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Developed and maintained by the NFCC

Casualty care

The guidance in this section has been written with the support of the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh. Pre-hospital care is a well-established branch of medicine in the United Kingdom, practised mainly by the ambulance service.

As the face of pre-hospital emergency medicine changes, the Faculty of Pre-Hospital Care aims to set and maintain clinical standards for all practitioners of the evolving specialty.

The principles of casualty care are to:

  • Keep the casualty safe
  • Identify and control catastrophic external compressible bleeding
  • Recognise and assess, manage and/or support airway compromise
  • Control the potential or actual injured spine
  • Recognise and assess, manage and/or support breathing and ventilatory compromise while treating life threatening chest problems
  • Recognise and assess, manage and/or support circulatory compromise and stop and/or identify bleeding
  • Assess and manage the patient with reduced level of consciousness
  • Expose and assess the casualty and evacuate to definitive care. This should be achieved whilst minimising exposure of the casualty to the cold environment (hypothermia) and putting strategies in place to reduce hypothermia (active rewarming with heaters or blankets)

Adopting a systematic approach to casualty care assessment, for example <C> Ac B C D E, allows life-threatening conditions to be rapidly identified and managed. Problems identified in this assessment should be dealt with as they are found. Following the intervention, the casualty is then reassessed. The principle of constantly reassessing of the casualty should be promoted.

The fire and rescue service may be presented with a single casualty or multiple casualties. Both situations will be dealt with in this guidance.

If a casualty is non-responsive, medical alert tags, bracelets or cards may provide information about pre-existing medical conditions.