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Assessment of circulation

Assessment in tactical environment

The primary survey is carried out in the order that identifies threats to life in the order in which the most rapidly fatal conditions are found first.
In general this means that airway assessment is carried out first; obstructed airways lead to death in minutes.

In settings where penetrating trauma is more common than blunt trauma, though, death from catastrophic haemorrhage (i.e. arterial bleeding) is more likley to cause very rapdi death than airway obstruction. In this case, therefore, the order of primary survey becomes CAcBCDE:
Catastrophic bleeding
cervical spine control

Catastrophic bleeding

May be pulsatile - will not be if under several layers of clothes or equipment
Will be bleeding briskly (until the casualty is about to die: "all bleeding stops eventually")
Will be red (assuming the casualty was adequately oxygenated when injured

If the environment is one in which you need to look initially for catastrophic haemorrhage then clothes need to be cut away to ensure this is not overlooked - check the back of the casualty too!