Primary & Secondary Assessment

Frederick Ding & Christopher Chan

Bronze Cross – Primary & Secondary Assessment The purpose of a primary assessment is to preserve the life of the victim, taking action where needed. Once the victim’s life-threatening conditions have been addressed, the rescuer must begin the secondary assessment – monitoring his condition, gathering information and finding other conditions that require treatment.

The Primary Assessment The lifesaver’s first obligation is to his own safety. Upon arriving at the scene: Area Check for hazards in the immediate vicinity, and remove them as safely as possible. Awareness Assess the level of consciousness – does the victim respond to voice or touch stimulus? Ambulance Activate EMS, preferably using a bystander. If qualified, an AED can be retrieved at this time. The rescuer must maintain the ABCs of all victims: A. Airway Keeping the airway open allows the body to take in oxygen and expel carbon dioxide. A blocked airway can lead to respiratory or cardiac arrest. Use the head-tilt chin-lift technique to open the airway. Check for and remove obstructions. B. Breathing Always use barrier devices!

Once the airway is open, check for normal breathing, making use of the look, listen & feel techniques. Look at the chest to observe the rising and falling of normal respiration. Listen for air movement. Feel for air coming through the mouth or nose. If there is no breathing or abnormal breathing, CPR must be initiated, beginning with 2 breaths. C. Circulation Oxygen-rich blood cannot be circulated without breathing. Hence, it is unnecessary to check for a pulse to determine whether CPR is needed; commence it immediately if no breathing is detected.

If trained, use an AED .

The purpose here is to squeeze the heart, causing blood to circulate. Refer to the Canadian Lifesaving Manual for proper CPR technique.

Refer to the Canadian Lifesaving Manual.

PG. 1

Frederick Ding & Christopher Chan

Treatment of the ABCs must be continued until the victim resumes breathing independently (unlikely with CPR alone), qualified help arrives and takes over, the rescuer becomes unable to continue, or the rescuer puts himself at risk.

The Secondary Assessment The secondary assessment consists of three major components: history, vital signs, and the head-to-toe examination. History At this point, the victim should be sufficiently conscious to give verbal responses to questions posed by the rescuer. A rescuer should take note of the SAMPLE questions: Continue to rest and reassure.

Signs & symptoms Allergies Medication Previous medical history Last oral intake Events leading up to the emergency Answers to these questions may need to be provided to paramedics or otherwise recorded. Vital signs Take note of changes or abnormal conditions in the following signs: ƒ Pulse (carotid, brachial, radial) ƒ Breathing ƒ Pupils ƒ Level of consciousness ƒ Skin colour & temperature If level of consciousness deteriorates, it may be necessary to recommence CPR. Head-to-toe examination

Keep monitoring ABCs.

Check the victim for abnormalities (e.g. bruising or minor bleeding). Examine the head, feeling for indentations, blood or fluid, and watch for signs of discomfort. Examine the neck; if there is pain there, immediately stop the examination and immobilize the neck. Check for obvious deformities and asymmetry of the shoulders, chest, and back. Examine the arms and hands for areas of pain or deformity. Examine the abdomen with gentle pushing and watch for pain, as this is where many organs lie. Then, examine the pelvis, a large bone with potential for damage, by pushing gently downward on both hips. Finally, examine the legs and feet for obvious injuries, shortening or rotation of one leg, and check that they can be moved normally. The Canadian Lifesaving Manual contains an excellent illustration of the head-to-toe examination in section 6.6.

Refer to the Canadian Lifesaving Manual.

PG. 2