Fundamental First Aid: The ABCs

The American Heart Association says we have to stop saying ABC and start using CAB. That's silly. Here's a way to remember the steps for treating a patient using ABC.

Before You Start

Professional rescuers practice universal precautions when providing medical care to victims. Universal precautions are steps used to reduce the potential for victims to infect rescuers. Practicing universal precautions requires personal protective equipment, such as gloves or eye protection.

To better protect yourself, you should make sure your first aid kit is adequately stocked with the personal protective equipment necessary to practice universal precautions.

Staying Safe

Safety is an ongoing concern that must never leave your thoughts.

There is a primal instinct in many people to dash to the rescue of those in need. Regardless of the dire circumstances of whatever terrible accident or injury you may witness, it's urgent that you keep your wits about you and stay safe.

Safety is an awareness of your surroundings and a healthy fear of unstable situations. By its very nature, an emergency is an unstable situation. If everything were truly under control, nothing bad would've happened in the first place.

If, for example, you see a person struck by a car in a crosswalk, do not rush headlong into the street to see if they're injured. You will no doubt find yourself lying next to them after being struck by the next car barreling down the road.

In its 2010 CPR Guidelines, the American Heart Association changed the order of ABCs. ABC is still the best way to remember the beginning, so here is a new way to think of the ABCs and still follow the CPR Guidelines:

  • A: Awake?
  • B: Breathing?
  • C: Continue Care

A: Awake?

Wake the Victim
Rod Brouhard

A is for Awake. Is the victim awake, yes or no?

If the victim is not awake, try to wake him. Give him a brisk shake of the shoulders or rub your knuckles on his breastbone and shout something. Anything will work. Try "Hey you!" or "Yo, dude!" or "Go Giants!" It doesn't matter what you say, as long as you say it nice and loud to give him a chance to wake up.

Not waking up? Make sure someone is calling 911 (if no one else is there to help, then you should call 911 before you do anything else). Now, move on to B: Breathing.

If she is awake, talk to her. If the victim can't talk, is she choking? If she is choking, do the Heimlich maneuver.

If the victim wants an ambulance or wants to go to the hospital, make the call. If she's talking but not making sense and she's confused, call 911 immediately and start thinking about why she might be confused.


B: Breathing?

Person practicing CPR on a dummy
Justin Sullivan / Getty Images

B is for Breathing. If your victim is not breathing, start CPR. Remember to tell someone to call 911 if you haven't already.

Start CPR by pushing on the middle of the chest, right between the nipples. Push hard and fast, at least 2 inches deep and at least 100 times per minute (sing "Stayin' Alive" or "Another One Bites the Dust" in your head and push with the beat).

If you've never taken a CPR class or you don't remember all the steps that well then just keep pushing fast and hard until somebody shows up to help.

If you feel comfortable with CPR, then follow the steps: 30 chest compressions, followed by two rescue breaths, and repeat.

But the Victim Is Breathing!

Think your victim is breathing? Take another look. Is he gasping for air kind of slowly, like a fish out of water? If so, start CPR just like if he wasn't breathing (learn how to do CPR on gasping victims).

So you've decided that your victim is breathing fairly normally. Someone called 911 when you realized your victim wasn't waking up (nobody's calling 911? Call now).

Take a breath (your victim is, so you can) and move on to C: Continue Care.


C: Continue Care

Man holding towel on bleeding wound

Rod Brouhard

C is to Continue Care. You have a victim who won't wake up (unconscious) but is breathing. 911 has been called and an ambulance is on the way. If the 911 operator tells you what to do, follow the operator's instructions and stop reading this.

If you're on your own, here are some tips to follow until the ambulance gets there:

  • If the victim is face down and unconscious, roll her on her back, face up.
  • If the victim has fluid, blood, vomit or food in his mouth, roll him on his side with his arm under his head.
  • Stop any bleeding by putting pressure on the wound.
  • If the victim stops breathing, start CPR.
  • Gather the victim's medications if available and lock up any dogs they may have.

Some conditions have special considerations:

  • Seizures
  • Low blood sugar
  • Anaphylaxis
  • Shortness of breath

When the Ambulance Isn't Coming

elderly patient gauze wrap


The ABCs up to this point assume that an ambulance is on the way or the hospital is not far. Sometimes, however, you're on your own for much longer. If that's the case, now's the time to treat simple injuries.

Injuries that need immediate care:

  • Amputations
  • Bee stings
  • Bleeding
  • Burns
  • Head Injuries
  • Snake bites

Exposure injuries (too hot or too cold) that need immediate treatment:

  • Heat illness (heat exhaustion and heat stroke)
  • Hypothermia

Injuries that can wait, unless you absolutely have to treat them:

  • Frostbite (do not thaw unless no chance of being frozen again)
  • Broken bones (only splint if you have to move the victim)

Dress wounds as needed (focus on the big stuff; little things can wait).

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  • Markenson D, Ferguson JD, Chameides L, Cassan P, Chung K-L, Epstein J, Gonzales L, Herrington RA, Pellegrino JL, Ratcliff N, Singer A. "Part 17: First Aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid." Circulation. 2010;122(suppl 3):S934 -S946.

  • Merchant RM, Topjian AA, Panchal AR, et al. Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2). doi:10.1161/CIR.0000000000000918

  • Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Circulation. 2010;122(suppl 3):S640-S656.

By Rod Brouhard, EMT-P
Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.