How to Conduct a Secondary Survey of an Injured Person

During a disaster, medical personnel can be overburdened or far away from you and others who may be injured. Understanding what to do after an initial assessment can be helpful to a victim and medical personnel as they arrive. This article will tell you how to conduct a secondary survey of an injured person.

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Steps

Reassessment and History.

    1
    Repeat your primary assessment quickly. Recheck the patient's airways breathing and circulation. This is also known as the ABCs. Repeating the primary examination is especially important if you are caring for multiple people.
    2
    Evaluate the patient's mental status. If he or she is conscious, ask for a name, what year it is and if the patient knows where he or she is. Introduce yourself as well.
        If the person is unconscious, or has just lost consciousness, note the change (if there is one) and the time if you have paper and pen with you. Skip down to the head-to-toe part of this article.
    3
    Start your secondary assessment by asking the patient about what happened. Take notes if you can. Remember to write down any suspected loss of consciousness during and after the event (however brief).
        Ask if he or she is experiencing any numbness or tingling anywhere in the body. This can indicate a spinal injury or stroke. Ask if he or she is experiencing light-headedness or nausea. Note the answers.
        Question the patient about any pain he or she is feeling. Be sure to ask when it started hurting, how he or she would describe the pain (sharp, throbbing etc).
        Ask if the pain is constant or comes and goes and how severe the pain is on a scale from 1 to 10, with 10 being the worst the patient ever felt.
    4
    Check the patient for a medical alert bracelet or necklace. Ask if there are any medical conditions you should be aware of such as diabetes or pregnancy.
    5
    Ask the patient if he or she is taking any medication or has allergies to food or medication. This is valuable information for medical personnel when they arrive.

Head to Toe Examination

    1
    Examine the head and face for possible fractures, eye trauma or head injuries. "Closed" head injuries are not always apparent and could include concussions and internal hemorrhaging.
    2
    Conduct a neural examination. Look at the patient's pupils for size and reaction to light. Note spontaneous movements of the person's arms and legs or lack of movement in all patients (conscious or not).
        Look at the color of the person's skin. Note if it is a normal color, pale or bluish. Feel a person's forehead with the back of your hand for temperature and note if it is hot, cold or clammy.
    3
    Check the patient's chest and abdomen for penetrating objects. If one is seen, do not remove it. Stabilize it, if you can, with gauze wrapped around the wound.
        Also look for bleeding, swelling or other obvious deformity (such as part of the chest looking caved in or a rib sticking out). If an open hole is seen, try to cover it with a sterile bandage.
    4
    Press against the chest and abdomen gently for tenderness and pain. Do not touch around a penetrating wound or other deformity. Note any of these findings and treat bleeding with pressure and a dressing as needed.
    5
    Observe the person's breathing. Note any gasping, unusually slow or fast breathing, coughing or any unusual noises while breathing in and out. Ask the person if he or she experiences any pain while breathing.
    6
    Examine the arms and legs for deformity and bleeding as well as abrasions and bruises. If an arm or leg looks crooked or otherwise deformed, splint it in the exact position it was found. Do not try and move it.
    7
    Finish your neural exam after checking out the rest of the body by asking the conscious patient to move fingers and toes.
    8
    Note if there is a lack of movement in any of them. Ask the person to squeeze your hand with each arm if there is no deformity or suspected neck or spinal injury.
    9
    Continue monitoring the patient's ABCs and mental status until medical personnel arrive. Inform paramedics or other personnel of the patient's condition.

Tips

    Immobilize a patient's head and neck if a head or spinal cord injury is suspected. Have a bystander hold the person's head still if there is no neck brace or makeshift supplies available.
    Call for emergency medical help as soon as possible.

Warnings

    Do not attempt to move a patient who has a suspected head or spinal wound unless absolutely necessary to preserve life (danger of fire or falling debris).
    Wear medical gloves while examining the patient to guard against blood-borne diseases if possible.
    Do not remove any penetrating object from a patient's body. Removing a foreign object can cause uncontrollable bleeding (hemorrhage).

Things You'll Need

    Gloves (latex or nitrile is preferred)
    First aid supplies and neck brace (if available)
    Flashlight (if available to check eyes)
    Paper and writing instrument (if available)
    Cell phone