This article elaborates the core principles & components of Basic Emergency Care (BEC) developed by the WHO, highlighting the significance of scene safety, the systematic ABCDE approach for emergency patient assessment & treatment, also the essential management measures. 

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The World Health Organization (WHO) has released a set of Basic Emergency Care guidelines known as the Basic Emergency Care (BEC), which was developed by the International Committee for the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM).

First contact healthcare providers, who have limited resources to handle acute sickness and injury, should approach the sick and wounded. Strong integrated health services rely on first-contact health professionals who are well-trained to provide prompt, high-quality treatment. Early intervention may save lives in time-sensitive, critical circumstances.

BEC gives a systematic approach to this process. Preparing and assisting all healthcare professionals in giving emergency treatment to critically sick patients is the content's main objective. The ABCDE approach is used throughout the Basic Emergency Care course.

Crucial Skills: When using the ABCDE technique, there are crucial practical skills for patient evaluation and care.

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ABCDE strategy

Patients' lives must be saved by early detection of life-threatening illnesses. Every patient is approached methodically using the ABCDE strategy, which helps to quickly handle the most urgent problems by early detection of life-threatening ones.

Prioritising interventions based on their level of importance ensures that any issues are resolved before moving on. By using the ABCDE method, one may make sure that breathing and circulation are sufficient to provide the body with oxygen and that the airway remains open.

This will guarantee that every patient is treated consistently and methodically and that medical professionals can communicate using the common ABCDE terminology.

The first step

1. Maintaining the safety of yourself, the patient and other people is the most crucial aspect of the first care of any sick or wounded patient. The safety of the scenario must come first when approaching a patient.
2. Should you become sick or sustain an injury, you will not be able to help others and will end up as an additional patient for other emergency personnel. Scene safety entails assessing the potential for violence, contagious diseases, and hazardous scenes.
3. Fire, chemical spills, and auto accidents are a few examples of hazards that might jeopardize your personal safety and your capacity to provide patient care.
4. When arranging for a transfer, dealing with a number of very sick or wounded patients, or in the case of an infectious epidemic or hazardous exposure, never hesitate to seek assistance promptly.

Safety

1. Before evaluating the patient, put on the proper personal protective equipment to shield yourself from infectious dangers.
2. Think about the PPE that is appropriate for the job in each circumstance. Gloves, eye protection, a gown, and a mask could be part of this.
3. Decontamination and cleaning are crucial. After every patient interaction, wash your hands with soap and water or use an alcohol gel cleaner.
4. For chemical exposures, clean or disinfect surfaces and consult local decontamination procedures.

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ABC Elements

This is a summary of the ABCDE approach's components. Although the letters are arranged alphabetically in English, their arrangement really indicates the importance of identifying life-threatening illnesses.

1. Airway: As you approach, you must look for and remove any obstructions that may be preventing air from reaching the lungs. We assess the airway first since a life-threatening illness affecting it might result in death within minutes. Immobilise the cervical spine if there has been trauma in order to stop potentially fatal subsequent injuries.
2. Breathing: You must make sure that enough air is entering the lungs.
3. Circulation: Here, assess the level of perfusion necessary to provide oxygen to the organs and look for any indications of potentially fatal haemorrhage.

Components DE

1. Disability: Here, you evaluate and safeguard spinal and brain functioning. There will be information about AVPU and GCS, as well as how to check your eyes and deal with low blood sugar.
2. Exposure: The patient must be thoroughly exposed in order to detect any injuries, disease indicators, and environmental dangers. It's critical to prevent hypothermia.

Keep in mind always to look for signs of trauma in each ABCDE segment.

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A- Airway

Airway evaluation

An easy method to start evaluating a patient's airway is to find out whether they can speak normally. When they are able to communicate regularly, the airway is open. If the patient is not speaking properly, look into possible causes.

Look for and hear fluid in the airway, and listen for any unusual noises that could indicate a blockage of the airway.

Examine the patient for any foreign bodies, any swelling in the airway, and if they are able to swallow their saliva. Look for any indications of a changed mental state, such as fatigue or bewilderment. whether the patient is unable to speak, listen for any movement of air coming from the mouth or nose, feel for movement in the chest wall, and observe whether the patient is breathing.

As soon as you find any issues, begin managing them. As you can see, we are doing our evaluation utilising the "look, listen, and feel approach," and we will continue to do so for all aspects of the ABCDE approach.

Airway management

1. You must open the patient's airway if they are unconscious and not breathing regularly.
2. The head-tilt/chin-lift manoeuvre may be used to open the airway if there is no reason to suspect damage.
3. If there is a possibility of trauma, the jaw-thrust manoeuvre and cervical spine immobilisation must be employed.
4. The cervical spine is kept from moving by using the jaw thrust manoeuvre. Consider putting an airway device in place to keep the patient's airway open if their degree of awareness is diminished.
5. An oropharyngeal and nasopharyngeal airway are examples of airway devices.

Airway choking

1. When the airway becomes blocked, choking occurs. It is urgent to clear the obstruction.
2. Examine inside the mouth if a foreign body is suspected, and remove it gently if it is seen.
3. Remain calm while encouraging the patient to cough if they are able to.
4. To release the obstruction, use age-appropriate back blows, abdominal thrusts, and chest thrusts if the patient is unable to cough or produce noises.
5. In the event that the patient passes out, do CPR as directed.

Airway secretions

1. If secretions are present, gently suction the airway or wipe it clean since they may restrict it.
2. Consider putting the patient in the recovery position on their side, which helps to maintain the airway open and enables secretions to drain more easily, if there is no trauma and the rest of the ABCDE is normal.
3. If you have stridor, a high-pitched noise, or observe swelling or hives, you should be evaluated for anaphylaxis, a severe allergic response.
4. The first line of therapy for a severe allergic response is intramuscular adrenaline.
5. To help with breathing, let the patient remain in a comfortable posture. Since these patients might become sick rapidly, being ready to give them over or transfer them to a facility with sophisticated airway treatment.

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B- Breathing

Breathing evaluation

The breathing assessment uses the same procedures as the airway exam: look, listen, and feel.

1. To determine if the patient is breathing, first look, listen, and feel them. Then, determine whether their breathing is shallow, rapid, or neither. Keep an eye out for symptoms of harder breathing.
2. These symptoms include irregular motions of the chest wall, nasal flaring, indrawing of the chest, and usage of auxiliary muscles. Pay close attention to any unusual breath noises.
3. Keep in mind that a silent chest may not be typical since severe airway restriction associated with wheezing might prevent audible breath sounds.
4. Check, listen, and evaluate breathing. Check to verify whether breath sounds are equal on both sides of the chest by listening. If one side is not making any breath noises, pound your chest and pay attention to the sound.
5. Consider if a substantial pleural effusion or haemothorax may be the cause of the dull sound with percussion on the same side as the missing breath sounds.
6. Consider a tension pneumothorax if there is hyper-resonance along with hypotension, dilated neck veins, or tracheal shift. Look up the oxygen saturation using a pulse oximeter if one is available.

Breathing management

1. Breathing abnormalities need to be promptly recognised and treated.
2. Follow CPR procedures and begin bag-mask ventilation with oxygen if available if the patient is unconscious and breathing abnormally or not at all.
3. In the event that the patient's breathing is insufficient—either too shallow or too slow—start oxygen bag-mask ventilation. Ventilation should not be delayed if oxygen is not immediately supplied.
4. Make plans for an instantaneous airway management transition.

Breathing control

1. Provide oxygen if the patient is breathing too fast or is hypoxic, and salbutamol if they are wheezing.
2. Anaphylaxis may cause wheezing; if this is concerning, provide injectable adrenaline.
3. Give oxygen and IV fluids, conduct needle decompression, and monitor for tension pneumothorax.
4. Make plans to transfer a chest tube right away. Interventions for a haemothorax or pleural effusion include oxygen and a chest tube. Consider the likelihood of trauma if the reason for the respiratory irregularity is unclear.

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C- Circulation

Circulation assessment

1. Use the look, listen, and feel method to evaluate the patient's circulation.
2. Examine the patient's skin and feel their limbs for indications of inadequate blood flow.
3. These symptoms include capillary refill times longer than three seconds and chilly, damp hands and feet.
4. Look for signs of low blood pressure, tachycardia (fast heartbeat), tachypnea (rapid breathing), and missing pulses.

Assessment of circulation

1. Look, and check patients may have bleeding from internal or exterior wounds, and hemorrhagic shock is a possibility.
2. Seek indications of bleeding both inside and externally.
3. Keep an eye out for symptoms of bleeding from wounds, from a pelvic fracture, from a femur fracture, from the stomach or intestines, and from the chest.
4. Pericardial tamponade may manifest as hypotension, dilated neck veins, and attenuated cardiac tones.
5. Verify the blood pressure of the patient.

Circulation management

1. Adhere to your appropriate CPR methods if the patient is experiencing cardiopulmonary arrest.
2. Give oxygen and intravenous fluids if you see symptoms of inadequate perfusion.
3. Use direct pressure or other bleeding control methods for external bleeding.
4. When a patient is uncontrollably bleeding from the outside, or if internal bleeding or pericardial tamponade is suspected, get professional assistance and send them right away to a facility that does surgery.
5. It is necessary to take complete control of any bleeding source. For pelvic fractures, splint femur fractures, and fractures where blood flow is impaired, use an external binder. Remember the risk of trauma if the reason for the poor perfusion is unclear.

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D- Disability

Disability assessment

1. The Glasgow Coma Scale or the AVPU (Alert, Voice, Pain, Unresponsive) scale is used to gauge the patient's degree of consciousness in trauma situations.
2.  A frequent cause of altered mental state is hypoglycemia.
3. When a patient is unconscious or disoriented, always check their blood sugar level.
4. Examine the pupil for any anomalies in size, response to light or equality, and feeling and movement in all limbs as part of your impairment evaluation.
5. During your examination, keep an eye out for any unusual, repeated shaking or motions on one or both sides of the body that can indicate convulsions or seizures.

Disability management 1

1. You may begin managing the patient based on the results of your examination.
2. The patient may be put in the recovery position if there is no trauma, no changed mental state, and no more abnormalities discovered during the ACBDE assessment.
3. Give glucose to treat hypoglycemia if the patient has changed mental state and the blood glucose level is low or you are unable to monitor.
4. Give the patient a benzodiazepine if they are actively convulsing. If the patient is experiencing seizures and is pregnant, consider eclampsia and provide magnesium sulphate.

Disability management 2

1. Small pupils, sluggish respiration, and altered mental state may all result from an opioid overdose. The remedy for an opioid overdose is naloxone.
2. Unequal pupils may be the result of increased cerebral pressure. If a spinal injury is not a worry, raising the head of the bed by thirty degrees may assist in relieving pressure.
3. Patients exhibiting indications of elevated cerebral pressure should be referred and transferred as soon as possible.
4. Consider trauma if the reason for the changed mental state is unclear, and immobilise the cervical spine if necessary.

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E- Exposure assessment

1. To find any concealed bites, rashes, injuries, or lesions, you must expose your patient throughout this process.
2. As you thoroughly examine the patient's complete body, remember to respect their dignity.
3. Examine and feel for any rashes that may be signs of an infection or hives, which might be signs of an allergic response.

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Risk management for exposure

A snake bite may be fatal. Immobilise the affected limb if you suspect a snake bite.

1. Take a photograph of the snake if it's safe to do so and email it to the hospital that refers patients instead of putting yourself in danger to capture the snake.
2. Make careful to take off any jewellery and clothes that restrict movement.
3. This is crucial if there is a limb injury or burns that may enlarge.
4. Patients who are severely wounded or unwell may not be able to control their body temperature.
5. By keeping the patient covered, taking off wet clothes, and drying the patient, hypothermia may be prevented.
6. During exposure, show the patient respect and keep your modesty safe.
7. Use the log roll method to turn the patient if there is a possibility of trauma or spinal cord damage.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.