Before reading through this document please read the disclaimer at the end.

Many people have no problem reciting their “ABC’s”, the 26 letters of the English alphabet, even if their first language is not English.
But, when there is an emergency and the “adrenaline pumps”, a person can even forget their own name! Hence, learning and practicing the steps in the “Emergency Alphabet™” may help to simplify the most important steps to follow when there is a medical emergency.

This is why there are only 6 letters in the “Emergency Alphabet”:
H-H-H-A-B-C

There are many different variations of these steps such as SRABC, or SABC, or ABCD but for me HHHABC has become the method I have come to prefer. Usually these steps take place almost simultaneously (e.g. while someone is phoning for an ambulance another person can check the victim’s airway).
It is important to follow the sequence of letters in the order that they appear; complete each step as best you can before commencing the next step. More often than not several steps can be achieved simultaneously.

Reading through this article by no means qualifies anyone to do any of the steps in this article; however, it can be used as a reminder and a guideline. Obviously it’s always best to complete an approved and accredited course with a reputable training institution – Emergency First Aid and CPR are comprised of practical interventions and hence it needs to be practiced under the guidance of a qualified instructor.

The first step in the “Emergency Alphabet” is “Hazards”. Helping in an emergency can be hazardous even after our best efforts but we can always work at making it safer.
Don’t become a patient yourself. Too often people who rush in to assist become injured and then ultimately hamper the rescue efforts, thwarting their well meaning intentions.
It is imperative that you learn to use as many senses as possible to ascertain whether or not it will be safe to proceed and help a victim. The specific senses are:

• Smell: e.g. flammable gasses, smoke etc
• Sight: e.g. oncoming traffic, criminals, aggressive dogs etc.
• Sound: e.g. skidding noise from a car braking, shouted warnings from bystanders etc.
• Touch: e.g. before opening a door of a burning building a fireman will touch the door with the back of his hand – if the door is hot then it may be best to leave the door closed and seek an alternative entrance / exit
• The “sixth” sense: e.g. listen to the “small, still voice” of reason and warning sometimes referred to as your conscience

It is impossible to go through all the different potential hazards, each and every emergency situation is unique; it is up to you to ensure that the scene is made as safe as possible.
Here are three examples that will hopefully tweak your awareness and get you thinking laterally:

a. Scenario 1: You come across a motor vehicle accident that has just happened in the fast lane of a three lane highway where the speed limit is 120km per hour. You decide you want to help. Below is a list of some dangers to consider:
i. Other cars coming behind you at 120km (and more) so you must consider protecting the scene. Use your hazard lights to warn oncoming vehicles to slow down; turn on your headlights even if it’s daytime (it’s an extra warning).
ii. Glass
iii. Oil
iv. Flammable Liquids
v. Hazardous cargo in the vehicle (e.g. snakes, chemicals etc.)
vi. Fire
Use your imagination; a motor vehicle accident has many potential hazards – stay alert and continually re-evaluate the safety of the scenario.

Consider the dangers in the following two examples:

b. Scenario 2: You arrive at a friend’s house and notice that the front door has been broken open. Before entering you peer through the lounge window and see your friend lying on the floor in a pool of blood apparently unconscious. You deduce that the friend may have been attacked.
This is a frightening situation to be faced with! Obviously your first reaction may be to rush in and help stop the bleeding and provide CPR if required… but what if the attacker is still in the house? The attacker would not want you to help the eye witness to the event to survive. You may also become injured and then the police would not be called and when the ambulance does eventually arrive they will need to share the resources to treat 2 patients instead of just one.
As difficult as this may be it may be best to call the police first and let them ensure that the scene is safe before you proceed. The number for the Flying Squad (Police) call centre in South Africa is 10111.

c. Scenario 3: Your mother-in-law is working in the kitchen when she suddenly collapses. You remember that she has a very protective dog called Ben that probably weighs more than you do (a cross between a German Shepherd and a bear). Perhaps it would be best to first entice the dog away from the kitchen before you start clambering all over his owner.

Use your imagination for the rest of these scenarios and think of some potential hazards:
d. Scenario 4: A burning building
e. Scenario 5: A chemical manufacturer
f. Scenario 6: A Nightclub
g. Scenario 7: A child stuck in a tree
h. Scenario 8: A person who fell down a mountainside

(Go back to the “Emergency Alphabet” List)

2. Hello

Once you have made the scene safer the second step in the “Emergency Alphabet” is “Hello”. This may sound obvious but is often neglected:
a. When you say hello to bystanders you, in essence, you commence introducing yourself and start gaining the trust of people around the scene.
b. There may already be someone assisting the victim and this person may be higher qualified than you.
c. Saying “Hello” to the patient is also very important: It can help you ascertain their level of consciousness and also acquire their consent for you to help them.
d. You will be able to gauge the severity of the incident and this will guide you in what help to call for – the next letter in the “Emergency Alphabet”.

(Go back to the “Emergency Alphabet” List)

3. Help

Once you have said “Hello” and assessed the severity of the scene you should call for help. Phone the emergency services as soon as possible. When in doubt: phone! I’ve heard it being said, “Rather phone 100 times too many than 1 time too few!” I agree.
Unfortunately the list of emergency telephone numbers in South Africa is extensive.
If it were me and my loved one was in a life-threatening emergency I would call all these numbers. This will increase the chances of a prompt response time. There are almost always bystanders and family members who are willing to help in anyway they can; for this reason I teach all these numbers but obviously emphasise the free numbers (112 on a cell phone and 10177 on a landline).
I implore you to do the same: Memorise all these numbers and allocate numbers to willing helpers:

(Go back to the “Emergency Alphabet” List)

4. Airway

Once you have called for help and are sure that an ambulance is on its way you should check that the patient’s airway is “opened, maintained, and protected”.
a. If the patient is unconscious and you do not suspect a neck injury you would perform what is called a “head-tilt chin-lift” manoeuvre. This manoeuvre is usually sufficient to open, maintain, and somewhat protect the airway.
b. If the patient is breathing effectively and normally but unresponsive you should turn the patient on his / her side. This position is called the “recovery position”.

(Go back to the “Emergency Alphabet” List)

Once you have opened the patient’s airway you need to lower your ear to about 3 cm from the patient’s mouth, looking toward the patient’s chest so that you can look, listen and feel for breathing for about 10 seconds. It could be difficult to check the patient’s breathing effectiveness this is why we take 10 seconds and we use three senses:
a. Look: Look toward the patient’s chest and look to see if the chest and stomach rise and fall with breathing effort.
b. Listen: Listen for air movement through the patient’s mouth and nose.
c. Feel: Feel for air movement from the patient’s breathing attempts with the side of your cheek that should be about 3 cm away from the patient’s mouth and nose.

If the patient is not breathing you would provide two effective artificial breaths (sometimes called “rescue breaths”):
1. While keeping the patient’s airway open, pinch their nose shut with your thumb and forefinger of the hand closest to the head.
2. The tips of the fingers of the other hand (nearest the patient’s chest) are used to lift the chin upwards.
3. Place your mouth over the patient’s mouth and gently give two breaths. This will require you to confidently open your mouth wide and seal your lips well over the patient’s lips to form an effective seal so that air does not escape as you exhale into the patient’s lungs.
4. Ensure that the patient’s chest rises with each rescue breath.
5. After each breath take your mouth off the patient’s mouth and turn your face toward the patient’s chest for about 2 seconds to allow the air to escape.
6. When giving breaths consider using a barrier device.

You will know if your attempts at giving rescue breaths are sufficient if you see the patient’s chest rise with each rescue breath. If you do not see the chest rise, then make one extra attempt by re-opening the airway properly (usually by more confidently tilting the patient’s head a little further back).
If this still does not work don’t delay any longer: move on to the next step… “Circulation”.

(Go back to the “Emergency Alphabet” List)

Once you have given (or attempted to give) two effective artificial breaths check if the patient has any of the following signs of Circulation :
a. Coughing
b. Movement
c. Normal breathing (“agonal” breaths or an occasional gasp is not normal)

If there are no signs of circulation then perform chest compressions:
1. Place the base of the palm of one hand on the centre of the patient’s chest (the sternum / breast bone) between the nipple line
2. Place your other hand on top of the first hand (sometimes it helps to interlock the fingers and preferably keep the fingers of the bottom hand straight)
3. Press down perpendicularly on the middle of patient’s chest (directly toward the ground) to a depth of about half the patient’s chest depth – avoid putting any pressure on the ribs.
4. Perform 30 chest compressions in a row at a rate of about 100 per minute.
5. Once you have performed 30 chest compressions (pushes on the chest) give another 2 rescue breaths.
6. Alternate 30 chest compressions with 2 rescue breaths.
7. Continue with “CPR” until the patient has signs of circulation (in which case you would place the patient in the recovery position) or until a medically qualified and certified person takes over from you. (the pulse check is only taught on healthcare provider courses).

(Go back to the “Emergency Alphabet” List)