Head to Toe Assessment

The secondary survey (head-to-toes) is a more thorough examination conducted by the first aider and is carried out for casualties with potential injuries. If the casualty is unconscious and breathing adequately, they are left in the recovery position, and the casualty’s signs of life are checked regularly throughout the secondary survey.

The Process

The secondary survey is conducted in a methodical manner from which signs, symptoms and history can be established and is started at the head of the casualty. DO NOT forget to wear gloves and carry out the secondary survey in the correct order. This prevents the possibility of missing a more serious injury.

Head

  • Instruct the casualty not to move their head
  • Instruct the casualty not to move their head.
  • Look for any bleeding, swelling or deformity to the head or face.
  • Ask the casualty if they have a headache.
  • Look for discharge, blood or clear fluid from the ears, nose, eyes, or mouth.
  • Check over bony structures of the face for deformity or tenderness.
  • Ask if they have any pain to their head/face.
  • Ask the casualty if they can clench their jaw and if they have any pain when doing so.

Neck

  • Look for any swelling, deformity or bleeding
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  • Look for any swelling, deformity, or bleeding.
  • Remind the casualty not to move their head.
  • Ask the casualty if they have any neck pain.
  • Gently feel over the neck area for any deformity, bleeding, tenderness or altered sensation.

Chest (Thorax)

  • Look for any deformity, bleeding or swelling to the chest and shoulders.
  • Gently check the shoulders for fractures/dislocations
  • Ask the casualty to take a deep breath.
  • Listen for any noisy breathing.
  • Look and feel for the rise and fall of the chest.
  • Ask the casualty if they have any pain or are short of breath.

Stomach (Abdomen) and Hips (Pelvis)

  • Ask the casualty if they have any pain to the stomach (abdomen) or hips (pelvis)
  • Gently feel over the abdominal area for tenderness, guarding (tightened area of muscle caused by injury)
  • Look for any swelling, bleeding, or bruising.
  • Is the stomach bloated (distended)?
  • Is the casualty guarding the stomach?

Arms

  • Look for any deformity, bleeding or swelling
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  • Look for any deformity, bleeding or swelling.
  • Ask the casualty if they have any pain to the arms.
  • Feel over the arms for any bleeding, tenderness, deformity, or loss of stability.
  • Does the casualty have any numbness or tingling to the arms?
  • Is there any loss of feeling or movement to the arms?
  • Ask the casualty to squeeze your fingers to assess strength and pain.

Pelvis

  • History of the incident
  • Take note of any indication of incontinence (which may indicate a recent history of unconsciousness)
  • Priapism (erection in a male) associated with trauma can be a sign of a serious spinal cord injury.
  • Internal pain
  • May be signs and symptoms of shock.
  • Possible outward rotation of the foot

Legs

  • Look for any deformity, bleeding or swelling.
  • Feel down each leg for bleeding, deformity, tenderness, and stability.
  • Ask the casualty if they have any pain to the legs.
  • Does the casualty have numbness or tingling to the legs?
  • Is there any loss of feeling or movement to the legs?

Spine

  • Ask if the casualty has pins and needles or loss of feeling anywhere.
  • Ask the casualty if they have any back pain.

With assistance:

  • Gently roll the casualty onto their side while supporting the head and neck
  • Gently feel and look for any deformity or bleeding to the back including the spine.
  • Gently roll the casualty back into their original position

During the secondary survey, if any serious injuries are found, they should be treated immediately. The first aider must also tailor the secondary survey to the situation and circumstances at the scene. If you do have to treat a serious injury handle the casualty carefully

NOTE:   If the casualty is suspected of having a spinal injury or complains about numbness or tingling to the arms and legs, DO NOT move the casualty unless it is to preserve life. Wait for the doctor/ambulance to arrive on scene. Keep the casualty warm while waiting.