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The revision of the primary survey: a 2011 review

01 July 2011
Volume 3 · Issue 7


This article outlines changes that have been made to the patient assessment primary survey for ambulance staff that was adopted by South Western Ambulance Service NHS Foundation Trust (SWAST). It provides a brief history of the airway, breathing and circulation approach (ABC), and the transition to (C) ABCDE undertaken in 2007, following the publication of the paper by Hodgetts et al (2006). The article intends to describe and build on the lessons learned from the last 4 years of using a standardized approach to patient assessment. The article is designed to create further debate among our peers regarding hybrids of patient assessment.

The original ‘ABC’ protocol was developed to provide an aide memoir for first aiders to use when dealing with a patient. It encompassed the mnemonic for airway, breathing and circulation (‘ABC’); and provided the process to be used when caring for an unconscious or unresponsive patient.

Some aspects of coronary pulmonary resuscitation (CPR) have been in place since the 18th century, with various methods implemented throughout history; however, it was in 1957 when Peter Safar wrote his book ‘ABC’ of Resuscitation that provided the basic aspects of future CPR training, and demonstrated the use of mnemonics for creating a standardized approach to teaching and learning (Mitka, 2003).

Ambulance primary survey concepts have evolved following little structure, other than those used in CPR. Paramedics were historically taught to treat conditions, signs and symptoms rather than using a structured approach to patient assessment. Much of their training was focused on understanding physical signs and symptoms, and linking these to likely causation conditions.

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