When it comes to emergency care in remote environments, the ABCDE approach remains a trusted and essential framework. But in the real world, where danger, delay, and limited resources shape every decision, even well-established systems need to adapt.
This isn’t a new framework. It’s a field-refined combination of existing models like ABCDE, <C>ABCDE, and XABCDE, informed by decades of experience in military, prehospital, and wilderness medicine.
What makes this version different is how it’s been reshaped by our World Extreme Medicine (WEM) faculty for austere, unpredictable, and hostile settings.
We originally created a simple infographic for social media to share key principles. But after sharing it with our global faculty, their insights were so valuable we decided to turn it into something bigger: a comprehensive blog & downloadable guide to primary trauma care in remote environments.
What follows is a refined interpretation of the trauma survey, shaped not just by textbooks, but by the people who’ve applied it under pressure, at altitude, in deserts, on expeditions, and in conflict zones.
Why Adapt the ABCDE Model?
The traditional ABCDE trauma approach (Airway, Breathing, Circulation, Disability, Exposure) is a well-established and widely taught framework. But when you’re working in an austere environment, far from advanced support, the sequence may need to be adjusted.
Our WEM faculty, made up of expedition leaders, military medics, pre-hospital doctors and remote paramedics, helped refine this into a field-ready model that starts with:
S → CABCDE(g)
S = Scene Safety & Shelter
🅲 = Catastrophic Haemorrhage
ABCDE(g) = Adapted Trauma Survey with Glucose Consideration
🛟 S – Scene Safety & Shelter
Before anything else, assess the scene:
- Is it safe to treat the casualty where they are?
- Is there ongoing environmental threat (weather, wildlife, terrain)?
- Can you move them to shelter before beginning treatment?
In short: Bothies before bandages.
Survival in remote medicine starts with environmental control.
🅲 Catastrophic Haemorrhage (Big C)
Exsanguinating haemorrhage kills fast, and must be controlled before airway.
- Apply direct pressure, tourniquet, or wound packing immediately
- Reassess for re-bleeding often
- Consider TXA (tranexamic acid) early, if trained and available
🅰 Airway
Maintain a clear airway while considering cervical spine injury, especially in trauma:
- Use jaw thrust if spinal injury is possible
- Use head-tilt–chin-lift only if no spinal concern or jaw thrust ineffective
- Consider basic adjuncts like OPAs or NPAs if available
Importantly: if airway is compromised, it always takes precedence over spine protection.
🅱 Breathing
Is breathing effective and adequate?
- Look, listen, and feel
- Identify and treat life threats like open chest wounds or tension pneumothorax
- Use chest seals or needle decompression as per training and kit
🅲 Circulation (Occult/Internal)
With external bleeds controlled, assess for internal haemorrhage:
- Check for signs of bleeding in the chest, abdomen, or pelvis
- Monitor radial pulse, skin colour, capillary refill (note: unreliable in cold)
- Reassess frequently: remote care often involves long waits for evacuation
🅳 Disability
Rapid neurological assessment:
- Use AVPU as your primary scale
- Check pupils and assess motor/sensory function
- Don’t forget glucose, hypoglycaemia can mimic reduced consciousness or stroke
🅴 Exposure / Environment
Complete the assessment with full body exposure:
- Look for hidden injuries (e.g., posterior wounds, burns)
- Prevent further heat loss, rewarm as needed
- Ask about allergies, medications, medical history if the patient is conscious
What Makes This Different?
This adapted model isn’t about changing the science, it’s about applying it under pressure in variable, hostile, or improvised environments. From snow shelters and desert crossings to disaster zones and high-altitude rescues, our faculty have tested these adaptations in real time.
By adjusting the standard trauma approach, this framework acknowledges that care under fire, environmental risk, and limited resources all shape clinical priorities.
Train With the People Who Teach This
We don’t just teach this, we live it.
Our Expedition & Wilderness Medicine courses are delivered by the same experts who helped shape this framework, giving you hands-on training in realistic field scenarios.
We offer courses across the UK, Australia, Europe, and the US. Open to medics, healthcare students, expedition professionals, and anyone preparing to operate far from immediate help.
We have made the social post & this blog into a handy downloadable graphic, click here to save it to your device to reference whenever you need it.
With thanks to our WEM Faculty Contributors, including:
Ben Watts, Scott King, Laura E, Matt Ashton-Edwards, Ryan Atkinson, Jamie Pattison, Burjor Langdana, Dave Gregory, Richard McGirr, Ella du Breuil, and Gem Aldridge.
References: Auerbach’s Wilderness Medicine, RCSEd Faculty of Pre-Hospital Care, WEM E-Book, WEM Faculty
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