The sequence of care – do new methods warrant a shift from the standard ABC to a CABC approach?


primary survey
ABC algorithm
emergency medical technician (EMT)
emergency medical service (EMS)

How to Cite

Whitfield S. The sequence of care – do new methods warrant a shift from the standard ABC to a CABC approach?. Australasian Journal of Paramedicine [Internet]. 2019Jul.8 [cited 2021Dec.4];160. Available from:


Adaptions and change are vital to the development of pre-hospital care. Emerging evidence-based practices ensure best patient care. The Airway, Breathing, Circulation (ABC) sequence of care in pre-hospital environment is ignoring a vital step in trauma support. This commentary provides an evidence-based discussion and explores the appropriateness of the current ABC sequence of care.


Johnson M, Boyd L, Grantham H, Eastwood K. Paramedic principles and practice ANZ. Elsevier; 2015, p. 36-8.

Fisher J, Brown S, Cooke M, et al. UK ambulance services clinical practice guidelines 2013. Bridgwater: Class Professional Publishing; 2013.

Hodgetts T, Mahoney P, Russell M, Byers M. ABC to ABC: redefining the military trauma paradigm. Emerg Med J 2006;23:745-6.

Lenzer J. Peter Josef Safar. BMJ 2003;327:624.

Carmont M. The advanced trauma life support course: a history of its development and review of related literature. Postgrad Med J 2005;81:87-91.

Thim T, Krarup N, Grove E, Rohde C, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med 2012;5:117-21.

Ferrada P, Callcut R, Skarupa D, et al. Circulation first – the time has come to question the sequencing of care in the ABCs of trauma; an American Association for the Surgery of Trauma multicenter trial. World J Emerg Surg 2018;13:8.

Kragh J, Dubick M, Aden J, et al. U.S. military use of tourniquets from 2001 to 2010. Prehosp Emerg Care 2014;19:184-90.

Welling D, McKay P, Rasmussen T, Rich N. A brief history of the tourniquet. J Vasc Surg 2012;55:286-90.

Shina A, Lipsky A, Nadler R, et al. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps. J Trauma Acute Care Surg 2015;79:S204-9.

Kragh J, Dubick M. Battlefield tourniquets: lessons learned in moving current care toward best care in an army medical department at war. US Army Med Dep J 2016;2:29-36.

Queensland Ambulance Service clinical practice manual. QAS; 2016. Available at: [Accessed 29 December 2018].

Clinical practice guidelines ambulance and MICA paramedics. Ambulance Victoria; 2018. Available at: content/uploads/2018/11/Clinical-Practice-Guidelines-2018-Edition-1.4.pdf [Accessed 29 December 2018].

Lee C, Porter K, Hodgetts T. Tourniquet use in the civilian prehospital setting. Emerg Med J 2007;24:584-7.

Response to the Australian Commission for Safety and Quality in Health Care on the Australian Safety and Quality Goals for Health Care – Consultation Paper. National Trauma Research Institute; 2012.

Shapiro G, Sarani B, Smith R. Tactical Emergency Casualty Care (TECC): principles and practice. In: Martin M, Beekley A, Eckert M, editors. Front Line Surgery. Springer, Cham; 2017 Available at: [Accessed 16 April 2019].

Rush S, Kosequat J, Scott A, et al. Efficacy of the mnemonic device “MARCH PAWS” as a checklist for pararescuemen during tactical field care and tactical evacuation. Philadelphia: Philadelphia College of Osteopathic Medicine; 2018. Available at: [Accessed 16 April 2019].

Kue R, Temin E, Weiner S, et al. Tourniquet use in a civilian emergency medical services setting: a descriptive analysis of the Boston EMS experience. Prehosp Emerg Care 2015;19:399-404.

The Economist. Trauma medicine has learned lessons from the battlefield. 2017 Available at: [Accessed 28 December 2018].

Mercier E, Cameron P, Smith K, Beck B. Prehospital trauma death review in the state of Victoria, Australia: a study protocol. BMJ Open 2018;8:e022070.

Protocols and pharmacology. Ambulance New South Wales; 2011. Available at: [Accessed 14 January 2019].

Clinical practice guidelines for paramedics and intensive care paramedics. Ambulance Tasmania; 2012. Available at: [Accessed 14 January 2019].

ACT Ambulance Service clinical management guidelines. ACT Ambulance Service. Available at: [Accessed 14 January 2019].

Clinical practice guidelines. St John Ambulance Northern Territory; 2013. Available at: [Accessed 14 January 2019].