The Secondary Survey
Only move onto the Secondary Survey if you’ve already done the
Primary Survey and succeeded in dealing
with any life-threatening conditions.
Then you can start questioning the casualty about what’s
happened and carefully check someone for any other injuries or
illnesses. If you can, jot down everything you find out and give
all this information to the emergency services or whoever takes
responsibility for the child, like a parent.
You need to find out:
• History: Question them about what
happened leading up to them injuring themselves or feeling unwell?
Ask those around them too and write everything down if they
• Symptoms: What symptoms do they tell you
• Signs: Check them over from head to toe.
What signs do you find on their body?
Ask them to describe exactly what happened leading up
to them feeling unwell or injuring themselves.
You can ask other people near the scene too and also look for
clues. For example, if they’ve had a car accident the impact on the
car will help you work out what type of injury they could have.
Then, ask them to tell you their medical history. Use the word
AMPLE to remember all the things you need to ask
Allergy – do they have any
Medication – are they
taking any regular or prescribed medication?
Previous medical history –
did they already have any conditions?
Last meal – when did they
last eat something?
Event history – what
Ask them to give you as much detail as possible about how
they feel. Listen carefully to what they say and make notes, if
Here are the key questions to ask them:
•Can they feel any pain?
•Can they describe the pain, e.g. is it constant or irregular,
sharp or dull?
•What makes the pain better or worse?
•When did the pain start?
Check the casualty over from head to toe, using all your
senses – look, listen, feel and smell.
You may have to loosen, open, cut away or remove clothing. Ask
their permission to do this and make sure you’re sensitive and
Make a note of any minor injuries as you go. Only return to
these when you have finished checking the whole body, to make
sure you don’t miss any more serious injuries.
Head to toe examination
Breathing and pulse: How fast and strong is
their breathing and pulse?
Bleeding: Check the body from head-to-toe for
Head and neck: Is there any bleeding,
swelling, sensitivity or a dent in the bone, which could mean a
Ear: Do they respond when you talk to them? Is
there any blood or clear fluid coming from either ear? If so,
this could mean a serious head
Eyes: Are they open? What size are their pupils
(the black bit)? If they’re different sizes this could mean a
Nose: Is there any blood or clear fluid coming
from the nostrils? This could mean a serious head injury.
Mouth: Check their mouth for anything which
could block their airway. Look for mouth injuries or burns in
their mouth and anything unusual in the line of their teeth.
Skin: Note the colour and temperature of their
skin. Pale, cold, clammy skin suggests shock. A flushed, hot face suggests fever or heatstroke. A blue tinge suggests lack of
oxygen from an obstructed airway, poor circulation, or asthma.
Neck: Loosen any clothing around their neck to
look for signs like a medical warning medallion or a hole in their
windpipe. Run your fingers down their spine without moving it to
check for any swelling, sensitivity or deformity.
Chest: Check if the chest rises easily and
evenly on each side as they breathe. Feel the ribcage to check for
any deformity or sensitivity. Note if breathing is difficult for
them or painful in any way.
Collar bone, arms and fingers: Feel all
the way along the collar bones to the fingers for any swelling,
sensitivity or deformity. Check they can move their elbows, wrists
Arms and fingers: Check they don’t have any
unusual feeling in their arms or fingers. If their fingertips are
pale or greyish-blue this could suggest their blood isn’t
circulating properly. Also look for any needle marks on the
forearms, which suggest drug use. See if they have a medical
Spine: If they’ve lost any movement or
sensation in their legs or arms. Don’t move them to check their
spine as they may have a spinal injury. Otherwise, gently put your
hand under their back and check for any swelling or soreness
Abdomen: Gently feel their abdomen to check for
any signs of internal bleeding, like stiffness or soreness, on each
Hips and pelvis: Feel both hips and the pelvis
for signs of a fracture. Check their clothing for any signs of
incontinence, which may suggest a spinal injury or bladder injury, or bleeding
from body openings, which may suggest a pelvic fracture.
Legs: Check the legs for any bleeding,
swelling, deformity or soreness. Ask them to raise one leg and then
the other, and to move their ankles and knees.
Toes: Check their movement and feeling in their
toes. Compare both feet and note the colour of the skin:
greyish-blue skin could suggest a problem with their circulation or
an injury due to cold, like hypothermia.