ABCDE Assessment for Paramedics
The ABCDE approach is the foundation of every paramedic assessment. Master each component — what to assess, what's normal, and what to do when you find a problem.
Start Free TodayWhy ABCDE is the Foundation of Paramedic Practice
The ABCDE approach provides a systematic, reproducible framework for assessing every patient — from the minor injury to the cardiac arrest. Its power lies in its consistency: by always working through the same sequence, you ensure life-threatening problems are identified and managed in order of priority.
Using ABCDE every time also builds a professional habit that impresses mentors, examiners, and colleagues — and more importantly, protects patients.
Treat as You Find
Don't complete the whole assessment before acting. If you find a problem at B (breathing), treat it before moving to C. Then reassess B after your intervention. This "assess-intervene-reassess" loop is the core of the ABCDE approach.
A — Airway
What to Assess
Is the airway patent, maintainable, or obstructed? Look for signs of partial or complete obstruction: gurgling (fluid/secretions), stridor (partial obstruction), snoring (soft tissue obstruction), absent breath sounds (complete obstruction). Ask the patient to speak — a clear voice suggests a patent airway.
What to Do
Simple manoeuvres first: head-tilt/chin-lift (non-trauma), jaw thrust (trauma). Suction for secretions. Airway adjuncts (OPA/NPA) for semi-conscious patients. Advanced airway (supraglottic device, intubation) if required and within scope.
B — Breathing
What to Assess
Look: respiratory rate, use of accessory muscles, chest symmetry, tracheal position, skin colour. Listen: air entry, abnormal sounds (wheeze, crackles, absent breath sounds). Feel: chest expansion, chest wall integrity (crepitus, instability). Measure: SpO2.
Normal Values
RR 12–20 breaths/min (adult). SpO2 ≥94% on room air. Symmetrical chest expansion. Clear bilateral air entry.
Common Abnormalities
Tachypnoea (>20) — pain, infection, shock, metabolic acidosis. Bradypnoea (<12) — opioid toxicity, CNS depression. Reduced unilateral air entry — pneumothorax, haemothorax, effusion.
C — Circulation
What to Assess
Heart rate, blood pressure, capillary refill time (CRT), skin colour/temperature/moisture, peripheral pulse quality, JVP, and signs of haemorrhage. 12-lead ECG when indicated.
Normal Values
HR 60–100bpm. SBP >100mmHg. CRT ≤2 seconds. Warm, pink, dry skin.
Shock Recognition
Early shock: tachycardia, cool peripheries, prolonged CRT, anxiety. Late shock: hypotension, altered consciousness, mottling. Treat the cause — haemorrhagic, cardiogenic, distributive (septic/anaphylactic), obstructive.
D — Disability
What to Assess
Level of consciousness (AVPU or GCS), pupil size and reactivity, blood glucose, pain score.
AVPU Scale
Alert — fully conscious. Voice — responds to verbal stimuli. Pain — responds to painful stimuli only. Unresponsive — no response. AVPU of V or below is clinically significant and warrants further assessment with GCS.
Blood Glucose
Check BM in any patient with altered consciousness, regardless of apparent cause. Hypoglycaemia (<4mmol/L) is a common, immediately treatable cause of reduced consciousness that is easy to miss.
E — Exposure
What to Assess
Expose to identify rashes, wounds, swelling, deformity, signs of injection, oedema, or other findings not visible with clothes on. Maintain dignity. Protect against hypothermia — exposure in cold environments causes rapid heat loss, especially in shocked patients.
Temperature
Measure core temperature if relevant — hyperthermia in heat illness or sepsis, hypothermia in exposure, elderly, or intoxicated patients.
ABCDE Practice Tools
AI Patient Scenarios Pro
Practise verbalising a full ABCDE assessment on a range of patients — from routine calls to life-threatening emergencies.
Chat with Hollie Free
Ask Hollie to quiz you on ABCDE components, explain normal values, or walk through what abnormal findings might indicate.
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Frequently Asked Questions
What does ABCDE stand for in paramedic assessment?
ABCDE stands for Airway, Breathing, Circulation, Disability, and Exposure. It provides a systematic framework for assessing patients in order of physiological priority — addressing the most life-threatening problems first before moving to the next step.
How do paramedics use ABCDE in practice?
The ABCDE approach is used for every patient assessment, from routine calls to life-threatening emergencies. For each component, you assess, identify any problems, intervene, and only move to the next step once the issue is managed or stabilised. This stops you being distracted by a dramatic-looking injury while missing a compromised airway.
Should ABCDE be used for every patient?
Yes — ABCDE should be the default approach for all patient assessments. It provides a consistent, reproducible structure that helps you spot deterioration, communicate findings clearly, and demonstrate systematic clinical thinking in OSCEs, placements, and practice.