A Secondary Assessment , (also known as a simple secondary survey)
is used in first aid after you have taken care of any life-threatening conditions.
You might or might not have already called 911,
depending on how life-threatening the situation is for the person who is injured or suddenly ill.
BUT
The victim could pass out before EMS (emergency medical services, such as an ambulance) gets to your location.
You can save someone’s life just by getting answers to questions
the emergency room doctors / EMTs would need to ask to best be able to help a victim.
Examples:
The victim might be allergic to a medication the doctors would want to give them.
They might be taking a medication that could have serious effects if they are given another medication.
The victim might have ongoing medical concerns that would affect their care.
When a woman is pregnant, she does not look like it for weeks, but it would be crucial for her care for everyone helping her (EMT, paramedic, emergency room personnel), to know she is pregnant.
As you ask the questions
Remember, don’t have them move any body part you suspect is injured and if you suspect a spinal injury you would be manually protecting the spine/neck from movement and would not want them to tilt their head yes or no in the process of answering questions. You could tell them to not move, and not nod their head yes.
Instead of asking “do you have any pain,” you could say “tell me about your pain.”
Note that elderly victims might not have their hearing aids in, or might not have hearing aids that they need.
Remember that someone with altered mental status, such as using alcohol or mind-altering drugs, or who has a concussion, might not be able to give you accurate answers to your questions.
If you did not do so already, introduce yourself, ask permission to give care, get victim’s name.
It could be good to be at eye level with the victim rather than standing towering over them.
(If you did not already call 911, at any point while you are taking this brief history or during the head-to-toe exam, if you find something that requires emergency medical personnel, stop the survey to call 911 immediately.)
And remember that (quoting from Red Cross materials that are covered elsewhere in this class in detail) “an injured or ill person must give permission before responders can provide first aid and emergency care.”
You do not always need to touch a person to give care, but you must get permission whenever you must touch a victim. Touching even includes a simple, friendly gesture like putting your hand on someone’s shoulder.
Interview the victim (write notes, including negative answers) and give the information to EMS personnel when they arrive.
(You can think of SAMPLE below as an expanded “SAM.”
If you use SAM you only ask about S = signs and symptoms, A = allergies and M = medications and medical conditions.)
Use SAMPLE as an easy way to remember the questions in a more complete interview commonly used by professional rescuers.
Signs and symptoms
What happened to you?
(You might also note if they are anxious or indifferent, restless, and/or disoriented.)
Do you feel pain anywhere?
Do you feel any numbness, tingling or loss of sensation? (If yes, where?)
Are you experiencing any lightheadedness, nausea?
(If they felt dizzy, was it a spinning feeling, or just lightheaded and did they lose balance?)
_________________________________________________
Sometimes ask for details about pain :
Provokes (What makes it worse/better? Does it only happen after you eat? Does it only hurt when you breathe deeply, only when you change position?)
Quality Ask them to describe the pain. (Don’t use a leading question such as, is your pain a burning pain? Answers could include sharp pain, stabbing, cramping, aching, burning, dull.)
Radiates / or another source says Region/Radiates Referred (Does it start in one place, and move to another? What makes it move? (spleen injury pain can be felt in the left shoulder, heart attack chest pain can radiate to the neck and jaw, kidney stones are associated with severe back/flank pain radiating to the groin, gallbladder pain can be felt in the right shoulder blade, a slowly bleeding abdominal aneurysm can cause abdominal pain radiating to the back)
Severity (Where is the pain on a scale of one (least) to ten (most, worst pain possible). “Worst headache of their life” could be more than just a common headache.
Time (When did it start hurting? How frequently does it occur? How long does it last? Does it come and go? Get better or worse? ) (Intermittent, hard to locate pain is common with problems of the abdomen.)
(If the onset and time categories seem to be redundant, think of the onset as WHY and the time as WHEN.)
_________________________________________________
Allergies
Do you have any allergies, (including food, plants/pollen, insects and medications)? What type of reactions have you experienced when you were exposed? Any recent exposure? Tightness in their throat?
(A metallic, mint, or rubber taste in the mouth can happen after venomous snake bite.)
Medications / Medical Conditions
Do you have any medical conditions or are you taking any medications? If so, what conditions do you have or what medications are you taking? Have you taken any in the past 12 hours? Did you skip taking a medication or take more than usual?
(including prescription, over-the-counter, herbal)?
They might not remember the names of their medications, so you could ask what are their medications for, and when did they last take them.
Don’t ask if they are taking any drugs, as they may misunderstand and think you are accusing them of illegal activities. But if that might be the reason they are having problems, you certainly need to find out.
Diabetic?
Heart problems? (may get you a better answer than asking about ‘Cardiac history’)
Epilepsy? Asthma? Pregnant? Check for medic alert tag.
Example: if they are taking Viagra, giving them nitroglycerin could have serious side effects. Some antibiotics may decrease the effectiveness of hormonal birth control such as the pill.
Pertinent past medical history
Have you experienced any recent falls, accidents or blows to the head? Have you ever been in any medical, surgical or trauma incidents?
(If you didn’t get the answer to this in the medical conditions questions):
Are you under a doctor’s care for anything?
If appropriate: Have you experienced anything like this before? Have you been feeling okay the last few days?
(History of high blood pressure? Recent surgery/illness? (complications?) Dehydrated? Didn’t eat any breakfast? Lack of sleep? Substance abuse? Previous injury to same site?
Same type of pain previously – was there a diagnosis?
Same location of pain previously – is the pain the same this time?)
Last oral intake
(also referred to as Last food or drink OR Last Ins and Outs.)
When did you last eat or drink anything? What did you last eat or drink?
(Don’t ask the victim “when was your last oral intake?”).
You could also ask the amount.
This includes solids, liquids and medications.
Changes in diet that might have caused that stomach upset.
In the wilderness it can take more time to get safely drinkable water and people sometimes choose to be regularly dehydrated.
Perhaps notice if they smell of alcohol.
Perhaps ask if oral intake over the past few days has been normal for them. When did you last defecate and urinate and were they normal? Example, was urine clear or dark. No recent diarrhea? Any blood?
Events leading to the incident
What were you doing before the accident happened? What were you doing when the incident occurred?
OR How did you get hurt?
OR Why do you think this happened? (As in, why do you think you just fainted?)
Try to not phrase the questions in a negative manner that could cause concern / embarrassment for the victim,
as in “What did you do?”
Finally, you could ask:
Is there anything else I should know?
Write down all the answers.
Then do a head to toe exam, starting by telling the victim what you are going to do. Keep explaining as you go along.
Head to toe exam
(in a simple secondary survey you hardly touch the victim, they do the moving around, but should only move if you do not suspect a spinal injury)
Visually inspect the body, including the scalp, face, ears, eyes, nose and mouth for cuts, bumps bruises and depressions.
(DOTS: Deformity, Open injuries, Tenderness, Swelling)
Compare the injured body part to the opposite uninjured part (injured right hand to uninjured left hand).
(DCAP BLTS deformities, contusions, abrasions, penetrations (another source says punctures/penetrations),
burns, lacerations, tenderness, swelling)
Look at face and lips (unusually wet or dry, pale, bluish, jaundice (yellow skin combined with yellow whites of the eyes = liver problems) flushed, ashen; note abnormalities).
Check eyes (pupils (the black center of an eye)- big, tiny, uneven size, both react the same to light?) ears, nose,
ask them to open mouth; look for fluid or blood (don’t try to control fluid coming from ears)
A significant percentage of people normally have pupils of slightly different size, but both should react to light the same way if, for example, you shine a flashlight (electric torch) in their eyes.
Dilated (bigger than normal) pupils can be caused by dilating eye drops from an eye exam (stay dilated for four to six or 24 hours), as a side effect from a medication (including antidepressants, antihistamines, anti-nausea medications, motion sickness medications, and anti-seizure medications).
Recreational/ illegal drug use (and withdrawal from these drugs) cocaine, ecstasy, LSD, methamphetamines, psychedelic mushrooms, long-term alcohol abuse.
Eye injury, brain injury/head trauma, adrenaline (from stress/ anxiety). The Centers for Disease Control lists dilated pupils as a late symptom of hypothermia.
Pinpoint pupils can be caused by some head injuries / brainstem stroke and the use of opioids (including morphine prescribed for pain relief), barbiturates, and medications prescribed for high blood pressure or glaucoma, other medications, some kinds of poisoning.
Determine skin appearance and temperature. Feel person’s forehead with back of your hand to determine if it is cold or hot.
Write down all observations, including anything that does not look right.
Don’t do the following if you suspect a spinal injury or move any body part you suspect was injured.
– Ask person to move head from side-to-side if there is no discomfort and if an injury to the neck is not suspected.
Note pain, discomfort or inability to move the neck.
– Ask person to shrug shoulders.
– Ask person to take a deep breath and blow out air.
Listen for changes in breathing and ask victim if he or she is experiencing pain during or right after inhaling.
Breathing (gasping, unusual noises, fast or slow, labored, noisy, gurgling, shallow or deep, pain when breathing, dry or productive cough, difficulty swallowing, difficulty speaking in full sentences/using phrases or sentences, example: can’t say more than one or two words before they need to take another breath)
Stridor = high pitched noise when breathing in; wheezing = high pitched noises when breathing out.
If coughing, increased frequency and severity? If sputum, increased production and/or changes in character?
If nasal discharge, what color? (Clear, yellow, green, reddish, brownish?)
Ask if any pain in abdomen (which quadrant?)
(Causes of abdominal pain include trauma, ectopic pregnancy, perforating ulcer, appendicitis, gall bladder infection or as simple as digestive system problems such as intolerance to some types of food, a viral illness, constipation.)
If they are vomiting, describe what is vomited, if diarrhea, describe the consistency.
(Opioid withdrawal signs or symptoms include vomiting, disorientation and lethargy.)
– Ask person to move hands, (wiggle) fingers, bend arm. Compare grip strength.
Can they identify which finger you touch on each hand, and have no odd sensations when you do?
(To compare grip strength, hold out both of your hands with your index fingers pointing out, and asking the person to squeeze one of your fingers with each hand at the same time, (a test of bilateral grip strength). Squeezing fingers is a way to test strength to see if it is equal in both hands and also a fairly standard test of someone’s ability to respond properly to your command.
– Ask person to move feet, ankles, bend leg. Check one limb at a time.
Can they identify which toe you touch on each foot, and have no odd sensations when you do?
Explain to bystanders and get a witness to your taking out someone’s wallet to identify them.