PHECC FAR common mistakes
PHECC FAR · Understand the traps and how to avoid them.
Reciting the PHECC step order from memory but applying steps out of sequence during the scenario-based practical assessment, for example checking breathing before confirming the scene is safe or before checking responsiveness.
Candidates memorise the algorithm as a list of words and rehearse it verbally, so under assessment pressure the sequence collapses into whatever step they remember next rather than a fixed, gated order.
What to do instead
Practise the sequence as a physical routine on a manikin or volunteer with a partner calling out each gate: danger, response, airway, breathing, circulation. Do not advance until the previous step is verbally confirmed. Repeat until the order is automatic before attempting timed scenarios.
Compressing the chest too shallowly or too slowly during CPR practice, often because the candidate is watching the instructor or counting aloud rather than focusing on depth and rate.
Candidates fear causing harm or are self-conscious, and the counting rhythm distracts from the physical target. Fatigue over a two-minute cycle also degrades depth without the candidate noticing.
What to do instead
Use a CPR feedback manikin or metronome and aim for a rate of 100 to 120 compressions per minute with a depth of about 5 to 6 cm in an adult, allowing full recoil. Swap compressor every two minutes and have a partner watch depth rather than the candidate self-assessing.
Delivering rescue breaths that are too large, too fast, or poorly sealed, so the chest does not visibly rise or the stomach inflates instead.
Candidates equate effort with effectiveness and blow hard, and they neglect head-tilt chin-lift positioning or mask seal under exam nerves, especially with a bag-valve mask.
What to do instead
Rehearse head-tilt chin-lift and jaw thrust on a manikin until the airway position is reliable, then give each breath over about one second and watch for chest rise before the second breath. Practise bag-valve-mask use with two rescuers and check seal by feel and by chest rise, not by how hard you squeeze.
Missing or delaying the recognition of a cardiac arrest because the candidate checks a pulse for too long or relies on pulse check instead of breathing and responsiveness.
Candidates are taught pulse checks as part of assessment and over-invest in finding a pulse, particularly with a simulated casualty who has a faint or difficult-to-feel pulse, losing critical minutes.
What to do instead
Base the arrest decision on unresponsiveness plus absent or abnormal breathing. Limit any pulse check to no more than 10 seconds and, if unsure, treat as cardiac arrest and start CPR. Drill this decision rule until it is reflexive.
Failing to place an unconscious but breathing casualty in the recovery position, or placing them without protecting the airway and monitoring breathing afterwards.
Candidates fixate on the primary problem they identified and stop once breathing is confirmed, treating recovery position as optional rather than a required step for an unresponsive breathing casualty.
What to do instead
Build a checklist habit: unresponsive plus breathing equals recovery position, then reassess breathing continuously. Practise the roll with attention to head position, dependent arm, and keeping the airway open, and verbalise ongoing monitoring during the practical.
Controlling severe bleeding with a loose dressing or by repeatedly lifting the dressing to look underneath, rather than applying firm direct pressure and maintaining it.
Candidates want reassurance that bleeding has stopped and are uncomfortable applying painful pressure, so they peek and re-dress, disrupting clot formation.
What to do instead
Apply firm direct pressure with a pad and hold continuously, adding further pads on top if bleeding soaks through rather than removing the original. Practise on a simulated wound and time a full continuous pressure hold without lifting.
Giving a poor or incomplete handover to arriving emergency services, omitting the mechanism of injury, time of onset, changes in condition, and treatments already given.
Candidates treat handover as an afterthought at the end of the scenario and have not rehearsed a structured format, so information is scattered or lost under time pressure.
What to do instead
Use a fixed structure such as the casualty's age and sex, chief complaint and time of onset, relevant history and medications, findings and trends, and treatments given with times. Rehearse a 30-second handover aloud at the end of every practice scenario until it is fluent.
Skipping or rushing the primary survey history questions, particularly allergies, medications, and past medical history, when the casualty is conscious and talking.
Candidates assume a talking casualty is stable and prioritise physical tasks, so reversible causes such as hypoglycaemia or anaphylaxis are missed.
What to do instead
Treat history as part of the primary survey, not an optional extra. Ask a fixed set of questions in a fixed order every time, and practise scenarios where the answer changes management, such as a casualty with known diabetes or a known allergy.
Failing to recognise when to stop or withhold CPR, or continuing resuscitation in an obviously unsafe scene or when signs of life return, without reassessing.
Candidates are drilled to start CPR and are unsure of the criteria for stopping, so they either persist inappropriately or fail to pause and reassess when the casualty shows signs of recovery.
What to do instead
Learn and rehearse the reassessment points: after each cycle check for signs of life, and stop when the casualty breathes normally, when a clinician or team takes over, when you are exhausted, or when the scene becomes unsafe. Discuss the local protocol with your instructor so the boundaries are clear.
Positioning and managing the casualty's airway incorrectly during a seizure or after vomiting, for example trying to restrain the casualty or insert objects into the mouth.
Candidates carry myths from lay first aid and panic when a casualty is fitting, defaulting to restraint or oral intervention.
What to do instead
Rehearse the correct approach: protect the casualty from injury, do not restrain, do not put anything in the mouth, time the seizure, and place in the recovery position once the seizure stops to protect the airway. Practise a seizure scenario with a timer and a partner so the sequence is familiar.