As stated earlier, the primary survey is a process
carried out to detect and treat life-threatening
conditions. As these conditions are detected,
lifesaving measures are taken immediately, and early
transport may be initiated. The information acquired
before and upon your arrival on the scene provides you
with a starting point for the primary survey. The
primary survey is a treat-as-you-go process. As each
major problem is detected, it is treated immediately,
before moving on to the next.
During the primary survey, you should be
concerned with what are referred to as the ABCDEs of
airway, breathing, circulation,
disability, and expose.
An obstructed airway may quickly
lead to respiratory arrest and death.
Assess responsiveness and, if
necessary, open the airway.
Respiratory arrest will quickly lead
to cardiac arrest. Assess breathing,
and, if necessary, provide rescue
Look for and treat
conditions that may compromise
breathing, such as penetrating
trauma to the chest.
If the patients heart has stopped,
blood and oxygen are not being sent
to the brain.
will begin to occur in the brain in 4 to
6 minutes; cell death will usually
occur within 10 minutes.
circulation, and, if necessary,
provide cardiopulmonary resuscita-
tion (CPR). Also check for profuse
bleeding that can be controlled.
Assess and begin treatment for
severe shock or the potential for
Serious central nervous system
injuries can lead to death. Assess the
patients level of consciousness and,
if you suspect a head or neck injury,
apply a rigid neck collar. Observe
the neck before you cover it up. Also
do a quick assessment of the
patients ability to move all
You cannot treat conditions you have
not discovered. Remove clothing
especially if the patient is not alert or
communicating with youto see if
you missed any life-threatening
Protect the patients
privacy, and keep the patient warm
with a blanket if necessary.
As soon as the ABCDE process is completed, you
will need to make what is referred to as a status
decision of the patients condition. A status decision is
a judgment about the severity of the patients condition
and whether the patient requires immediate transport
to a medical facility without a secondary survey at the
scene. Ideally, the ABCDE steps, status, and transport
decision should be completed within 10 minutes of
your arrival on the scene.
The object of a secondary survey is to detect
medical and injury-related problems that do not pose
an immediate threat to survival but that, if left
untreated, may do so. Unlike the primary survey, the
secondary survey is not a treat-as-you-go process.
Instead, you should mentally note the injuries and
problems as you systematically complete the survey.
Then you must formulate priorities and a plan for
The secondary survey for a patient who presents
with medical illness is somewhat different from that of
an injured patient. Usually the trauma assessment is
about 20 percent patient interview and 80 percent
physical exam. On the other hand, the medical
assessment is 80 percent patient interview and 20
percent physical exam. Both the physical exam and
patient interview should always be done for all medical
and trauma patients.
NOTE: Remember, if the patients condition
deteriorates, it may not be possible to complete
the secondary survey before starting to
transport the patient.
The subjective interview is similar to the
interview physicians make before they perform a
The main objective of the
interview is to gather needed information from the
patient. Other objectives of the interview are to reduce