# Do you agree with this statement?



## ironguy321 (Mar 11, 2008)

I remember my instructor telling us...

"If you forget everything in this class, ALWAYS remember ABC and you'll be ok"

Agree or disagree?


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## emtwacker710 (Mar 11, 2008)

I'm gonna have to agree with that, as ABC's are the very first thing you do while assessing a pt. because if you don't have ABC's then there is really nothing you can do until you correct them, and if you really did forget everything from class except ABC's by the time you finish those someone else should be arriving


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## MedicPrincess (Mar 11, 2008)

Absolutley....definantly!!!  And remember, just because you have covered the ABC's when that patient that is hootin and hollerin, screamin and yellin....suddenly sits straight up, holds onto the rails of the stretcher, and in a normal volume voices says to you....  "I am about to die now!'.....remember you are about to go straight back to the A...get ready to catch her because she is probably 400lbs and going slump to the right any second!...

Oh wait...thats how my luck goes....


Yes....when you get stumped, go back to ABC's.  The nice thing about that is when your testing, it buys you a little time as well.  If you can't think of what to do next, you can always ask for another set of vitals, their respiratory status, ect.....


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## skyemt (Mar 11, 2008)

ironguy321 said:


> I remember my instructor telling us...
> 
> "If you forget everything in this class, ALWAYS remember ABC and you'll be ok"
> 
> Agree or disagree?



if you do that, you will be only slightly more qualified than a layperson...

you will have no physical skills, no assessment skills, etc...

he is trying to make the point about the ABC's... if something could kill the patient in the next few minutes, FIX IT FIRST!

however, it is NOT literal...

if that's all you remember, you wouldn't deserve to even call yourself a Basic, which is saying a lot.


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## MedicPrincess (Mar 11, 2008)

Where that instructor and all the other ones that use are are going with that is when all heck is breaking loose....your first on scene of that 12 car pileup with multiple ejections/entrapments and that pregnant woman giving birth while in the over turned vehicle......or your patient codes in front of you....

When you suddenly have your AH CRUD meter pegged....take a second, to take a deep breath....remember your training....and start from the beginning.....


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## skyemt (Mar 11, 2008)

MedicPrincess said:


> Where that instructor and all the other ones that use are are going with that is when all heck is breaking loose....your first on scene of that 12 car pileup with multiple ejections/entrapments and that pregnant woman giving birth while in the over turned vehicle......or your patient codes in front of you....
> 
> When you suddenly have your AH CRUD meter pegged....take a second, to take a deep breath....remember your training....and start from the beginning.....



very true...

however, i believe that this mentality is producing many EMT's who believe that if they assure the ABC's are ok, they don't really have to do anything else...  

i have seen it in my own agency... there is little attention paid to skilled history taking, and other skills, and it is due to the ABC's being emphasized at the cost of all else...

yes, they are Vital... but there is more to it than that... but, this is why there are two week programs, and why Basic's are looked at in a , lets say, less than stellar light...


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## Airwaygoddess (Mar 11, 2008)

Yes, the ABC's are the very first part of the patient's assessment, which is very important, but it is just as important to also carry out the rest of the assessment.  This helps provides a clear  picture of the patient's medical history for the EMT, and provides a good hand off report to  the medic, which in turn, the transfer of care of the patient when the patient arrives at the ED.  Part of the assessment is also being the patient's advocate.


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## Jon (Mar 11, 2008)

Your instructor was joking, to an extent... so don't take it 100% literally.

But, he has a point... ABC's are a good start. BUT: they ARE just a start.

As Princess said... when the :censored: really hits the fan... and you have NO IDEA what to do first... worry about the ABC's... then you'll come up with a "next step" and take care of that... and so forth.

What do we do when we do triage? We check ABC's, and if we can change anything (reposition airway, control severe bleeding) we do that... and then move on.


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## BossyCow (Mar 11, 2008)

Like most quotes taken out of context, its difficult to understand.  

I can see, I think what he meant. When you are in a total thrash call, being able to remember ABCs is a good starting point. Allowing yourself to be distracted by other injuries and missing the thing that's going to kill them while you work on those, is an easy trap for new EMTs to fall into. 

Do I think that ABCs are all we need to do? Of course I don't and I doubt that's what the instructor meant.

Do I think that the instructor was trying to dumb-down the program? Maybe, maybe not, Without hearing the whole presentation, ior knowing the instructor, t's impossible to say.

I believe that if you can get a new EMT started with ABCs on every call, it can kickstart the process they learned in school and move the booklarnin' out of their heads and into their hands. Often a brand spankin' new EMT can be overwhelmed when they have to care for their first, very own patient. I interprete this comment as an instructor, giving those new EMTs something to cling to at that moment, to silence the worry and initiate the care. 

Of course, I'm sure there are those who will take it all very differently.


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## JPINFV (Mar 11, 2008)

I think a better mantra than "insure ABCs if you don't know what else to do" would be to follow the 3rd law of the House of God.

"The first procedure at a cardiac arrest [or when ever all hell has broken loose], is to take your own pulse."

Take a second, calm down, and focus. The problem isn't neccessarily poor education. The simple fact is that stressful situations hamper your ability to recall information. So, especially if you're new, you are going to have problems  on your first calls making sure that you do what you need to do. It's not necessarily a character fault (not neccessarily not a character fault either), but biology.


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## ironguy321 (Mar 11, 2008)

BossyCow said:


> Often a brand spankin' new EMT can be overwhelmed when they have to care for their first, very own patient.



I'm glad you said this because I'm in that boat at the moment. I want to be an EMT to help people and gain experience to be a paramedic or a FF/EMT but at the same time I'm afraid of messing things up. It's a twisted web I've spun:wacko:


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## Webster (Mar 11, 2008)

While obviously you'll be able to do more than just ABCs, those three things are the meat and potatoes of patient care, in my opinion.  Other treatments can be executed after them, but the lack of any of an open Airway, Breathing, or Circulation makes it so you can't do anything else.


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## Chimpie (Mar 11, 2008)

ironguy321 said:


> .... but at the same time I'm afraid of messing things up. ...



Oh, don't worry.  You're going to mess things up.  You'll put something in at the wrong angle, you'll move something to the left when you should have moved it to the right, you'll make the face of "oh :censored: I just f'd up" in front of your patient.  The thing to do is admit your mistakes, correct them, learn from them, and move on.


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## skyemt (Mar 11, 2008)

Webster said:


> While obviously you'll be able to do more than just ABCs, those three things are the meat and potatoes of patient care, in my opinion.  Other treatments can be executed after them, but the lack of any of an open Airway, Breathing, or Circulation makes it so you can't do anything else.



this is just the type of thinking that promotes inadequate patient care...
the ABC's are NOT the meat and potatoes of patient care...

of course, for the very small percentage who need life saving interventions, then yes... they are the meat and potatoes... what about the other 99%?

will you just do nothing, since they are not going to die in the next ten minutes?

As others have said, the ABC's are a starting place, not the end.


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## ffemt8978 (Mar 12, 2008)

Webster said:


> While obviously you'll be able to do more than just ABCs, those three things are the meat and potatoes of patient care, in my opinion.  *Other treatments can be executed after them,* but the lack of any of an open Airway, Breathing, or Circulation makes it so you can't do anything else.





skyemt said:


> this is just the type of thinking that promotes inadequate patient care...
> the ABC's are NOT the meat and potatoes of patient care...
> 
> of course, for the very small percentage who need life saving interventions, then yes... they are the meat and potatoes... what about the other 99%?
> ...



I believe this is the same philosophy, just worded different.  If you don't do the ABC's first, how do you know if you need to give your life saving interventions?


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## LucidResq (Mar 12, 2008)

skyemt said:


> this is just the type of thinking that promotes inadequate patient care...
> the ABC's are NOT the meat and potatoes of patient care...
> 
> of course, for the very small percentage who need life saving interventions, then yes... they are the meat and potatoes... what about the other 99%?



ABCs are not just for the "the very small percentage who need life-saving interventions", unless you think that "A" just means "do they have an airway?", "B" means "are they breathing?" and "C" means "do they have a pulse?". If you expand what you're thinking about when you think ABCs, then yes, they are definitely the meat and potatoes for 99% of patients, actually. 

Airway - do they have one? If yes, are they at risk of losing it due to the MOI/NOI? FBAO? Epiglottitis? Anaphylaxis? Unconsciousness leading to obstruction by tongue? Angioedema? Do they need suction? OPA, NPA or Combitube? 

Breathing - what's the general rate, quality, and work of breathing? Breath sounds? Pain upon breathing? Coughing? Blood or fluid being coughed up? History? Medications? Chest movement? Percussion? Trachea position? Paradoxical movement? Oxygen? 

Circulation - general pulse quality and rate? Bleeding? (either related or unrelated to trauma**), Skin color, temperature and condition? Blood pressure? History? JVD? Shock? 

I know that this bleeds the ABCs into the rest of your assessment, but when you think about the vast number of conditions that involve mostly one of the ABCs, it makes sense: asthma, pneumonia, stroke, MI, a broken ankle, some frequent flier with a cough... serious or not, an ABC problem, no matter how minor, is often the root of a patient's problem.

One time I provided care for a man that clearly did not have a life-threatening problem at all just by looking at the ABCs... he came up to me and calmly told me that he had accidentally cut his finger (okay... the As and Bs seem good) but I looked at this finger and it was indeed bleeding (uh oh... C problem) so I put a bandaid on it.


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## JPINFV (Mar 12, 2008)

That's an extreme expansion of problems then. A very large percent of medical problems are then considered to be an ABC problem. Renal? Yep, that's a C. Left side CHF? B and C. Fever? Possible sepsis, so that's another C.

So, yes, expanding ABCs to consider every possible event or disease that can affect one of those, is yes, not using it properly. It's like saying a bruise and a arterial bleed are equals since they're both problems with C (bleeding). 

Of course to muddle the waters further, cardiac problems can present as breathing problems. So, your patient is hypoxic and breathing decently. Is it because their anemic ("C" problem), V/Q mismatch (C OR B problem, and not neccessarily helped or hindered by supplemental O2), etc?


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## skyemt (Mar 12, 2008)

LucidResq said:


> ABCs are not just for the "the very small percentage who need life-saving interventions", unless you think that "A" just means "do they have an airway?", "B" means "are they breathing?" and "C" means "do they have a pulse?". If you expand what you're thinking about when you think ABCs, then yes, they are definitely the meat and potatoes for 99% of patients, actually.
> 
> Airway - do they have one? If yes, are they at risk of losing it due to the MOI/NOI? FBAO? Epiglottitis? Anaphylaxis? Unconsciousness leading to obstruction by tongue? Angioedema? Do they need suction? OPA, NPA or Combitube?
> 
> ...



sorry, i'm not sure what your point is... the ABC's are to correct IMMEDIATE LIFE THREATS, or threats that could kill the patient in the immediate future.

i'm not sure how many calls you have been on, but out of thousands, the percentage who were in immediate life danger is small, at least here.

of course, there are a million things in theory that can go wrong, etc...
but, i'm looking at what percentage of our patients have are at risk of immediate life threats and it is small.

sorry to take away some glamour, but that's just the way it is.


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## firecoins (Mar 12, 2008)

If your patient is having a critical problem *A*irway *B*reathing and *C*ircultion

If your patient is not having a critical problem, *A*mbulate *B*efore*C*arry

works for me.


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## certguy (Mar 12, 2008)

Once the scene is safe for you and your partner , ABC's come first and formost for ALL pts. If these aren't intact , the rest doesn't matter .


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## Ridryder911 (Mar 12, 2008)

Wow! Several posts to describe something that should be second nature and assessed within the first 1-5 seconds before even making contact with the patient. 
No one ever heard of "across the room" assessment? 

When you first enter the room, you see the patient sitting, laying, etc. One immediately looks for the posture they are in (tripod position, upright with pillows, etc), look for abd, chest rising and falling; listen (snoring respirations, are they pale, flushed, diaphoretic? do you hear harsh external adventitious sounds? (wheezes, rhonchi, stridor), again a quick overview for bleeding, body fluids, dangers to you and your patient (live wires, weapons), etc. 

All of this should be performed even before getting to the patient, and can be performed within the first few seconds. Then when getting to the patient a more detailed of ABC's can be performed if needed.

Majority of the calls, I can tell my patient condition from my first observation of the patient. I am not surprised by making contact with them. 

Seriously, does one really think I have perform a head tilt then, look, feel and listen to be able to detect if they are breathing or not? If I have an EMT that cannot detect that, without performing such, it is time to be recycled. Time to get on with the program.

R/r 911


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## skyemt (Mar 12, 2008)

Ridryder911 said:


> Wow! Several posts to describe something that should be second nature and assessed within the first 1-5 seconds before even making contact with the patient.
> No one ever heard of "across the room" assessment?
> 
> When you first enter the room, you see the patient sitting, laying, etc. One immediately looks for the posture they are in (tripod position, upright with pillows, etc), look for abd, chest rising and falling; listen (snoring respirations, are they pale, flushed, diaphoretic? do you hear harsh external adventitious sounds? (wheezes, rhonchi, stridor), again a quick overview for bleeding, body fluids, dangers to you and your patient (live wires, weapons), etc.
> ...



thank you... i have been trying to convey this point throughout this entire thread...

come on Basics! be better than ABC!!!


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## JPINFV (Mar 12, 2008)

Ridryder911 said:


> Wow! Several posts to describe something that should be second nature and assessed within the first 1-5 seconds before even making contact with the patient.
> No one ever heard of "across the room" assessment?



Actually, the "across the room" assessment was hashed out about a month ago with people honestly arguing that you can't assess a patient prior to reaching him. Of course this was the same thread where people were trying to hash out if, protocol wise, LOC check comes before ABCs. 

http://emtlife.com/showthread.php?t=6634&page=4


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## skyemt (Mar 12, 2008)

JPINFV said:


> Actually, the "across the room" assessment was hashed out about a month ago with people honestly arguing that you can't assess a patient prior to reaching him. Of course this was the same thread where people were trying to hash out if, protocol wise, LOC check comes before ABCs.
> 
> http://emtlife.com/showthread.php?t=6634&page=4



like Rid said, doing a more detailed ABC's when you get to the patient...
obviously forming a good general impression, you haven't gotten there yet...

i'm sorry you are still smarting from that other thread...

if you go back and reread it, it is totally off topic from this one.


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## Arkymedic (Mar 12, 2008)

JPINFV said:


> Actually, the "across the room" assessment was hashed out about a month ago with people honestly arguing that you can't assess a patient prior to reaching him. Of course this was the same thread where people were trying to hash out if, protocol wise, LOC check comes before ABCs.
> 
> http://emtlife.com/showthread.php?t=6634&page=4


 
Whats the first thing you do? Annie Annie are you ok? lol. LOC does come before ABCs. If the pt is unconscious and unresponsive, chances are they dont have a patent airway. If they are unconsc. they probably are having a breathing and circulation prob as well.


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## JPINFV (Mar 12, 2008)

Arkymedic said:


> Whats the first thing you do? Annie Annie are you ok? lol. LOC does come before ABCs. If the pt is unconscious and unresponsive, chances are they dont have a patent airway. If they are unconsc. they probably are having a breathing and circulation prob as well.


The actual fact is that much of the initial assessment can be obtained either prior to reaching the patient or simultaneous in the immediate moments after reaching the patient. So, you're checking LOC and you touch the patient. Is the patient warm? Cold? Well, now you've got skin signs down (assuming your also looking at the patient). The problem is that people want to say, "OMG, you FAIL because you're going out of order."

Assessment isn't a check list or cook book that you run down by going:
1. Now I'm going to check LOC.
2. Now I'm going to check ABCs.
3. Now I'm going to check skin signs.
4...

Unless you pervert ABCs to mean any and all conditions that involve or affect a persons airway, breathing, or circulation.


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## Ridryder911 (Mar 12, 2008)

Okay, let the bashing begin...LOL Part of the problem is we go back to uggghhhhh training and education. Yes, that dreaded word. 

As some of you are aware I am totally against teaching acronyms. The reason being is EMT's attempt to place such in every situation. I actually see students attempting to "whisper" each little letter while performing an assessment. In the manner to teach every crucial step, we do it methodology step by step. Nothing wrong with that, however' here comes the problem; applying it to real life events. 

There are very few patients in real life scenarios, that one is going to go step by step on any treatment or skill. In real life situations, short cuts are made, logical deferment is made. For example does one really check cap refill on those with a non-palpable blood pressure, surely one can see cold waxy skin and knowing physiology that is of one has a blood pressure < 40-60 torr one is not going to see cap refill. So would one be in the wrong not checking? 

Treatment and assessments should not be as a robotic mode. Not each and every assessment and treatment should be the same over and over, however; it should be systematic. Making sure that all that needs to be covered is.  

I get amused reading some of the responses on "the protocols says". The reason I usually do not even pay attention to such posts is they are ludicrous. Perform about 25 to 30 assessments a day five days a week, then tell me you are going to perform each one the same. 

Do you await for someone to take vital signs before performing a secondary or physical assessment or await someone intubating the patient before taking a blood pressure? Remember, v.s. is the first step of secondary and by doing so you just jumped to the next phase before the first phase was finished... GASP! Oh my you got out of sequence! Ahhh You broke protocols! 
C'mon folks.. one has to use common sense. The reason _..." C-Spine before AVPU"..._ is made in case the patient awakes and moves around. Then again, technically speaking you have just performed battery and assault. Did you get the permission "to touch the patient?".  Again, good old common sense. Unfortunately, something we cannot teach and it appears more and more not that common. 

Again, alike scene size up, most are done as a glance and visually looking, "across the room" assessments should be made. If I have a employee that has to await to make contact with the patient before they realize if there is potential problems or not, they will be seeking other employment opportunities. Across the room assessment is taught and encouraged by courses such as ATLS, Trauma Nurse, PHTLS, ITLS, etc.. on and on. 

As I have discussed over and over, medicine is a science and practiced as an art. It takes practice, experience, and yes by making mistakes to learn off. (* the key is to learn of your mistakes, and NOT repeating it over!)

R/r 911


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## skyemt (Mar 12, 2008)

JPINFV said:


> The actual fact is that much of the initial assessment can be obtained either prior to reaching the patient or simultaneous in the immediate moments after reaching the patient. So, you're checking LOC and you touch the patient. Is the patient warm? Cold? Well, now you've got skin signs down (assuming your also looking at the patient). The problem is that people want to say, "OMG, you FAIL because you're going out of order."
> 
> Assessment isn't a check list or cook book that you run down by going:
> 1. Now I'm going to check LOC.
> ...



two separate things... training to pass an exam, and real life, which Rid has described...

but, whether you like it or not, the exam is cookbook style, and if you go out of order you can fail, depending on what you flip-flop... so for those learning, as was the one who started the thread you referred to, they must follow that cookbook approach to pass their exam. sorry, but that's the way it is... we can have another debate about whether or not it should be so...

what you do after you pass the exam, as an EMT, is another matter.


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## Arkymedic (Mar 12, 2008)

JPINFV said:


> The actual fact is that much of the initial assessment can be obtained either prior to reaching the patient or simultaneous in the immediate moments after reaching the patient. So, you're checking LOC and you touch the patient. Is the patient warm? Cold? Well, now you've got skin signs down (assuming your also looking at the patient). The problem is that people want to say, "OMG, you FAIL because you're going out of order."
> 
> Assessment isn't a check list or cook book that you run down by going:
> 1. Now I'm going to check LOC.
> ...


 
JPINFV, I was being a little sarcastic with my post. Thats why I used Annie lol. I wrote my post in such the way as I did for all those trying to make ABCs fit every medical condition. I personally believe in the across the room theory and like Rid said a lot of it is combined together and shortcutted. Sorry for being a smart *** in the way I attempted to write the post.


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## Ridryder911 (Mar 12, 2008)

Another point for common sense. One should be able to apply what is drilled and tested over and then appropriately apply that accordingly to the situation and real life. The point is to know and realize that alike protocols are *guidelines* and not exacts. 

R/r 911


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## ironguy321 (Mar 12, 2008)

skyemt said:


> two separate things... training to pass an exam, and real life, which Rid has described...
> 
> but, whether you like it or not, the exam is cookbook style, and if you go out of order you can fail, depending on what you flip-flop... so for those learning, as was the one who started the thread you referred to, they must follow that cookbook approach to pass their exam. sorry, but that's the way it is... we can have another debate about whether or not it should be so...
> 
> what you do after you pass the exam, as an EMT, is another matter.



I think your referring [since I started this chaos]. I know I have no experience under my belt other than my ride outs/clinicals but I understand what a lot of people are saying here. My skills are rusty, I'll admit since I'm in fire school, but I remember during my ride outs I ALWAYS looked at ABC's first, than did what I had to from there. My medic never corrected me so I'm assuming I did things correctly.


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## firetender (Mar 13, 2008)

...and let's not forget, acronyms and the like are soon-to-be-discarded tools that carry us until we learn they're tools that get discarded. The learning curve takes what it takes until experience "hard-wires" a personally effective approach toward patient care into our spines.


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## fma08 (Mar 13, 2008)

ironguy321 said:


> I remember my instructor telling us...
> 
> "If you forget everything in this class, ALWAYS remember ABC and you'll be ok"
> 
> Agree or disagree?


ABC, ambulate before carry, absolutely agree


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## paramedix (Mar 18, 2008)

Whilst I was on course and doing road pracs with my instructor I learned to go by that rule. 

We attended to a call at an old age home and the patient was lying on his bed. After the call we had a debriefing session and the doctor who evaluated me flunked me on the above mentioned call. Her reason was purely I forgot the basics... ABC!!!

I argued I have done the ABC and could prove it. Then the question was asked, on how many pillows was the patient's head? Oops... The patient was in fact lying on three pillows and the airway was NOT fully open.

So always remember the ABC's. The statement is quite right. But don't forget the S before ABC... SAFETY FIRST.


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## Firesurfer75 (Mar 26, 2008)

I agree with that.. maintain airway so they can breath to be able to supply oxygen to the body from any cardiac function.


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