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Secondary Survey

Learning Outcomes:

  • Learn how to collect patient information and vital signs

  • Conduct head-to-toe examinations effectively​

  • Prioritise casualties and plan appropriate evacuation methods

  • Learn different methods to transport casualties effectively

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Lesson Content:

Summary Video

Collect Information 
To obtain from casualty if possible to hand it over to the paramedics/ambulance

Acronym AMPLE:

  • Allergies

  • Medication

  • Past medical history

  • Last meal/last oral intake

  • Event history (What was the event that led to the injury?)

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Assess Vital Signs

After conducting Primary Survey and Secondary Survey, assess the following vital signs at regular intervals. Record the time and information.

1. Check the level of consciousness (AVPU) 

  • (A) The casualty is alert and conscious

  • (V) The casualty responds to verbal stimulation

  • (P) The casualty responds to painful stimulus

  • (U) The casualty is completely unresponsive

2. Pulse rate

  • Assess the rate, rhythm and strength

3. Breathing rate

  • Look for normal breathing which is regular and not laboured

  • Assess the rate, rhythm and depth.

4. Skin Color

  • Normal skin is pink, warm and dry.

  • When in shock, the skin may appear pale/bluish grey, cold and sweaty

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Head-to-toe Examination
Examine the body in the same order as Rapid Body Survey except more time is taken to confirm any abnormalities – injury, wounds and deformities.

  • Check Skull - No tenderness, no deformity

  • Check Scalp - No haematoma

  • Check Pupils - 3/3, equal and react to light

  • Check ENT (Ear, Nose, Throat) - No fluid coming out

  • Check Mandible (jaws) - No tenderness, no deformity

  • Check Cervical (neck) - No tenderness, no deformity

  • Check Clavicle (collar bone) - No tenderness, no deformity

  • Check Shoulder - Shoulder Balance

  • Check Chest Spring - Chest spring negative

  • Check Abdomen - Soft and no distended

  • Check Arm - No tenderness, no deformity

  • Check Pelvis - Pelvis spring negative

  • Check Leg - No tenderness, no deformity

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This includes sorting of casualty (Triage) by:

  • Priority of Attention

  • Urgency for Evacuation

  • Evacuation and Transport​​​​​​​​​​​

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Casualty Transport

1. Priority of Attention

  • Unconscious casualties: Check that there is normal breathing. Place casualty in recovery position if spinal/head injuries are not suspected.

  • Serious casualties: Chest Injury (Injury to the respiratory or cardiovascular system); head injuries but conscious; fractures and wounds

  • Minor injuries: minor wounds.

2. Urgency for Evacuation: The casualty needs to be immediately transported from the scene of accident to the medical facility to seek further medical care.

  • Urgent Evacuation: All unconscious casualties, all casualties with chest or abdominal wounds, all casualties with head injuries.

  • Less urgent evacuation: Other wounds and fractures.

  • Non-urgent evacuation: Walking injured, minor injuries.

3. Evacuation And Transportation Plan

  • Stretcher Evacuation:

    • When to Use: For casualties with spinal injuries, multiple injuries, or severe chest and abdominal wounds.

    • Things to take note: MUST keep the spine straight to prevent further injury, coordinate movements among rescuers, use straps to secure the casualty, and plan the route to avoid hazards.

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  • One Rescuer Method:

    • When to Use: For conscious casualties who cannot walk unsupported due to injuries.

    • Things to note: One rescuer can support the casualty while they walk. If more assistance is needed, two or three rescuers can help carry the casualty together to ensure safety and stability during the move.

    • Most useful types of One Rescuer Method: ​

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One Rescuer Method

1. Shoulder Drag

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2. Human Crutch

  • Purpose: Assist a casualty with one injured leg to walk on their good leg.

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Note: If upper limbs are uninjured, the casualty can use a second supporter or a walking stick for additional help.​​​

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  • Purpose: For short distances over rough surfaces.

  • Steps:

    • Stabilize the casualty’s head with your forearms.

    • Crouch behind the casualty, help them sit up, and cross their arms over their chest.

    • Pass your arms under the casualty’s armpits and grasp their wrists.

    • Carefully pull the casualty backwards.

  • Caution: Do NOT use if there are shoulder, head, or neck injuries.

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  • Steps:

    • Stand on the injured side (except for upper limb injuries).

    • Put your arm around the casualty’s waist and grasp their clothing at the hip.

    • Place the casualty’s arm around your neck and hold their hand with your free hand.

    • Move off with your inside foot, taking small steps at the casualty’s pace.

    • Reassure the casualty as you move.

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3. Cradle Carry

  • Purpose: For lightweight casualties who are unable to walk.

  • Steps:

    • Pass one arm beneath both of the casualty's knees.

    • Rest the casualty’s neck on the bend of your other arm.

  • Usefulness: Provides close support for short distances.

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Questions:

Please access the questions via this link: https://forms.gle/gEjdZ16iwDmr95xw5 

Key Pointers:
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Recall AMPLE:

  • Allergies, Medication, Past medical history, Last meal, Event history.

  • You can ask for any of these in between primary survey to identify injuries better.

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