Information - Secondary Assessment

Background information for Key Stage 3 and parents.

Casualty Assessment

In previous sessions, we highlighted how you carry out an initial assessment and if necessary, how to contact the emergency services. As part of the approach, we looked at the person's position, what was around them and what they were holding. All
this information, plus what we collect with secondary assessment helps us build a picture of what is wrong. We consider this as:

Doctor sitting holding a clipboard and pen
  • History - What happened? How long have they had the symptoms? Have they been ill before?
  • Signs - What do you see that is wrong with them? What are they holding? What injuries can you see? Is there vomit or blood on the floor?
  • Symptoms - What do they tell you about their pain, their feeling of wanting to be sick or what can they not feel in the case of nerve damage?

Secondary assessment on a responsive casualty

The initial assessment has not provided all the information above, so once we have carried out an initial assessment on every casualty to ensure they all have an airway, we begin a secondary assessment on each casualty. You can remember the key things
to ask, by remembering SAMPLE.

S
Signs and Symptoms

This is a reminder of what you see and what the casualty has told you.

A
Allergies

You need to check as to whether they are allergic to anything as this may be causing their emergency or it might affect how you treat them. For example, if they had a cut and they were allergic to plasters, you would need to use something
different.

M
Medication

When they tell you what medication they are taking, you probably won't know what it is for, but it is ok to ask them to explain. It may help you understand what is wrong or it might just be important information to pass to the ambulance
service when they arrive.

P
Past medical history

Not all medical conditions require medication or they do not need to take the medication any more as their symptoms have improved. You may have a diabetic who controls their condition through diet, a casualty who suffers from migraines
or a casualty who has broken the same foot before.

L
Last meal

What we eat can affect how we are. A casualty may be acting out character as they diabetic and they have missed their last few meals or a casualty may be vomiting and had undercooked chicken the night before, suggesting food poisoning.

E
Event

This is where find out what happened to casualty, for example, they fell from the top of the ladder or they fell from first rung of the ladder. This will make a difference in your thinking, as the top ladder could have caused a spinal
injury, while the first rung is less likely.

It does not matter which order you ask the questions, but it is important to ask Allergies early on, in case there is something that will affect your treatment.

SAMPLE is an easy way to handover to the ambulance service. You do not want to give them a story, but key facts. If you follow SAMPLE in your handover, you will keep to facts and show what you have considered, even if it is 'No known allergies'.

Pain

While carrying out a secondary assessment, they may mention something hurts. You can get some important information by asking about the pain. You can consider:

  • We all have different pain levels, so ask them how severe the pain is for them on a scale and keep monitoring for changes in this level. You can ask the casualty 'If 0 is no pain and 10 is the worst pain you have ever had, how painful would you
    say it is?'
  • We can consider how long they have had the pain and how long it has been that painful. As an example, an appendix may ache for some time before it suddenly gets really painful. The sudden change in pain level would indicate an ambulance was needed
    quickly.
  • Where does the pain go, as we can get referred pain which may help recognise where the injury actually is? In the case of a heart attack, the pain can go from the chest up the left side of the neck and down the left arm.
  • We can consider does anything make the pain easier. In the case of angina, unlike a heart attack, the pain normally eases on rest or in the case of a sprained ankle, the pain may get worse when they put weight on it.

Secondary assessment in an unconscious casualty

If the casualty is unconscious, they are not going to be able to tell us where it hurts and we will have to look for the injuries.

As part of the initial assessment, we considered how unresponsive we found the casualty. This will be important in the way they react when looking for injuries. If they groan to pain, we know to listen for a groan as we check or if they just flinch
to pain, we know to watch a flinch or maybe both.

In a secondary assessment on unconscious casualty, we start at the head and work our way down to the toes. We are looking for any signs of injury which could include:

Three different emergency bracelet
  • bleeding
  • bruises
  • burnt areas
  • mishappen limbs
  • wet areas due to them wetting themselves
  • bloodshot eyes
  • any emergency necklaces, bracelets or cards
When carrying out a check of an unconscious casualty you must remember the person's dignity at all times and remember they may not be completely unresponsive so talk through everything you are doing. If an adult is about, it is best to have called
them to help carry out a safe check of a casualty.