The DRSABCD action plan sets out what to do when someone collapses: Danger, Response, Send for help, Airway, Breathing, CPR and Defibrillation, in that order. It is the basic life support sequence published by ANZCOR (the Australian and New Zealand Committee on Resuscitation), and you practise it on a manikin in every nationally recognised first aid and CPR course.
What is on the ANZCOR Basic Life Support flowchart?
The flowchart has one step per letter, with three checks that decide your next move.
- Danger: is it safe to approach?
- Response: does the person respond to you?
- Send for help: call Triple Zero (000).
- Airway: open it.
- Breathing: are they breathing normally?
- CPR: 30 compressions, then 2 breaths.
- Defibrillation: attach an automated external defibrillator (AED) as soon as one is available.
The flowchart (last reviewed August 2023) ends by telling you to continue CPR until the person responds or breathes normally.
Danger: is it safe to help?
Before you go closer, make sure the scene is safe for you, bystanders and the person. ANZCOR's examples include keeping at least 10 metres from a fallen power line until the electrical authority says it is safe, and switching off the power before you touch someone who has had an electric shock at home. If the person is somewhere dangerous, such as a road, you may need to move them.
Response: how do you check if someone is unresponsive?
Talk to them first and then touch them, an approach ANZCOR calls 'talk and touch'. Give a simple command such as 'Open your eyes' or 'Squeeze my hand', and then squeeze their shoulders firmly.
Some Australian first aid providers teach the spoken prompts as COWS: Can you hear me? Open your eyes. What is your name? Squeeze my hand. Although COWS is not an ANZCOR term, it does the same job.
If there is no response, or only a groan without the eyes opening, treat the person as unresponsive. If they do respond, stay with them and keep checking.
Send for help: when should you call Triple Zero (000)?
Call as soon as you know the person is unresponsive. Phone Triple Zero (000) and ask for an ambulance, or have someone else call while you stay with them.
If you are alone with a mobile, Ambulance Victoria's advice is to put it on loudspeaker beside the patient so that the call-taker can talk you through CPR, and to stay on the line unless they tell you to hang up. If others are around, send one person to call and another to fetch the nearest AED.
Airway: how do you open someone's airway?
Check the mouth first, then tilt the head back and lift the chin. ANZCOR says to do this in the position in which you found the person, without rolling them over just to check.
- If something is in the mouth, such as vomit, food or blood, roll them onto their side and turn the head slightly downwards so that it drains. Clear what you can see with your fingers, but do not sweep blindly.
- If the mouth is clear, leave them as you found them. With one hand on the forehead and the other lifting the chin, tilt the head (not the neck) back.
ANZCOR puts an unconscious person's airway ahead of any other injury, including a possible spinal injury. For an infant, keep the head in a neutral position and do not tilt it back. Our guide to infant and child CPR covers what else changes.
Breathing: what if it is not normal?
Start CPR. Anyone who is unresponsive and not breathing normally needs it, and gasping does not count as normal breathing. If they are breathing normally, use the recovery position instead.
With the airway open, look, listen and feel. Look for movement of the upper abdomen or lower chest, and listen and feel for air at the nose and mouth. Occasional gasps (agonal gasps) are common after cardiac arrest, and ANZCOR says to start CPR even if they occur.
Do not feel for a pulse, because ANZCOR says that pulse checks are unreliable and should not decide whether someone receives CPR.
CPR: what are the ratio, rate and depth?
Give 30 chest compressions followed by 2 breaths, and repeat. The ratio is 30:2 for all ages, at a rate of 100 to 120 compressions a minute (almost 2 a second) and a depth of about one third of the chest.
- With the person on their back on a firm surface, put the heel of one hand in the centre of the chest and the other hand on top.
- Press down about one third of the chest's depth, which is more than 5 cm in an adult, and let the chest come fully back up each time.
- Give each breath over about one second, just enough to make the chest rise.
If you are unable or unwilling to give breaths, do compressions only, and do not stop to check for breathing. ANZCOR treats rib fractures as an acceptable consequence of CPR when the alternative is death.
Tiredness shows in your compressions before you feel it. In a manikin study that ANZCOR cites, compressions became shallow within a minute, although rescuers only noticed fatigue after five. For that reason, if someone can take over, swap at least every two minutes.
Defibrillation: when should you use an AED?
Use an AED as soon as one is available. Keep CPR going until the AED is switched on and the pads are attached, and then follow its prompts.
CPR alone will not save someone in ventricular fibrillation (VF). They need a shock, and ANZCOR's AED guideline puts the drop in survival at about 10% for every minute it is delayed. The machine decides whether to shock, and ANZCOR says that AED use should not be restricted to trained people. Keep everyone clear during a shock. Our post on what an AED's pads, prompts and shock button do covers this in detail.
When do you use the recovery position?
Use the recovery position when someone is unresponsive but breathing normally. ANZCOR suggests putting them on their side, because on their back the tongue can fall back and block the throat, and anything they bring up can be inhaled.
Keep the head tilted back so that the airway stays open, and do not sit them in a chair or put their head between their knees. Stop any bleeding and keep checking their breathing. If it stops being normal, roll them onto their back and start CPR.
Why is the DRSABCD action plan in every first aid course?
It is included because the national units assess it. HLTAID009 Provide cardiopulmonary resuscitation and HLTAID011 Provide First Aid both require you to manage an unresponsive person in line with Australian Resuscitation Council guidelines (the ARC is ANZCOR's Australian member). That includes positioning someone who is unconscious and breathing, performing at least 2 minutes of uninterrupted CPR on an adult manikin on the floor, and following an AED's prompts to deliver a shock.
Reading the steps will not make them automatic, and ANZCOR's training guideline notes that CPR skills can fade within weeks to months of a one-off course.
If you would like to practise the sequence, you might like to start with a nationally recognised first aid or CPR course. If you are considering Scope Institute, our HLTAID011 Provide First Aid course covers DRSABCD along with bleeding, burns, fractures, asthma and anaphylaxis for a workplace first aid certificate, while our HLTAID009 Provide CPR course covers DRSABCD, adult and infant CPR, and AED use for those who need CPR alone.
Sources
- Basic Life Support Flowchart – ANZCOR
- Basic Life Support guidelines (Guidelines 2 to 8) – ANZCOR
- Guideline 6: Compressions – ANZCOR
- Guideline 7: Automated External Defibrillation in Basic Life Support – ANZCOR
- Call Push Shock: frequently asked questions – Ambulance Victoria
- HLTAID011 Provide First Aid – training.gov.au
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