What is the first step in the on-board primary survey during a medical emergency?

• A. Ensure scene safety, obtain consent if possible, and determine if the patient is responsive.
• B. Check responsiveness.
• C. Begin chest compressions immediately.
• D. Call EMS and wait for instructions.

Answer: (A)

The first thing to establish is safety. You must make sure the scene is safe for you and the patient before you touch anyone or move them. If the patient is conscious, you seek consent before giving care; if they’re unconscious, consent is considered implied and you proceed with assessment. Quickly determine responsiveness to gauge how to proceed—whether the person is awake and able to communicate, which helps you decide the urgency and the next steps.

This sequencing matters because you can’t start proper care if you or the patient are in danger, and you need consent (when possible) to treat a conscious person. The other actions—starting CPR or dialing for help—depend on what you find after you’ve checked safety and responsiveness. For example, CPR starts only if there’s no pulse and no breathing, and you call for EMS as part of the overall response, but not before you’ve ensured safety and assessed responsiveness.