Life Support
By Mike Rubin, BS, NREMT-P
Alphabetical Disorder
Don’t treat the ABCs as a protocol, but as a checklist of critical items
Do you remember the first time you learned about the ABCs? only do we almost always spot it before evaluating airway or
After grammar school, I mean. For me it was 1991. I was taking breathing, but it also overrides other treatment priorities. I
a first-aid course—the one that teaches 101 uses for cravats— mean, it’s bad form to be staring at someone’s tonsils while
so I could join the local rescue squad. Airway, breathing and they’re exsanguinating. And in the absence of life-threatening
circulation were introduced after the “Responding to Mushroom hemorrhage, breathing, not airway, should be next, because
Clouds” lecture and before “Poisonous Creatures You’ll Never speech and chest movement make breathing much easier to
Encounter.” How fortunate, I thought, that our three most impor- detect than pharyngeal foreign bodies. Might as well leave the
tant physiological needs happen to align with the beginning of airway alone unless breathing is a problem.
the alphabet. I think we just coined “the CBAs.” For those of you uncomfort-
With practice I mastered mandible manipulation, pocket- able about field-stripping the alphabet, here’s a contrived but
mask management and chest compressions—on Rescue accommodating CBA-to-ABC translation:
Annie, at least—and started to feel like a lifesaver. That From: To:
“Were
the ABCs
lasted until my second call, a diabetic whose needs, within
my nascent spectrum of caregiving, fell somewhere between
defibrillation and sling-and-swathe. My efforts to forcibly
C: Circulation
B: Breathing
A: Airway
A: Arterial bleeds
B: Breathing
C: Choking
examine the airway of our combative hypoglycemic patient That’s a start, but there are other details we detect even before
intended clearly entertained the crew. Were the ABCs intended only for bleeding—noise and odors, for example. By assigning more
only for patients with the mental status of manikins? I figured a real than one key word per letter, we can broaden the ABCs to better
cardiac arrest would show me. fit real-world assessments:
patients I didn’t have to wait long. Shortly after receiving my original A: Unless we’re wearing headphones and SCBA gear (might
AHA card, I responded with an ALS crew just before dawn to a be a gift idea for the firefighter who has everything), we’ll
with the female “not breathing.” We found our elderly patient supine and notice prominent sounds and smells even before we see our
mental motionless in bed. Her husband had suspected something was patient. Can’t help it. Let’s acknowledge reality by begi