Every Minute Matters Before the Ambulance Arrives
Someone collapses at the MRT station. A child falls badly at the playground. You're the first person at the scene of a road accident.
What do you do?
The next two to three minutes — before the ambulance arrives — are often the most critical. Research consistently shows that bystander intervention dramatically improves survival rates in cardiac arrest, major trauma, and uncontrolled bleeding. In Singapore, the average emergency response time is around 8–11 minutes. That is a long time if someone has stopped breathing or is bleeding severely.
The good news: you don't need to be a doctor to help. You need to know the DRSAB framework.
What Is the DRSAB Framework?
DRSAB is a systematic, stepwise approach taught to first responders and increasingly to the general public. It stands for:
- D — Danger
- R — Response
- S — Send for Help
- A — Airway
- B — Bleeding
Each step builds on the one before it. The structure matters because the most common mistake people make in emergencies is rushing straight to the injured person without first checking whether it is safe to do so.
D — Danger: Check Before You Act
Before you approach anyone who is injured, stop for three seconds and look around.
Ask yourself:
- Is there oncoming traffic?
- Is there fire, smoke, or risk of explosion?
- Are there downed power lines or flooding near electrical equipment?
- Could falling objects or structural collapse be a risk?
- Is there a threat from another person?
If it is not safe to approach, do not. Call 995 from a safe distance. A second victim does not help the first — and well-meaning bystanders who rush in without assessing danger sometimes become additional casualties themselves.
If the hazard can be removed — switching off a car engine, directing bystanders to stop traffic, or moving a fallen object — do that before approaching. Otherwise, wait for the SCDF.
The rule is simple: you are most useful alive and uninjured.
R — Response: Is the Person Conscious?
Once you have confirmed it is safe, kneel beside the person and assess their level of consciousness.
How to check:
- Tap both shoulders firmly
- Shout clearly: "Hello! Can you hear me?"
- Look for any response: movement, speech, eye opening, or groaning
What to make of what you see:
If the person speaks and moves normally, they are conscious. Reassure them and stay with them.
If they only respond to loud shouting, their consciousness is reduced. Keep them still and monitor closely.
If they only respond to a firm pinch or sternal rub, this is serious. Treat as a medical emergency.
If there is no response whatsoever, this is life-threatening. Move immediately to the next step.
S — Send for Help: Call 995 Right Away
Call 995 to activate the Singapore Civil Defence Force (SCDF) emergency ambulance.
When the operator answers, be prepared to tell them:
- Your exact location (building name, unit number, nearest landmark or cross street)
- What happened ("A woman in her 60s has collapsed and is not responding")
- The number of people affected
- Whether there is obvious bleeding, difficulty breathing, or signs of trauma
Stay on the line. The dispatcher can guide you through CPR steps in real time, and the call helps them prepare the ambulance crew before arrival.
If you are alone: Shout for bystanders to help first. Then call 995 before starting any treatment — the ambulance must be dispatched as early as possible.
Ask for an AED if you are in a public space. Automated External Defibrillators are available in MRT stations, shopping malls, schools, community centres, and many office buildings across Singapore. The SCDF myResponder app (free on iOS and Android) shows AED locations near you and alerts nearby trained volunteers in real time.
A — Airway: Open the Airway and Check Breathing
An unresponsive person's tongue can fall back and block the airway. Correcting this is simple and potentially life-saving.
Step 1: Head tilt, chin lift
Place one hand on the person's forehead and tilt the head gently back. With two fingers placed under the bony part of the chin, lift the jaw upward and forward. This moves the tongue away from the back of the throat.
Important: If you suspect a neck or spine injury — after a fall from height, a diving accident, or a road collision — do not tilt the neck. Instead, place both hands on either side of the jaw and push it forward without moving the head. If you are uncertain, an open airway takes priority over a potential spinal injury.
Step 2: Look, listen, and feel for breathing
With the airway open, bring your cheek close to their mouth and look at their chest.
- Can you see the chest rising and falling?
- Can you feel breath on your cheek?
- Can you hear any breathing sounds?
If they are breathing, place them in the recovery position: roll them onto their side, support the head, and angle the mouth downward so that any vomit can drain freely. Monitor continuously.
If they are not breathing normally, begin CPR immediately.
B — Bleeding: Control Serious Bleeding
Uncontrolled haemorrhage is one of the leading preventable causes of trauma death — and direct pressure applied quickly by a bystander makes a significant difference.
If there is significant bleeding:
1. Apply firm, direct pressure. Use your hand, a cloth, or folded clothing pressed hard over the wound. Do not lift the pressure to check — keep pressing continuously for at least 10 minutes.
2. Do not remove objects that are impaled in the body. Glass, metal, or debris lodged in a wound acts as a plug. Removing it can cause haemorrhage to worsen dramatically. Stabilise the object in place and apply pressure around it — not over it.
3. Use a tourniquet for limb bleeding if available. For life-threatening bleeding from an arm or leg that cannot be controlled by pressure alone, a tourniquet applied 5–7 cm above the wound and tightened until bleeding stops can be life-saving. Note the exact time of application and tell the paramedics.
4. Elevate the limb if possible. Raise an injured arm or leg above the level of the heart while maintaining pressure over the wound.
If They Are Not Breathing: Start CPR
If the person is unresponsive and not breathing after you have opened their airway, begin cardiopulmonary resuscitation without delay.
Hands-only CPR for bystanders:
- Kneel beside the person. Place the heel of one hand on the centre of their chest — on the lower half of the breastbone, between the nipples.
- Place your other hand on top and interlace your fingers.
- With your arms straight, press firmly straight down at least 5–6 cm (roughly 2 inches).
- Release fully to let the chest recoil, then compress again. Aim for 100–120 compressions per minute — the beat of Stayin' Alive by the Bee Gees is a well-known reference.
- Do not stop until an AED arrives, the person starts breathing normally, or a trained responder takes over.
If you are trained in full CPR, give 30 compressions followed by 2 rescue breaths in a continuous cycle.
Call out to bystanders to rotate every two minutes so compressions remain effective.
Using an AED
An AED is designed to be used by anyone — it gives clear audio and visual instructions and will only advise a shock if the heart is in a shockable rhythm. You cannot harm someone by using one.
To use an AED:
- Power it on (lift the lid or press the power button)
- Follow the voice instructions
- Attach the electrode pads to the bare chest as shown in the diagrams on the pads
- Keep everyone clear while it analyses the heart rhythm
- Press the shock button only when instructed — and make sure no one is touching the person
- Resume CPR immediately after the shock
Common Mistakes to Avoid
Even well-meaning bystanders can inadvertently worsen a situation. These are the errors I see most often — and how to avoid them.
Rushing in without checking for danger. The instinct to help immediately is natural, but approaching an unsafe scene without first assessing hazards can turn a single casualty into two. Take three seconds to scan for traffic, fire, electrical risks, or structural hazards before you move.
Moving someone with a suspected spinal injury. After a fall from height, a road accident, or a diving incident, assume a neck or spine injury is possible until proven otherwise. Moving the person incorrectly — especially the neck — can convert a partial injury into permanent paralysis. Keep them still unless there is an immediate life threat (such as a fire) that requires moving them.
Removing an impaled object. It is counterintuitive, but an object lodged in a wound — glass, metal, or debris — is acting as a plug. Pulling it out can cause catastrophic haemorrhage that was previously controlled. Leave the object in place, stabilise it, and apply pressure around it.
Stopping CPR too early. Bystanders often stop compressions after a minute or two because they are exhausted or unsure if they are helping. Each minute without effective chest compressions reduces the chance of survival by approximately 10%. Keep going. Call out to rotate with a bystander every two minutes if possible.
Not calling 995 before starting first aid. The ambulance being dispatched early is more important than starting treatment 30 seconds sooner. Call first, then act.
Giving food or water. A person who is drowsy, confused, or has reduced consciousness cannot protect their airway properly. Food or fluid given in this state can be aspirated into the lungs, causing serious complications. Even if the person asks for water, do not give it until they are fully alert and assessed by a medical professional.
When the Ambulance Arrives
When the SCDF paramedics reach the scene:
- Give a clear handover: what you observed, what happened, and what steps you took
- Tell them the time CPR began, or when a tourniquet was applied
- Step back promptly and let them work — your role as a bystander is complete and you have done everything that could be done
After the Emergency: When to See a Doctor
If you were involved in or witnessed a traumatic incident, it is normal to feel shaken or physically sore. Adrenaline can mask injury symptoms for several hours — pain in the chest, neck, back, or abdomen that appears later may indicate an injury sustained at the scene.
See a doctor if:
- You were physically involved and are experiencing delayed pain or swelling
- A wound has been cleaned but shows signs of infection (redness spreading, warmth, discharge, fever)
- You are experiencing disturbing thoughts, flashbacks, or difficulty sleeping following a traumatic event — this is common and very treatable
At Angsana Medical, we manage acute injuries after emergencies, assess and clean wounds, arrange X-rays or imaging if needed, and provide follow-up care. We also support patients experiencing post-traumatic stress at primary care level.
Get Trained
The DRSAB steps above are a starting point. For hands-on practice with a mannequin and real AED equipment, consider:
- Singapore Red Cross — first aid and CPR/AED certification courses
- Singapore Civil Defence Force (SCDF) — free DARE (Disaster Assistance and Rescue) community training
- National Resuscitation Council Singapore — standardised CPR and AED certification
Being able to act quickly and correctly when someone is hurt is one of the most valuable skills any person can have. It takes only a few hours to learn, and it can make the difference between life and death.
This article is for general educational purposes only and does not constitute medical advice. In any medical emergency, call 995 immediately. Do not delay activating emergency services to read or follow any written guide.
Dr Dhivian is a family physician at Angsana Medical, Everton Park, Singapore. He holds an MBBS and MMed (Family Medicine) from the National University of Singapore and manages acute injuries, wound care, and post-emergency follow-up at the clinic.