Emerg Med J 21:216-225 doi:10.1136/emj.2003.013524
  • Prehospital care

The ABC of community emergency care

2 The system of assessment and care of the primary survey positive patient

  1. J Wardrope1,
  2. R Mackenzie2
  1. 1Accident and Emergency Department, Northern General Hospital, Sheffield, UK and Medical Advisor to South Yorkshire Ambulance Service
  2. 2Accident and Emergency Department, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to:
 Mr J Wardrope
 Accident and Emergency Department, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK;

    Emergency situations cause stress, especially if they are unfamiliar or present new and different challenges. Specific life threatening medical emergencies may only be experienced by most practitioners a few times in their career1,2 and even experienced clinicians require training and practice to maintain confidence and skills. Using a system of care and assessment will improve consistency. This article aims to set out a system of assessment for the patient with emergency care needs. It can only offer a framework, proper application will require training, flexibility, common sense, and experience.


    The objectives are:

    • To describe a system to identify immediately life threatening problems (the primary survey positive patient)

    • To provide guidance on the management of the primary survey positive patient

    • To introduce the SOAPC system for the full evaluation of a patient who might be suitable to treat and refer or treat and leave.


    Most acute medical patients do not have an immediately life threatening airway, breathing, circulation, or neurological problem. The patient who is talking normally, is fully orientated, is not pale or sweaty, has no dysponea, has a normal pulse, and is not breathless is unlikely to be in immediate danger. However the patient’s condition may change very quickly and some need careful monitoring and re-evaluation (for example, the patient with chest pain may have a sudden cardiac arrest). Making decisions about the presence or absence of an immediate threat to life can be difficult. There is evidence that important clinical signs of urgent airway, breathing, circulation, or neurological problems may be easily missed, misinterpreted, or mismanaged in the emergency setting in hospital practice1,2; the risks of clinical errors in prehospital practice is likely to be greater.

    Fortunately, there are common presentations for most acute medical emergencies that can be anticipated. These include shortness …

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    Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


    0.5% - 43% response rate
    3% - 41% response rate
    10% - 16% response rate

    Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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