Inadequate ABC assessment

Can you confidently confirm that the airway is open with normal quiet breathing and that the breathing has adequate ventilation/respiratory effort? If not, you must move the casualty into a better position to be sure.

If unconscious, the airway can be blocked by the soft tissues due to the position of the head and neck, e.g. with the head bent forward or by bleeding from facial injuries. Unless the airway is opened, oxygen will not get into the lungs and the athlete may die. It may be that the effect of gravity on a face down casualty means the floppy tongue falls forward and does not obstruct the airway so does not need to be moved, or the face pressed against the floor may force the tongue back to cause on obstruction. Assess each case individually before deciding if they need to be moved.

Airway assessment is covered in greater detail in a dedicated earlier chapter.

Paralysed breathing muscles from a spinal cord injury will lead to inefficient breathing and ventilation, leading to lack of oxygen and ultimately unconsciousness and cardiac arrest. If the ineffective breathing isn’t identified early and addressed, then the casualty may die.

If you are unhappy with the ABCDE assessment and think you need to improve the airway, it is acceptable to change the position of the athlete in order to attempt to do so. This may be an emergency roll to allow you to perform an airway manoeuvre such as jaw thrust, or position the casualty so that blood or vomit can freely drain away from the airway.