How to Perform Primary and Secondary Survey in a First Aid Emergency

In life, when we are trying to solve something, the very first thing we do is to identify the problem.

For example, if your car broke down and you want to repair it, you must find out which part is broken. It also applies to first aid. Whenever you encounter an emergency that involves an injured casualty, you must first find out what is wrong.

There are two important assessments of the casualty:

Primary survey
Secondary survey

They both represent the overarching and sequential aspect of casualty assessment. While these two are used primarily in trauma scenarios, the assessment components are also applicable to most patients. Doing so will provide a comprehensive clinical picture of the casualty.

Using these two assessments, you will be able to identify whether a person is in a life-threatening situation. You will know what injuries they may have and the level of danger that requires immediate treatment.

Once an assessment is made, the next appropriate actions depends on the findings from these assessments.

PRIMARY SURVEY

The goal of the primary survey is to help emergency first responders to detect immediate threats to life. Immediate life threats typically involve patients’ responsiveness, airways, and breathing, which are the most important information in deciding your treatment.

The most common mnemonic for the primary survey is the ‘DRABC’ which stands for Danger, Responsiveness, Airway, Breathing, Circulation.

This is the order of priority to ensure the most critical steps are undertaken in a logical order. This systematic approach also ensures nothing is missed.

The DRABC is worth remembering because every time you come across any emergency, primary survey is the first thing to-do.

Danger

The first and most important rule in first aid intervention is your safety. Hence, make sure that it is 100% safe before approaching a scene. Do not put yourself at risk by approaching unsafe conditions. Unsafe conditions including uncontrolled traffic, live electricity, or places or objects that can cause you to fall or trip over.

Once the scene is safe to approach, you can begin to assess the casualty.

Response

Assess the patient’s level of responsiveness using the AVPU scale.

Alert – is the casualty moving or talking? If they are not showing any signs of alertness, proceed to the next one.

Voice – See if the casualty is responding to loud voices. If no response, proceed to P.

Pain – is the casualty only responding to painful stimuli? If there are no signs of responsiveness, proceed to the last one.

Unresponsiveness – if your reach this point, you can assume the casualty is unresponsive.

Airway

If the casualty is unresponsive, there might be some problems in their airway. Check the airway by placing the casualty on their back, with head slightly tilted backward. Place your hand on the chin and forehead, then lightly tap the back of the head. Use your fingertips on the chin area to lift their mouth open to open the airways.

Breathing

Look for any signs of breathing difficulties – whether it is on abnormal patter, infrequent, or no breathing at all. Begin CPR if you notice any of these symptoms.

Circulation

The major life threat when it comes to circulation is a hemorrhagic shock. To assess the casualty, check for their pulse rate, skin color, capillary refill time, and blood pressure. If you reach this point and the casualty is not breathing, you need to call Triple Zero (000).

Once the primary survey is completed, use the information from the assessment to proceed further.

If the casualty is unconscious and has breathing difficulties, call Triple Zero, and perform CPR (cardiopulmonary resuscitation).
If the casualty is conscious and breathing, proceed with the secondary survey. Communicate with the casualty to get more information about the injury.

SECONDARY SURVEY

The secondary survey should commence after the primary survey is completed, immediate life-threats are identified and managed, and casualty is stable. The secondary survey is for less obvious problems that may require first aid.

This assessment involves a more thorough head-to-toe examination. It aims to detect other significant but not immediately life-threatening injuries through history and physical exams.

The secondary survey is a systematic approach to identify any bleeding or fractures on the casualty. It starts to the head, shoulders and works down to the legs.

Head and face

Check the face and scalp and look for any lacerations or bruising, including mastoid or periorbital bruising. The presence of such injuries may be indicative of a base of skull fracture.

Proceed with assessing the eyes for any penetrating injury and check the ears for any leak or bleeding. Do not forget the nose and look for any deformities and bleeding.

Neck

Examine the neck with the cervical collar should be open. While doing so, there should be manual in-line stabilisation on the head. Examine the anterior neck and check for signs of tracheal deviation, wounds, and bruising, and distension of the neck veins. Note any pain on the cervical spine, tenderness, or deformity.

Shoulders & Chest

For shoulders, place both hands on opposite sides and run them down to compare both sides of the body.

For the chest, start by feeling the rib cage. Broken ribs can be extremely painful on conscious casualties. If you suspect broken ribs, ask the casualty first before deciding the next steps.

Abdomen

Inspect the abdomen, the perineum, and the external genitalia. Look for any seat belt or handle-bar injuries, bruising, lacerations, or penetrating injuries.

Palpate for areas of tenderness in parts over the liver, spleen, kidneys, and bladder.

Back

Perform log roll at least once, either in primary or secondary survey. Inspect the back and note any deformity, bruising, and lacerations. Also, note for any loss of tone and sensation.

Limbs

Inspect all the limbs and joints of the casualty. Note any visible bruising, lacerations, muscle, nerve, or tendon damage.

Knowing primary and secondary surveys can be one of the most important acts a rescuer can do to help the casualty. Attending a first aid course will teach you how to do both primary and secondary assessment.

The First Aid Course Sydney have contributed this article to Asset College’s website. While Asset College can deliver First Aid courses in QLD, First Aid Pro also deliver First Aid courses in other states right across Australia.