Secondary survey

An effective procedure to establish non-life threatening injuries 

Purpose of a Secondary Survey

On completing a successful Primary Survey and establishing the casualty is breathing normally, and isn't experiencing any major blood loss, a Secondary Survey procedure can be performed. During this methodical survey you are looking for other non-life threatening injuries or illnesses. A Secondary Survey is alternatively referred to as the ‘head to toe’ or ‘top to toe’ survey.  Use all your senses to look, listen and feel your way along the casualty’s body, avoiding an unnecessary movement to the casualty.  During which time asking bystanders and the casualty (conscious casualty) some simple questions to gain an insight to the establish the history leading up to the event. 

Sample questions to ask

What happened? The communication will establish the history of the event leading up to the illness or injury and in addition, you'll be aware the casualty is still conscious. What can I see? This will provide vital signs of any injuries (bruising, swelling deformity, etc.). Carefully listen to what the casualty is telling you. These are the symptoms of the injury or illness the casualty is experiencing  (location and type of pain, nausea, feeling hot or cold, etc.).

If necessary leave the casualty in the position that you found them and begin your survey at the head slowly working down to the toes.  

Head - to - toe survey

1. Head and neck

- Continue to monitor the casualty’s breathing and circulation.

- Run your hands across the head and around the back of the neck checking for fluid, lumps, bumps, irregularity or deformity.

- Check your hands.

- Look in the ears for fluid (see head injuries) and talk to the casualty, looking for a response.

- Look in both eyes, compare and contrast pupil size, look for discoloration or foreign objects.

- Assess the skin. Is it normal in colour? Pale or flushed? Cold or hot? Wet or dry? The skin will tell you if there is something wrong.

2. Chest


- Run your hands across the shoulders and collar bones, compare and contrast. Loosen any clothing around the neck area to aid breathing and circulation. Can the casualty breath easily? - - Feel both sides of the chest, looking for equal pain-free movement from the casualty.

3. Stomach and Hips

- Gently feel the stomach area looking for pain or discomfort.

- Do the same with the hips without moving the casualty, whilst looking for signs of bleeding or incontinence.  

4, Arms

- Run your hands along each arm feeling and looking for lumps, bumps, irregularity, and deformity.

- If the casualty can move their arms, hands, and fingers, ask them to do so.  Check the fingertips for signs of cyanosis.

5, Legs

- Run your hands along each leg feeling and looking for lumps, bumps, irregularity, and deformity.

- If the casualty can move their legs, hands or fingers ask them to do so.

- If possible check the toes for signs of cyanosis. 

6. Medical clues

Your casualty may provide additional hidden clues around their body which may help you establish what is wrong with them. 

Pockets - be aware of needles! Check inside for ID or medication such as inhalers, epipen or GTN spray.

Medic Alert Bracelets. Check for bracelets with an engraved medical conditions the casualty may suffer from (Anaphylaxis, Epilepsy, Diabetes).