PRIMARY SURVEY 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 emergency care: airway, breathing, circulation, disability, and expose. A=Airway. An obstructed airway may quickly lead to respiratory arrest and death. Assess responsiveness and, if necessary, open the airway. B=Breathing. Respiratory arrest will quickly lead to cardiac arrest. Assess breathing, and, if necessary, provide rescue breathing. Look for and treat conditions that may compromise breathing, such as penetrating trauma to the chest. C=Circulation. If the patient’s heart has stopped, blood and oxygen are not being sent to the brain. Irreversible changes will begin to occur in the brain in 4 to 6 minutes; cell death will usually occur within 10 minutes. Assess 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 severe shock. D=Disability. Serious central nervous system injuries can lead to death. Assess the patient’s 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 patient’s ability to move all extremities. E=Expose. You cannot treat conditions you have not discovered. Remove clothing– especially if the patient is not alert or communicating with you–to see if you missed any life-threatening injuries. Protect the patient’s 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 patient’s condition. A status decision is a judgment about the severity of the patient’s 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. SECONDARY SURVEY 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 treatment. 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 patient’s condition deteriorates, it may not be possible to complete the secondary survey before starting to transport the patient. Subjective Interview The subjective interview is similar to the interview physicians make before they perform a physical examination. The main objective of the interview is to gather needed information from the patient. Other objectives of the interview are to reduce 4-4