Primary Survey (ABCDE)
Systematic first assessment of any seriously injured or unwell patient. Find and fix life threats in order — airway, breathing, circulation, disability, exposure — before anything else. Adapt to local policy and available equipment.
Checklist— tick steps as you go
0/25 steps done
1Prepare
2A — Airway (with C-spine control)
3B — Breathing
4C — Circulation
5D & E — Disability and Exposure
Decision flowchart
Seriously injured patient arrives
Airway patent? (talking, no noise or obstruction)
Yes
Breathing adequate? (RR 10-29, SpO2 over 92%, symmetrical chest)
Yes
Signs of shock or active bleeding?
Yes
Pressure on bleeding; 2 large IVs; fluid bolus; TXA within 3 h
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
No
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
No
High-flow O2; decompress tension pneumothorax; assist with BVM
Signs of shock or active bleeding?
Yes
Pressure on bleeding; 2 large IVs; fluid bolus; TXA within 3 h
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
No
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
No
Suction, jaw thrust, airway adjunct; protect C-spine
Breathing adequate? (RR 10-29, SpO2 over 92%, symmetrical chest)
Yes
Signs of shock or active bleeding?
Yes
Pressure on bleeding; 2 large IVs; fluid bolus; TXA within 3 h
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
No
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
No
High-flow O2; decompress tension pneumothorax; assist with BVM
Signs of shock or active bleeding?
Yes
Pressure on bleeding; 2 large IVs; fluid bolus; TXA within 3 h
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
No
Record GCS, pupils, glucose
Expose fully, examine, keep warm
Deteriorating at any point?
Yes
No
Secondary survey, definitive care or referral
Educational guidance only — adapt to your resources, scope of practice and local policy. Last updated 12 August 2026.