You should learn how to apply the ABCD’S to a patient’s lifeline. The acronym ABCD's will help you remember the steps to follow as you help an individual and provide care. Once you reach the end of the Lifeline you return to “A” and continue to monitor a patient’s lifeline.
A = Assess scene, Alert EMS and Airway Open. You assess the scene for safety, call the Emergency Medical Service and open the patient’s airway.
B = Breathing. Check the patient’s Breathing and if necessary, begin rescue Breathing.
C = Circulation. Check the patient for signs of circulation and if necessary, begin Chest Compressions.
D = Defibrillation.
S = Serious bleeding management: Shock management: Spinal injury management.
The first thing to do is assess the scene: Is the situation safe? Are there any hazards that will cause my partner or myself more harm? These include physical dangers such as rock fall and avalanches but can also include weather (lightning, wind) and environmental dangers (extreme cold, high altitude). Once you have addressed these and feel that you are safe from them, you can now begin a rapid primary assessment of life-threatening injuries by following the acronym ABCDE.
The ABCDE of Assessment
A – Airway with Cervical Spine Stabilization
Q: Is there air moving in and out? Think: Look, listen, and feel. If the climber has sustained a fall that could have damaged his spine, stabilize his neck and protect his spine.
A: YES – Move on to B.
A: NO – Look for cause of obstruction. If you see something, remove it. Attempt to open the airway with jaw thrust or head tilt-chin lift and begin CPR. Call for help immediately.
B – Breathing
Q: Is the patient breathing, and if so, how? Fast rate, uneven chest rise, or laboring to catch their breath?
A: YES – Breathing without difficulty, move on to C.
A: NO – No breathing = begin CPR and call for help.
A: NO – Labored breathing = Position for comfort, reassure, give oxygen (if available), and call for help.
C – Circulation:
Q: Does the climber have a pulse? Check multiple locations (radial/wrist, carotid/neck, femoral/groin).
A: YES – Move on to next question for circulation.
A: NO – Begin CPR, call for help.
Q: Is the climber bleeding profusely? If so, where?
A: YES – Find source (Look on the ground, the chest, abdomen, pelvis, and thighs. Remember bleeding can be internal) and stop bleeding with direct pressure, elevation, or tourniquet.
A: NO – Move on to D.
D – Disability:
Q: Is the patient fully alert?
A: YES – Move on to E.
A: NO – Assess by AVPU scale. How do they respond? Call for help.
A – Awake
V – Verbal
P – Pain
U – Unresponsive
E – Environment:
Q: Does your current environment offer danger to patient’s condition?
A: YES – Protect your patient and limit exposure. Get them dry, warm, insulated from cold ground, and out of the wind. If at altitude, move lower if possible.
A: NO – Think about evacuation or continuing to climb if no injuries.
Remember to reassess your partner as often as needed based upon injuries; identify resources and dangers of your current situation, and all potential methods of evacuation. To learn more about assessment and caring for injured climbers, read about wilderness medicine and consider taking a Wilderness First Aid (WFA) or Wilderness First Responder (WFR) course.