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S-CABCDE Assessment

Civilian Systematic Trauma Assessment — EMS / PHTLS Standard

S
Scene Safety
  • 360° scan before approach — traffic, fire, structural, hazmat, violence
  • Establish safety perimeter, redirect bystanders
  • Call emergency services first — 112 / 999 / 911
  • Don PPE: gloves, eye protection, hi-vis if available
⚡ 10-second 360° scan before you step in. You can't help anyone as a second casualty.
C
Catastrophic Hemorrhage
  • Tourniquet for life-threatening limb bleeding — proximal to wound, note time
  • Direct pressure for all other major bleeds — firm, sustained
  • Wound packing with hemostatic dressing for deep wounds
  • Do not remove dressings — add more on top if soaked through
⚡ Same as MARCH 'M' — hemorrhage kills faster than airway in most trauma.
A
Airway
  • Talking? → airway patent — monitor and move on
  • No spinal concern: head-tilt chin-lift
  • Spinal concern (fall, MVA, blunt): jaw thrust only — no neck extension
  • Suction blood/vomit; OPA if no gag reflex, NPA if gag present
⚡ Any significant blunt mechanism = assume spinal involvement until proven otherwise.
B
Breathing
  • Rate (12–20/min), depth, symmetry, accessory muscle use
  • Auscultate: absent one side = pneumothorax or hemothorax
  • SpO₂: target >94% (>88% in known COPD)
  • Open chest wound → vented chest seal; tension PTX → needle decompression
⚡ Tachypnea + unilateral absent sounds + hypotension = tension pneumothorax. Needle now.
C
Circulation
  • HR, BP, cap refill (<2 sec), skin colour and temp
  • Class III shock: HR >120, hypotension, confusion, mottled skin
  • IV/IO access — 18G antecubital or IO proximal tibia
  • Permissive hypotension in haemorrhagic shock — target radial pulse, not a number
⚡ Class I–II shock is easy to miss. Tachycardia alone with mechanism = treat aggressively.
D
Disability (Neurological)
  • AVPU: Alert / responds to Voice / responds to Pain / Unresponsive
  • GCS ≤8 → manage airway, consider intubation
  • Pupils: equal and reactive normal; unequal fixed = raised ICP emergency
  • Blood glucose — hypoglycaemia mimics TBI; treat <4 mmol/L (72 mg/dL)
⚡ Always check glucose. A confused trauma patient might just need 10mL of 50% dextrose.
E
Exposure / Environment
  • Cut all clothing — inspect entire body surface, front and back
  • Log roll to assess spine, back, buttocks — 3-person technique ideally
  • Check axillae, groin, perineum — commonly missed injury sites
  • Cover immediately after inspection — prevent hypothermia
⚡ Expose last — don't let dramatic injuries distract you from completing A–D first.
Train online at medready.io — TCCC scenarios
Training reference only · PHTLS / ATLS Standards