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 can.

• Symptoms: What symptoms do they tell you they have?

• Signs: Check them over from head to toe. What signs do you find on their body?

History

Event history

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.

Medical history

Then, ask them to tell you their medical history. Use the word AMPLE to remember all the things you need to ask them:

Allergy – do they have any allergies?

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 happened?

Symptoms

Ask them to give you as much detail as possible about how they feel. Listen carefully to what they say and make notes, if possible.

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?

Signs

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 discreet.

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 any bleeding.

Head and neck: Is there any bleeding, swelling, sensitivity or a dent in the bone, which could mean a fracture?

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 injury.

Eyes: Are they open? What size are their pupils (the black bit)? If they’re different sizes this could mean a head injury.

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 and fingers.

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 warning bracelet.

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 side.

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.