cold sweaty skin, a weak rapidpulse, and rapid breathing indicateshock.See Shock, p36.9

UNCONSCIOUSNESSUnconsciousnessUnconsciousness may occurfor a number of reasons.Head injury, low bloodsugar in diabetes, seizuresand strokes can all result inunconsciousness. You do notneed to know the cause totreat unconsciousness.Before the loss of consciousnessthe person may experience yawning,dizziness, sweating, have changes inskin colour, blurred vision or nausea.HOW TO HELP MANAGE UNCONSCIOUSNESS:ɠ Obtain help. Send someone tocall an ambulance immediately.ɠ Position the casualty in theStable Side Position.ɠ Check for any injury or illnessduring the secondary assessment.ɠ Quickly stop any bleeding.ɠ DO NOT give the casualty anyfood or drink.ɠ Stay with the person.The major danger to anunconscious casualty is airwayobstruction from the tongue.Position the casualty ontheir side.10Identify and assessunconsciousnessThere are levels of unconsciousness.A deeply unconscious casualty willnot be able to speak or respondto what you say. The Level ofConsciousness: AVPU chart on page7 provides methods to check levels ofconsciousness.Initially you will have identifiedunconsciousness while checkingfor response during the primaryassessment using the Shout andtap method.All unresponsive/unconsciouscasualties should be positioned ontheir side, ensuring that the airway isopen. Monitor breathing.DO NOT leave the person sitting in achair or put their head between theirknees.Any person who fails to respondor shows only a minor response tosimple commands such as “openyour eyes; squeeze my hand; let it go”should be managed as if unconscious.

(Recovery position)The Stable Side Position (aside-lying recovery position)is designed for unconscious,breathing casualties. It helpsto maintain an open airwayand allows vomit and otherfluid to drain freely fromthe mouth.If a casualty is unresponsive (doesnot respond to your “shout andtap”, for example talk and touchcommands such as “open youreyes” or “squeeze my hand”),groans without opening their eyes,or does not react to you graspingand squeezing their shoulders firmlyto elicit a response, then gentlyposition the casualty in the StableSide Position (recovery position)while being careful to avoid anytwisting or forward movement of thehead and spine.The Stable Side Position issometimes referred to as therecovery or lateral position.The Stable Side Position(recovery position)STABLE SIDE POSITIONStable Side PositionWhere you suspect neckor spinal injuries in anunconscious casualty, logroll them onto their side,supporting their head andkeeping the spine in line.See Log Roll, p68.An unconscious, breathingcasualty who is obviouslypregnant should be placedon their left side.11

DRSABCD – RESUSCITATIONDRSABCDUnresponsive and not breathing normally CPRDRSABCDContinue CPR until normal breathing returns.Check for DANGERSCheck for RESPONSE (Shout and Tap)SEND for help (Dial 111 – Consider AED)Open the AIRWAY (Head tilt/Chin lift)Check for BREATHING ( Look, listen and feel for breathing for 10 seconds)CIRCULATION/CPR/DEFIBRILLATION (AED)Attach Automated External Defibrillator (AED) as soon as possible.NoYes(Breathing abnormalor absent)Child (under 8 years) Infant (0-1 year)Adult (over 8 years)Start CPR* (30:2)Go for help if aloneIf alone, go for helpafter one minute ofCPRStart CPR* (30:2)DefibrillationAttach AED as soon asDefibrillationAttach AED as soon aspossible and follow voicepromptspossible and follow voicepromptsContinue CPR untilContinue CPR untilresponsiveness ornormal breathing returns12(Breathing present)responsiveness ornormal breathing returnsPosition the casualtyin the Stable SidePositionIf not fully responsive orunconsciousMonitor ABCsStop bleeding.Treat shock.Look for other injuriesor casualties* See chart opposite

DRSABCD – RESUSCITATIONResuscitationOpen Airway. Check for Breathing. Start CPR.If available, attach AED. Follow voice prompts.AdultChildInfantCompressions.Push hard.CompressionsCompressionsTwo hands, centreof chest.One hand, centreof chest.Two fingers, justbelow nipple lineCompressions tobreaths30:230:230:2Compressionsper minute100-120100-120100-120(over 8 years)Start withCompressions1/3 depth of chest(1-8 years)(0-1 years)For all your first aid training needs in New Zealand0800 RED CROSS (0800 733 276)redcross.org.nz13

BASIC LIFE SUPPORT FLOWCHART14Basic Life Support Flowchart

Chainof survivalThe aim of CPR is to provideoxygen to the brain and heartuntil appropriate advancedcardiac life support canrestore normal heart beatand breathing.Most sudden cardiac arrestsoccur outside of hospitalwith death occurring withinminutes of onset.Most adults require CPR as a resultof a heart problem so an emphasisis placed on calling the ambulance,early CPR and attaching an AED assoon as possible.For the purpose of resuscitation anadult is anyone over eight years of age.Resuscitation should be startedwhere the person is unresponsiveand not breathing normally.For more information visit theNew Zealand ResuscitationCouncil website nzrc.org.nzThe chain of survival lists thepriorities and actions to be followedto give the casualty the best chanceof surviving sudden cardiac arrest.RESUSCITATION CHAIN OF ly accessHOW TO HELP TO GREATLY IMPROVETHE CHANCE OF SURVIVAL:ɠ Get access to advanced careas early as possible (callfor help; call an ambulanceimmediately).ɠ Start CPR fast.ɠ Use an AED (defibrillator) assoon as possible.ɠ Continue CPR until advancedcare help arrives.Early CPREarlydefibrillationEarly advancedcare15

RESUSCITATION – ADULTResuscitationAdult – CPR action checklistHOW TO HELP 1 Check for dangers and hazards. Consider safety.2 Response: Shout and tap the casualty to see ifthey respond.3 Send for HELP. Call an ambulance immediately.4 Airway openɠ Open the airway using Head tilt/Chin lift.5 Breathing: Check for normal breathing.Look, listen and feel for breathing – airflow atthe mouth and nose (check for no more than10 seconds).ɠ If not breathing normally, start CPR.ɠ If breathing and unconscious.– Position the casualty in the Stable Side Position.– Monitor for breathing, treat for shock.– Go for help if alone.6 Circulation / CPR – Start CPRɠ Position casualty laying on their back on a hard,flat surface.ɠ Compressions – give 30 compressions.ɠ Rate of compressions: 100–120 per minute.ɠ Hands on centre of chest (use heels of hands).ɠ Depth: 1/3 depth of chest (5cms or more onan adult / 5cms for a child / 4cms for an infant).Smooth up and down pressure.ɠ Minimise pauses.Open airwayHead Tilt Chin LiftLook, listen and feelfor breathing (no morethan 10 seconds)CPR ratio 30:230 compressions:2 rescue breaths7 Give two effective rescue breaths, over onesecond each.ɠ An effective breath is completed when thechest begins to rise.8 Continue CPR at a ratio of 30:2Give 30 compressions to two breaths until helparrives or the casualty begins to breathe.9 Defibrillation – Get and attach AED as soon aspossible and follow voice prompts. Use AED assoon as possible for all ages.16Attach AED assoon as possiblePhotos courtesy Tracey Kearns

Adult – DRSABCDCPR (i.e. chestcompressions andrescue breathing)is provided forcirculation.HOW TO HELP DDANGERSCheck for hazards and risks.Ensure safety for self, casualty and bystanders.RRESPONSE (AVPU)Shout and tap, if unresponsive.SSEND FOR HELPSend or shout for help. Send bystander to callan ambulance immediately. Consider AED.AAIRWAYOpen airway by using Head tilt/Chin lift.BBREATHINGLook, listen and feel for breathing forup to 10 seconds.If not breathing normally START CPR.If ALONE, go for help before starting CPR.CCIRCULATION/CPRCommence CPR:30 compressions / two rescue breaths.Depth: compressions at least 1/3 of the chestdepth using two hands centre of chest.Rate: 100-120 per minute.Each rescue breath delivered over one second.DDEFIBRILLATIONIf NOT BREATHING NORMALLY, continue withCPR. Attach AED as soon as possible and followvoice prompts.RESUSCITATION – DRSABCD – ADULTResuscitation17

DEFIBRILLATION AND AEDSDefibrillation and AEDsA defibrillator is an electronicdevice that sends anelectrical shock through thecasualty’s chest in an attemptto restore a normal heartrhythm. Early defibrillationsignificantly improves thechance of survival.Defibrillators located in places likeshopping malls, supermarkets andother public facilities are usually anautomatic, easy to use, voice-guideddevice and are therefore called anAutomated External Defibrillator(AED). These can be used by membersof the public, even without training.If paediatricspecific pads areavailable they canbe used on children under the age ofeight years. If they are not availableuse standard adult pads ensuring thepads do not touch each other. Forsmaller children, place one pad onthe centre of the chest and the otherpad on the upper back between theshoulder blades.Pad location isshown on the AED.For all unresponsive casualties whoare not breathing, start CPR andattach an AED as soon as one isavailable.The AED checks the casualty’sheart rhythm, decides if a shock isneeded and provides step-by-stepinstructions. Simply turn on the deviceand follow the voice instructions onhow to perform each step that isrequired.You cannot accidentally shock thecasualty as the AED decides on, anddelivers, the shock process. It will notshock someone who does not needa shock.18Modern AEDs are easy to useand can be purchased throughNew Zealand Red Cross.redcrossshop.org.nz/aed

Child (and infants under one year old)For the purposes ofresuscitation a child isconsidered to be aged eightyears and below.Unlike adults, children are rarelyaffected by cardiac arrest due toheart attack. Most non-breathingchildren are the result of airway andbreathing problems.RESUSCITATION – CHILD / INFANTResuscitationWhen you are alone and the childor infant is not breathing, performCPR for one minute then call anambulance immediately.CALL FASTWhen you are alone and thechild or infant is not breathing,perform CPR for one minutethen call an ambulanceimmediately.19

RESUSCITATION – CHILD / INFANTResuscitationChild under eight years old (includes infant)CPR action checklistHOW TO HELP 1 Check for dangers and hazards. Consider safety.2 Check for response. Shout and tap, pick infant up.3 Send for help – ask bystanders to call an ambulanceimmediately.IF ALONE, stay with the child or infant. Consider AED.4 Airway openInfant (under oneyear old)Open airway. Move headinto neutral positionɠ Child – Head tilt/Chin liftɠ Infant – Move head into neutral position andsupport lower jaw as pictured.For how to resuscitate an adult, see p16.5 Check for normal breathing.Look, listen and feel for breathing (no more than10 seconds).ɠ IF NOT BREATHING NORMALLY, start CPR.ɠ IF ALONE, go for help after one minute of CPR.Look, listen and feelfor breathing (nomore than 10 seconds)6 Circulation / CPR – start CPRɠ 30 compressions.ɠ Rate of compressions: 100-120 per minute.ɠ Apply smooth up and down pressure.ɠ Child 1–8 years old – Position one hand on the centreof the chest. Depth of compressions should be 1/3 ofthe chest depth.ɠ Infant under one year old – Two fingers just below thenipple line. Depth of compressions should be 1/3 ofthe chest depth.CPR RATIO 30:230 compressions:Two rescue breaths7 Give two effective rescue breaths (an effectivebreath is completed when the chest begins to rise).Each rescue breath delivered over one second.8 Continue CPR at a ratio of 30:2IF ALONE, go for help after one minute of CPR. Give30 compressions to two breaths until there is either aresponse from the child or until help arrives.9 If child begins to breathe, position on their side andmonitor breathing.20Photos courtesy Tracey KearnsAttach AED as soon aspossible (use paediatricpads if available)

Child under eight years old (includes infant)DRSABCDHOW TO HELP DDANGERSCheck for hazards and risks. Ensure safety for self, casualty and bystanders.RRESPONSE (AVPU)If casualty is unresponsive.SSEND FOR HELPSend or shout for help. Send bystander to call an ambulanceimmediately. IF ALONE, stay with the child. Consider AED.AAIRWAYChild (1–8 years old) – Open airway by Head tilt/Chin lift.Infant – Open airway by moving head into neutral position.BBREATHINGLook, listen and feel for breathing for 10 seconds.IF NOT BREATHING normally; START CPR.IF ALONE, go for help after one minute of CPR.CCIRCULATION/CPRContinue CPR – 30 compressions : two rescue breaths (30:2).Rate of compressions: 100–120 per minute.Child compressions – 1/3 of the chest depth.Infant compressions – 1/3 of the chest depth.Each rescue breath should be delivered over one second.IF ALONE, go for help after one minute of CPR.DDEFIBRILLATIONAttach AED as soon as possible and follow voice prompts.For smaller children, place pad on the

Written and designed by New Zealand Red Cross. Photographs and illustrations courtesy of American, Australian, New Zealand, Samoa, Tuvalu and Papua New Guinea Red Cross, IFRC Pacific Delegation, New Zealand Resuscitation Council and National Heart Foundation of Australia. Additional photogra