Wilderness First Responder Guide: How to Perform the ABCDE Primary Survey

When you're the first responder in a remote environment, knowing how to quickly assess and respond to life-threatening injuries is vital. The ABCDE Primary Survey gives you a structured approach to rapidly evaluate a patient’s condition and prioritize treatment in the field. Whether you're deep in the mountains or miles from the nearest road, this assessment could save a life.

What Is the Goal of the Primary Survey?

The goal of the Primary Survey is to identify and treat conditions that pose an immediate threat to life. It’s the first step in managing trauma or medical emergencies in wilderness settings.

This systematic approach is especially important when dealing with:

• An altered level of consciousness

• Significant trauma or visible injuries

• Unknown medical conditions in remote locations

ABCDE: A Systematic Approach to Wilderness Emergency Response

Approaching a victim using the ABCDE acronym allows you to address critical threats in order of importance. The steps are:

• A – Airway

• B – Breathing

• C – Circulation

• D – Disability

• E – Environment (or Exposure)

Even if a patient appears alert and stable, this survey should be used. For those who appear well, it can be brief. For those who don’t — every second counts. If you find a life-threatening issue during this assessment, stop and treat it before moving on.

Airway: First Priority in the Field

The first step is to check the airway. A clear airway ensures oxygen can reach the lungs and carbon dioxide can be expelled. Signs of obstruction might include:

• Blood, vomit, or foreign objects in the mouth

• Inability to speak

• Gurgling, choking, or silence

If the patient is conscious, have them talk to you. If they can speak clearly, their airway is likely open. If not, clear visible obstructions and use the head-tilt, chin-lift technique to open the airway.

Breathing: Ensure Oxygen Is Reaching the Lungs

After confirming an open airway, observe the patient’s breathing:

• Is the chest rising and falling evenly?

• Are they breathing too fast, too slow, or gasping?

• Are breath sounds clear or labored?

If the patient isn’t breathing or is struggling, assist with rescue breathing or other interventions. In some cases, supplemental oxygen (if available) may be appropriate.

Circulation: Check for Pulse and Bleeding

With the airway and breathing stabilized, move to circulation. Key checks include:

• Presence or absence of a pulse

• Skin color and temperature

• Major bleeding or shock

If there’s no pulse, begin CPR immediately. If there is visible bleeding, apply direct pressure and control it before proceeding. Keep an eye out for signs of internal bleeding or hypovolemic shock.

Disability: Rapid Neurological Check

Once the ABCs are addressed, assess the patient’s disability or neurological status. You're checking:

• Responsiveness and level of consciousness

• Movement of fingers and toes

• Pupil size and reactivity

• Confusion or disorientation

Use tools like AVPU (Alert, Verbal, Pain, Unresponsive) or Glasgow Coma Scale if you're trained. Even a brief neuro check can give you critical insight into head trauma or stroke.

Exposure/Environment: Protect From Further Harm

The final step is to consider environmental factors. Exposure to cold, heat, or wet conditions can quickly turn bad to worse.

Check for:

• Hypothermia or hyperthermia

• Wet clothing or environmental hazards

• Visible injuries you might’ve missed

Dry the patient if they’re wet, provide warmth, shade, or shelter depending on the conditions, and be aware of your surroundings.

Why ABCDE Matters in Wilderness First Response

As a Wilderness First Responder, you’ll often be the first (and only) person capable of medical care on scene. In environments far from definitive care, the ABCDE Primary Survey is your anchor. It helps you prioritize, avoid tunnel vision, and prevent small issues from becoming fatal.

This structured approach ensures:

• No aspect of care is overlooked

• Life-threatening conditions are treated in order of severity

• You stay calm and focused under pressure