Know your H-H-H-A-B-C

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You are here: Home FEATURES Featured November/December 2016 Know your H-H-H-A-B-C


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Know your H-H-H-A-B-CHaving been on both the receiving end and the treatment side of injuries during his 25 years as an artisan, volunteer firefighter, South African Police Service reservist, rugby medic and later a SHERQ officer and manager, DAVID HOUGH has had the benefit of seeing things from both sides of the coin...

Most people think that rendering first aid is simple and “anyone can do it”. For the most part they are correct. However, the ability to ignore the stress, tension and chaos around you when treating a severely injured person is nothing to joke about.

Listening to the stories of emergency services' personnel brings a consistent thread to the fore: they were all trained very thoroughly for this particular job and they continue to receive training each and every day. A vital part of this training deals with one of the most overlooked issues when preparing to render first-aid treatment.

This is the “safety” aspect... It’s an issue we often take for granted. We see someone in need of help and all too quickly our mind switches into “machine mode”, the Superman cape comes out and off we go, with little or no regard for the safety aspect of what we are about to attempt.

Part of the foundation training any first aider receives is the H-H-H-A-B-C. These letters indicate six vital steps in ensuring both the first aider and the casualty remain alive.

H – Hazards; H – Hello; H – Help; A – Airway; B – Breathing; C – Circulation.

Although the H-H-H requires absolutely no training at all, unfortunately the A-B-C does. If done incorrectly, more harm can be done than good. As such, I will not expand on these items, but focus more on the “easy stuff”.

Both law and best practice dictate that what is seen on the television and movie theatres should be ignored, and an accredited course should rather be attended to learn the correct, safe way to “promote recovery” of a casualty by “doing no harm”.


Most safety personnel should know what these are, and can easily identify them under normal day-to-day situations. What about when you only have a split second to identify, assess and react?

Typically, we all spot the big things; machines running, traffic, and the like, but we don’t always see the little ones such as: fuel on the road, electrical current, silica dust and blood-borne pathogens.

Before considering rendering first aid, we need to perform a risk assessment of the scene. Simply put, we need to ask ourselves three questions: Is it safe for me? Is the casualty safe? Is it safe for me to access the area?

If the answer to any one of these questions is “no” then it is not safe to render first-aid treatment. Even though people may be trying to force you to assist, common sense dictates that there should rather be one casualty than two.

Let’s consider each of the questions individually:

Q1: “Is it safe for me?”

We need to look at issues such as: What can affect me and cause me harm? One of the most common mistakes untrained people make is to provide treatment without their first line of defence – suitable latex or nitrile gloves – against blood-borne pathogens like HIV, hepatitis B and viral haemorrhagic fever, to mention but a few that can be transmitted via fluids such as blood.

Dressings, bandages or splints can always be improvised, but there is no way to improvise when it comes to gloves. Use proper gloves, or don’t do it at all! A box of decent latex gloves costs less than R100, and the container is about the size of a box of facial tissues. Why take the chance?

Q2: “Is the casualty safe?”

In this instance there is role reversal: instead of the casualty infecting you, you are now the danger, as there is the possibility of bacteria on your hands, which can be passed on through contact. This is another reason to ensure that you have suitable gloves.

Q3: “Is it safe for me to access the area?”

Is there a potential for something to happen to you or the casualty while accessing the scene, or while on scene? If so, then you cannot begin providing assistance until that danger is removed, or mitigated. Situations falling into this category include: traffic, unstable structures, machinery that is moving or has potential to move, energised systems, fuel, fire and a hostile environment.


Most of us take this for the simple form of greeting that it is, but in this case it is the quickest way to assess your casualty’s brain function and condition.

If he or she answers immediately it usually means that the injury may not be as severe, and at least they can tell you what happened, how they feel, where it hurts, and so on.

If there is no response, tap them on their shoulder and talk to them. If they don’t answer, things may be much worse than they initially appear, and could include heart attack, stroke, head/brain injury or internal injuries.

This is also an efficient way to gain information from your patient to convey to the emergency services when requesting assistance. It helps the dispatcher when you can give accurate and concise information. All you have seen, heard, experienced up to this point is vital when completing the last “H”.


Notifying the emergency services is as simple as picking up a telephone and dialling one of two cost-free numbers; 10177 from a landline or 112 from a mobile phone. If you find yourself in a workplace-related incident, refer to your company’s emergency response plan and contact the relevant private ambulance service.

Once through to the dispatcher, some specific things need to be done to streamline the process. If you are unable to do this yourself send a bystander, and don’t forget to give him or her all the information you have gathered.

1. Identify yourself. State first-aid training (if any) and/or whether a first-aid officer is present on scene.

2. Give your contact number, preferably a mobile number.

3. Provide the location of incident. Note landmarks as reference points, especially in rural and township areas.

4. Give the number of casualties.

5. Describe the condition of the casualty or casualties. For example, highlight whether they are badly injured and whether cardiopulmonary resuscitation (CPR) is in progress, whether there is loss of limb, or a possible broken limb.

6. Answer any questions from the dispatcher before ringing off.

7. Do not end the call until the dispatcher has rung off.

I have often been part of crews dispatched to scenes that are in other provinces. There is nothing more frustrating for the crew (who are aware of the urgency of the casualty’s condition and required treatment), being sent to the wrong details of the area and wasting valuable time.

This is why all the information you have gathered in steps 1 and 2 are so vital, and why it is so important to give a contact number so the emergency services can call you if they cannot locate the accident scene.

These are all equally important links in the chain of survival for the casualty and the simplest of things to perform without any specialised training.

If one of these links is broken, the entire chain falls apart. The use of common sense is our instinctive way of knowing what we should or shouldn’t do.

Don’t take the chance. If in doubt ... get out! Then call the professionals…