The first three steps in any rescue or first aid situation... Assess, Alert & Attend

Assess / Survey the Scene

As a rescuer, you are of zero help to a casualty if you get injured yourself. Before rushing in to assist another, take a moment to assure the environment is safe for you.

Assessing a scene should only take about 5-15 seconds, although there are a number of important issues that need to be evaluated during this brief period.

Check the area for Danger! Determine whether or not the environment poses a hazard to you as a rescuer. If a scene is unsafe, do not enter it. If the area is not safe to approach, stay back and call 911. This is especially important to remember when dealing with emergencies involving confined spaces, fire, electricity, chemical spills, and other situations where the rescuer may become another casualty. During this phase you should also attempt to determine the number of casualties, the nature of the injuries, and any clues to the cause of the injury.

Alert EMS / Call 911

Once it has been determined there is an emergency, it is time to activate and alert the Emergency Medical System. If possible, enlist others to help so you may begin care of the casualty. Ask a bystander to activate EMS by calling 911, or if no one else is available to assist, the rescuer should make the call themselves. Try to speak calmly and include important information such as the location, phone number, and the casualty’s condition. Stay on the line with the 911 dispatcher.

If a rescuer suspects the casualty is experiencing a cardiac emergency, the rescuer should have an assisting bystander return with an AED if one is available as well as the nearest first aid kit or other rescue supplies.

Attend / Primary Survey

The first things to look for are conditions that may threaten a casualty’s life. The rescuer should begin treatment and primary assessment by talking to the casualty if conscious. Rescuers will then want to control severe bleeding and treat for shock or other serious injuries or illness.

Check for Responsiveness

(Tap and shout ~ “Are you okay?”)

If there are no obvious signs of responsiveness such as movement, talking, coughing, or breath – or if there is only gasping or inadequate breathing, then immediate action is required!

If the casualty is unresponsive, then either full C.A.R.E. CPR™ or Compression-Only CPR™ is required.


Primary Survey

If there are more than one casualty, a rescuer should refer to the triage section for assessment and assisting. Evaluate for confusion or unresponsiveness. If the casualty has been unconscious for any length of time, immobilize the head and neck, and activate EMS immediately. Perform a head-to-toe evaluation. Look for signs of trauma, bleeding, deformity, embedded or impaling objects, discoloration, or anything that might be of concern. Be sure to locate any concealed injuries that may be more life threatening than the obvious injuries that may be noticed first. To determine if an individual may have a potential fracture, a rescuer may simply ask the casualty if they can move the area without causing pain. If the casualty is unable to move the area, or if it causes significant pain, do not allow them to move it, and treat it as if known to be a fracture.

In order to prioritize your treatment, a rescuer should be constantly aware of the most life threatening situations. This becomes even more important when dealing with an unconscious casualty who cannot relate information to the rescuer. It may be necessary for a rescuer to consider the following questions:

Life Threatening Priorities

  1. Is the casualty responsive? If there are no obvious signs of responsiveness such as movement, talking, coughing, or breathing; or if there is only gasping or inadequate breathing, then immediate action is required! If the casualty is conscious and talking, then it is evident that the casualty is breathing and has a heartbeat.
  2. Is there severe bleeding? See Bandaging a Wound for minor bleeding and Stop the Bleed for serious bleeding guidance.
  3. Is there severe shock? See Shock section for specific treatment.

These items must be dealt with in order of their severity. For example, although any of these situations could cause a fatality, severe bleeding should not be addressed until Step 1 (Unresponsiveness, which may include breathing and heartbeat), has been remedied, as these are a more immediate threat to life.

Secondary Survey

A rescuer should be prepared to perform a secondary survey once it has been determined that the casualty has no life-threatening injuries or conditions requiring ongoing care. The secondary survey is to check for less obvious problems that may require first aid. The secondary survey follows these steps:

  1. Interview the casualty and/or bystanders. Inquire about allergies, medical conditions and the use of any medication.
  2. Check for vital signs. Check for level of consciousness and alertness. Breathing and pulse should be regular.
  3. Perform a head to toe check. Avoid any movement if you suspect a muscle, bone, head or spinal injury.
  4. Check the casualty for normal body temperature with the back of the rescuer’s hand.
  5. If the casualty does not have any neck pain, have the casualty move their head back and forth and side to side to check for injury.
  6. Check the nose, ears and mouth for blood or fluids.
  7. Check the shoulders by asking the casualty to shrug their shoulders.
  8. Check the abdomen and chest for internal injuries by having the casualty breath deeply.
  9. Check the casualty’s arms and legs for additional injury by having them move their limbs slowly.

Continue to monitor casualty for consciousness. The casualty’s condition can suddenly worsen, so it is important to continue to watch for any changes and be ready to perform CPR if necessary.

Rest & Reassure

As the rescuer waits for Emergency Medical Services to arrive, the rescuer should have the casualty rest comfortably and calmly reassure them that help is on the way. This can be one of the most important acts a rescuer can do to help the casualty. If a rescuer can help keep the casualty calm and comfortable, it is possible to prevent them from going into to shock or deeper, more severe shock, which is a life-threatening condition.