From DR ABCDE to FAMOUS PE: Transforming how we respond to confined space emergencies

When we talk about accidents in confined spaces, the conversation too often starts, and ends, with rescue. But here’s the hard truth: the emphasis on getting someone out first, rather than stabilising them where they are, could be costing lives and futures.

DR ABCDE is not fit for purpose when it comes to first aid in confined spaces. It’s time for a new acronym – FAMOUS PE - one that integrates first aid and rescue, and which will help save lives and improve the outcome for individuals (patients and rescuers) involved in incidents.

We already know the number of fatalities in confined spaces each year (up to 22 in the UK a year). What we don’t know is how many people survive  or other incidents, and how many of them then have to live with life-changing injuries or long-term conditions because first aid wasn’t given immediately at the point of the incident.

The Hidden Toll of “Rescue First”

Imagine this: a worker suffers a cardiac arrest inside the hull of a ship. The rescue team focuses on extraction, but no CPR is given until they’re out. Without immediate continuous chest compressions, blood and oxygen stop flowing to the brain, and in just minutes, that can then lead to severe and permanent brain injury or death.

Or take a trauma case - an arterial bleed. A person can bleed out in just 3 to 5 minutes. Yet the average emergency response time in the UK is 7–10 minutes. That’s a fatal gap.

In cases like these, the difference between life and death, or between full recovery and lifelong disability, lies in immediate, effective first aid which is mindful of the unique conditions, e.g. air quality, not to delayed treatment after extraction.

Rescue and Casualty Care Must Work Hand-in-Hand

At Brooklyn Specialist Training Solutions, we believe that rescue operations and casualty care must be tightly integrated. Every responder must be trained to deliver the right treatment at the right time, even in challenging confined space conditions.

That’s why our training emphasises rapid and appropriate casualty care, to meet the needs of the injured person without compromising the safety or effectiveness of the team.

“It’s not enough to know how to get someone out. You have to know how to keep them alive while you do it,” explained David Nice, Founder & Managing Director, Brooklyn STS, who has developed FAMOUS PE.

Introducing FAMOUS PE: A New Approach to Confined Space Casualty Care

It is David’s experience as a paramedic and member of the London Ambulance Service Hazardous Area Response Team (HART) which has led to him developing FAMOUS PE.

He said: “From my experience, I recognise that traditional first aid frameworks don’t always fit the realities of confined space incidents, and this is leading to poorer outcomes for both casualties and rescuers. This has to change; which is why I have developed FAMOUS PE. It is specifically for use in high-pressure, confined space situations.”

It builds on the familiar DR ABCDE primary survey (Danger, Response, Airway, Breathing, Circulation, Disability, Exposure) but adapts it to the unique demands of confined space casualty care, where blood loss, air quality, and accessibility are critical factors.

F – Foreseeable Risks?

A – Alert or Unresponsive Casualty?

M – Massive Arterial Bleeding?

O – Open or Obstructed Airway?

U – Unviewable Airway?

S – Signs and Symptoms?

P – Package and Treat the Casualty?

E – Extricate the Casualty?

FAMOUS PE provides a structured, time-critical survey for confined space first responders. It ensures that life-threatening conditions are prioritised and managed before and during rescue, not after.

This approach is now a key building block of Brooklyn’s Confined Space Casualty Care Training, designed to help teams work more effectively under pressure and achieve better outcomes.

The Call to Action: We Must Do Better

“We can’t keep accepting that confined space fatalities are inevitable, or that surviving means you’re ‘lucky.’ Survival without timely first aid can mean brain injury, disability, or death. We must improve our response and our care together. The casualty and responder don’t have time to wait,” said David.

David has created an explainer video to introduce the FAMOUS PE framework and show how it works in real-world scenarios. He urges all organisations and safety professionals to invest in appropriate first aid training, such as Confined Space Casualty Care, which directly addresses the additional hazards, including poor air quality, limited space, and complex extrication, that make confined space incidents so dangerous.

Watch the FAMOUS PE explainer video below:

Take Action: Prepare Your Team for Real-World Confined Space Emergencies

If your team works in or around confined spaces, now is the time to review your procedures, update y, and ensure every responder knows how to deliver life-saving care when seconds matter most.

Get in touch with us here, to learn how we can deliver first aid training on your site, that addresses the unique pressures and dangers associated with confined space incidents.