by Kaitlyn Edwards

Created on: September 15, 2010   Last Updated: November 30, 2011

The purpose of the secondary survey is to look for other injuries or complaints which need treatment but which, unlike for the primary survey, are not immediately life threatening.

The secondary survey is conducted in a logical, systematic order, ensuring that all areas of the body are assessed, reducing the risk of problems being missed.

The secondary survey starts at the head. Both sides of the head are felt simutaneously, comparing the two sides. The palms of the hands are used to feel for bumps, soft spots, indentations and blood. Work down the head, checking the face. At the eyes, you should check for them being blood shot, equal sized and reactive pupils and the development of black eyes; this might suggest a head injury. At the ears and nose you should check for clear, straw coloured or blood stained fluid; this may indicate a spinal injury. The cheeks, mouth and jaw should also be checked.

The neck, shoulders and chest should be checked next. Check that the bones feel right, for lumps, bumps, bruises and bleeding.

The arms should be checked, again for lumps, bumps, bruises and other abnormalities. Needle marks and medic alert bracelets should also be checked for.

Work your way down the rest of the torso. Check the abdomen for rigidity and bruising which may be indicative of internal bleeding. Check the small of the back for any evidence of incontinence.

The legs should be checked, thigh to toe.

Throughout the whole assessment, you are checking for symmetry of one side of the body to the other. Asymmetry is rare in the human body, and any such discovery should be investigated. It is important to look for any thing unusual; laboured breathing, rashes, excessive sweating. If conscious, slurring of the speach, facial droop, or decreased mobility.

Whilst conducting the secondary survey, as for the primary survey, you should be wearing gloves to prevent cross-infection between the casualty and yourself.

It is important that you talk to the casualty, even if he is unconscious. It is widely believed that hearing is the last sense to go and the first to return. It will reassure the casualty as to what you are doing. It may reassure bystanders, too. Whilst preforming the secondary survey, try to have a witness present.

If the casualty is conscious, or there are bystanders who either have witnessed the event or who know the casualty, ask questions as these can be helpful in your diagnosis. Check briefly for physical clues in the area that may help in your treatment of the casualty. An inhaler, GTN or an epi-pen might suggest asthma, chest pain or an allergic reaction, for instance.

And don't forget to treat what you find.

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