1. Determine if the patient is responsive by using the shake and shout method. There are four levels of responsiveness. They are known as the AVPU scale:

• Alert – The patient responds appropriately.

• Verbal – The patient responds to verbal stimuli, but not appropriately.

• Painful – The patient responds to painful stimuli only, such as a pinched finger.          

• Unresponsive – The patient is unconscious.

• Alert – The patient responds appropriately.

Initial Assessment

A = Airway

B = Breathing

C = Circulation

H = Hemorrhage

2. Immediately CALL (911) to activate the EMS system if the patient does not respond appropriately or appears to be unconscious.  

If possible have someone else do this so you can remain with the patient.

3. Roll person onto back. If head or neck injury is suspected, move only if absolutely necessary.

4. OPEN the AIRWAY, use the head-tilt / chin-lift method by tilting the victim’s head back by lifting the chin gently with one hand while pushing down on the forehead with the other hand. IF a neck injury is suspected, DO NOT move victim’s head or neck. First try lifting the chin without tilting head back. If breaths do not go in, stabilize head. Then, lift up the jaw with your fingers by placing your fingers just below the ears, jaw–thrust method.

5. CHECK for BREATHING, (3-5 seconds). Look, listen, and feel method. Put your ears over the victim’s mouth and nose while keeping the airway open. Look at the victim’s chest to check for rise and fall; listen and feel for breathing. (Whenever possible use a mouth-to-barrier device for protection before performing rescue breathing)

Back to index

6. GIVE 2 SLOW BREATHS while using the head-tilt/chin-lift to keep airway open, pinch nose shut. Take a deep breath and seal your lips around barrier device or tightly around victim’s mouth. Give 2 slow breaths (1½ to 2 seconds), pausing between them to take a breath. Watch chest rise to see if breaths go in.                                     

If neither of these two breaths went in, re-tilt the head and try 2 more breaths. If still unsuccessful, suspect CHOKING (foreign body airway obstruction).

a. Give up to 5 abdominal thrusts. Straddle victim’s thighs, put heel of one hand against middle of victim’s abdomen slightly above navel and well below breastbone’s notch (keep fingers pointed towards victim’s head). Put other    hand directly on top of other hand. PUSH INWARD and UPWARD using both hands with up to 5 quick abdominal thrusts. Each thrust should be a distinct attempt made to relieve the object.                                            

b. Perform finger sweep. Use your thumb and fingers to grasp victim’s jaw and tongue and lift upward to pull tongue away from back of throat. With the index finger of your other hand, slide your finger down along the inside of one cheek deeply into the mouth and use a hooking action across to the other cheek to dislodge foreign object.

If the airway remains blocked, rotate through cycles of 2 rescue breaths, re-tilt head, 2 more breaths, up to 5 abdominal thrusts, and finger sweeps until object is removed or EMS system replaces you.

7. CHECK for CIRCULATION (pulse) (5-10 seconds). While keeping victim’s head tilted back, place 2 fingers on the Adam’s apple and then slide these fingers down into the groove of the neck (carotid artery)  on the side closest to you.  

8. CHECK for HEMORRHAGE (severe bleeding).  Whenever possible inspect with gloved hands.  Control the bleeding by applying direct pressure over the wound. Place a sterile gauze dressing or any clean cloth directly over the wound and press against it.  If an extremity is involved, elevate the wound above the heart level and apply direct pressure. If bleeding continues, apply pressure at a pressure point * while applying direct pressure to the wound.  *Unless you know the exact location of the pulse point, this technique is useless.

Back to index

9. PERFORM RESCUE PROCEDURES based on what you found:

a.      If there is a pulse, give rescue breathing every 5-6 seconds. Every minute stop and check pulse.

      b.   If there is NOT a pulse, immediately begin CPR  (chest compressions and rescue breathing). Find the proper hand position by sliding your fingers up rib cage edge to notch where the ribs meet the breastbone. Place your middle finger on or in the notch with your index finger next to it. Put the heel of other hand on breastbone next to index finger. Remove the other hand from the notch and put it on top of hand on the chest and interlace your fingers. Keep your fingers up, off victim’s chest. Give 15 compressions by placing your shoulders directly over your hands on the chest, keep arms straight and elbows locked, pushing breastbone straight down 1½ to 2 inches. Follow with 2 slow breaths. Continue cycles of 15 compressions to 2 breaths. Recheck pulse every few minutes.

Once you have completed an initial assessment of the patient and treated any life-threatening conditions you find, you should perform a head–to-toe physical exam and history. This is also known as an ongoing assessment.

Regularly recheck the patient’s ABCH status, (if stable every 15 min. / unstable every 5 min.). If at any time the patient’s ABCH status changes, immediately stop your ongoing assessment, perform another initial assessment, and correct any problems you encounter.

Ongoing Assessment

     D = Deformities

     O = Open

     T = Tenderness

     S = Swelling

Back to top

Look for Medical alert medallions around the patient’s ankles, wrist, or neck. You may find, however, that you must remove the patient’s clothing if it interferes with your assessment or treatment. If you do remove his or her clothing do so discreetly.