Assessing an Emergency & the Unresponsive Child

In the primary survey known as DR ABC, what do the letters stand for, in order?

• ADanger, Response, Airway, Breathing, Circulation✓
• BDanger, Response, Assess, Breathing, Consciousness
• CDial, Respond, Airway, Bandage, Comfort
• DDanger, Rescue, Assess, Bleeding, Call

Answer: The primary survey checks for danger, then the child's response, then the airway, breathing and circulation, which for a first aider means looking for severe bleeding. The other sequences mix in steps such as bandaging, dialling or assessing consciousness that are not the letters of DR ABC, and they put actions out of the life-saving order.

You find a child lying still beneath the climbing frame while other children are still swinging above him. What should you do first?

• AShake the child firmly by the shoulders and shout his name
• BMake sure the area is safe for you and the child✓
• CTilt the child's head back and look inside his mouth
• DCarry the child indoors and lay him on a soft mat

Answer: Checking for danger comes before anything else so that you do not become a casualty yourself and the child is not hurt again, which here means stopping the other children and clearing the space. Shaking a child is not how response is assessed, opening the airway comes only after danger and response have been checked, and moving a possibly injured child without need is unsafe.

How should a trained paediatric first aider check whether a collapsed child is responsive?

• APinch the earlobe hard and watch for a flinch
• BPress hard on a fingernail and shout their name
• CRub the breastbone with your knuckles until they react
• DTalk to them loudly and gently stimulate them by touch✓

Answer: Response is assessed with verbal and tactile stimulation, speaking loudly and stimulating gently, and painful stimuli are never used on a child. Pinching, rubbing the sternum with knuckles and pressing a nail bed are all painful methods that the guidelines rule out.

An eight-month-old baby is unresponsive. How should you position her head to open the airway?

• AHold the head in the neutral position and lift the chin with two fingers on the bony chin✓
• BTurn the head to one side and press upwards on the soft tissue beneath the chin
• CTilt the head as far back as it will go and lift the chin with your thumb hooked under the jaw
• DRest the head on a folded towel and hold the mouth open with one finger on the tongue

Answer: For an infant the head is kept in the neutral position with only a slight tilt, and the chin is lifted with two fingers placed on the bony part so that the soft tissues under the jaw are not pressed and the airway is not blocked. Full head extension is for adolescents, pressing the soft tissue closes the airway, and a towel under the head or a finger on the tongue does not open it.

After using head tilt and chin lift on an unresponsive four-year-old, for how long should you look, listen and feel for normal breathing?

• AFor up to 10 seconds✓
• BFor exactly 5 seconds
• CFor up to 30 seconds
• DFor at least 20 seconds

Answer: With the airway open by head tilt and chin lift, breathing and signs of life are checked for no longer than 10 seconds so that rescue breaths and compressions are not delayed. Waiting 20 or 30 seconds wastes time in a child who may not be breathing, and a rigid 5-second check is not what the guidelines specify.

An unresponsive child is making occasional slow gasps and you cannot decide whether this is normal breathing. What should you do?

• AAct as though they are not breathing normally and begin CPR✓
• BWait another 30 seconds and then reassess the breathing
• CPlace them in the recovery position and keep watching
• DSit them upright so that the gasping can settle down

Answer: The guidelines are clear that if there is any doubt about whether breathing is normal, the rescuer should act as if it is not, because occasional gasps are not effective breathing. Delaying to reassess, putting the child in the recovery position or sitting them up would postpone the rescue breaths and compressions the child needs.

You are a trained paediatric first aider alone with an unresponsive child and you have your mobile phone. When and how should you call 999?

• AAfter completing the secondary survey, from the landline in the office
• BImmediately, using the phone's speaker function so your hands stay free✓
• CAfter one minute of CPR, holding the phone to your ear between compressions
• DAfter five rescue breaths, by sending a text to the emergency SMS service

Answer: A trained rescuer with a mobile calls the ambulance service straight away on speaker so that CPR can start while the call handler gives instructions, and some services also offer a video link. One minute of CPR before calling applies only when there is no phone to hand, and leaving the child to use a landline or delaying until the secondary survey would lose vital time.

You are alone with an unresponsive baby who is not breathing normally, and there is no phone within reach. What should you do?

• AGive CPR for five minutes, then carry the baby to the nearest adult
• BShout for help and wait beside the baby until someone arrives
• CGive about one minute of CPR before leaving to get help✓
• DLeave straight away to find a phone, then come back and start CPR

Answer: A single rescuer without a phone performs one minute of CPR first and only then leaves to summon help, so that the baby receives rescue breaths and compressions without delay. Leaving immediately delays that first minute, five minutes is far longer than recommended, and simply waiting gives the baby no treatment at all.

An unresponsive three-year-old is breathing normally and shows no sign of injury. What should you do while waiting for the ambulance?

• APlace them in the recovery position and check their breathing at least every minute✓
• BRoll them onto their front with the face down on the mat and check breathing every five minutes
• CLay them flat on their back with a cushion under the head and check breathing every ten minutes
• DSit them up against a wall with the head forward and watch for any vomiting

Answer: The recovery position keeps the airway open and lets vomit drain, and breathing must be checked continuously or at least every minute in case it stops. Lying flat on the back with the head raised can block the airway, sitting an unresponsive child up does not protect it, and lying face down with checks only every five or ten minutes risks missing a change.

In which situation should you avoid turning an unresponsive breathing child into the recovery position?

• AWhen the child fell from height and may have a neck or back injury✓
• BWhen the child is under five years old and small enough to lift
• CWhen the child has just been sick and there is still vomit in the mouth
• DWhen the child is lying on a hard floor rather than a soft mat

Answer: The recovery position is not used where trauma such as a spinal injury is suspected; instead the head is held still in line with the body and the child is moved only if the airway is at risk. Vomiting is actually a reason to use the recovery position, and neither the child's age nor the surface they are lying on rules it out.

A six-month-old baby is unresponsive but breathing normally. How can you keep him in a recovery position?

• ALay him face down on a firm mat, with the head turned to one side
• BHold him in your arms with the head tilted downwards, supporting the head and neck✓
• CSit him upright in a car seat, with the straps loosened so the chin drops forward
• DLay him on his back in a cot, with the head raised on a folded blanket

Answer: A baby can be held in the recovery position in your arms with the head tilted downwards so that the airway stays clear and any vomit drains, while you support the head and neck. Lying on the back with the head raised, sitting in a car seat with the chin dropped, or lying face down on a mat do not protect the airway of an unresponsive baby.

A child you placed in the recovery position was breathing normally, but you are now not sure whether she is still breathing. What should you do?

• ALift her into a sitting position and pat her firmly on the back
• BTurn her onto her back and open the airway again to check✓
• CWait for the ambulance crew to arrive before moving her at all
• DLeave her where she is and press on the chest to feel for movement

Answer: If you are unsure about the position or the breathing, the guidelines say to turn the child onto their back and re-open the airway so that breathing can be properly reassessed and CPR started if needed. Pressing on the chest in the recovery position is not a reliable check, sitting her up does nothing for the airway, and waiting for the crew could leave a child who has stopped breathing untreated.

When does a first aider carry out the secondary survey?

• AOnly when the child is fully conscious and able to describe their symptoms clearly
• BOnce any life-threatening problems found in the primary survey have been dealt with✓
• COnly after the ambulance crew has arrived and formally taken over the child's care
• DBefore the primary survey, so that all injuries are known before the airway is checked

Answer: The secondary survey, a check for other injuries and illness, follows the primary survey and begins only when the life-threatening problems it revealed have been managed. Looking for other injuries before the airway and breathing are secured puts the child at risk, and the survey does not depend on the crew arriving or the child being able to talk.

Two children collide on the playground. One is crying loudly with a bleeding nose; the other is silent and not moving. Which child do you go to first, and why?

• AThe crying child, because a child who is making noise is the more distressed of the two
• BWhichever child is nearer, because the order of treatment makes no difference in practice
• CThe silent child, because an unresponsive child who may not be breathing takes priority✓
• DThe crying child, because visible bleeding must always be stopped before anything else

Answer: When there are several casualties the first aider prioritises the one whose life is most at risk, and a silent, motionless child may be unresponsive and not breathing, whereas a child crying loudly clearly has an open airway and is breathing. A nosebleed is not immediately life-threatening, distress is not the same as danger, and treating whoever is nearest ignores the priority the primary survey is designed to set.