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The Secondary Survey

The secondary survey is a comprehensive compilation of clinical signs and symptoms, measured in

combination with pertinent medical history, which is the foundation of a detailed patient examination.

Once a paramedic has completed the primary survey and has addressed any immediate concerns that were time critical, they may begin the secondary survey which includes: the patient interview (history taking), a clinical examination and a full set of vital signs.

 

  1. Identify the patient as fully as possible, including their name, date of birth, home address, and Medicare number.

  2. Determine their Chief Complaint (e.g. symptom) or Condition (e.g. sign). If there are multiple complaints or conditions, then prioritize those that may be urgent of life threatening.  Common questions include:

N     when did the patient last feel “Normal” (for them)?

O     the Onset of this situation (time and rate of onset, activity at onset, possible causes)

P     which actions are Provocative or Palliative?

Q     what is the Quality of the pain or sensation the patient is feeling?

R     is there any Radiation of the discomfort? If so, where and under which conditions?

S     what is the Severity of the complaint? (using 0-10, or mild/mod/severe, or visual analogue scale prn)

T     is this Typical for the patient and was there any precipitating Trauma?

U     Undigested food? When (and what) did the patient last eat or drink?

  1. Determine the incident history, the family history and the social history of the patient, as appropriate. Common questions include:

  • Any existing medical conditions? (Cardiac, Respiratory, Neuro, etc. Any disabilities?)

  • Ask “Anything else?” - be sure to exhaust all aspects of the patient’s medical history

  • Who is their regular medical provider? Any alternative health-care providers?

  • Problem focused history (eg. respiratory focused system history/interview for the SOB patient)

  • Family history: Adopted? Parents alive/dead - what causes? Any diseases in blood relatives?

  • Social history: Gender-at-birth, Education, Occupation, Socioeconomic issues, Sexual history, Marital/partner status

  • Alcohol, Cigarettes, Caffeine, Other drug use, Recent travel (where and when), previous hospital experiences and preferences

  1. Determine any patient allergies, including those to environmental, chemical, food, drug or other possible allergens.

  2. Determine patient medications, including alternative/complimentary ‘remedies’, prescription drugs, illicit substances, or over the counter medications.

  3. Perform a complete set of vital signs.  These typically include:
     

  • Levels of Responsiveness (eg. Glasgow Coma Scale, AVPU, etc)

  • Level of Pain

  • Skin condition (colour, temperature, diaphoresis, turgor)

  • Pupil shape, size, equality, response to light and accommodation

  • End tidal carbon dioxide (EtCO2)

  • Temperature (peripheral, and core prn)

  • Respiratory rate, depth, effort and pattern

  • Electrocardiogram (ECG)

  • Blood Pressure

  • Pulse rate, rhythm and strength (noting any absent pulses)

  • Blood sugar levels (prn)

  • Oxygen/Haemoglobin saturation (SpO2)

  1. Perform an appropriate physical assessment:

  • In general trauma - a comprehensive head to toe examination

  • In isolated trauma - a focused examination of the injury

  • In medical cases - a focused, systems-based examination based on the presenting complaint or condition

  1. Collaboratively develop and implement an appropriate treatment plan in conjunction with other medical professionals involved in the case.  Consider:

  • Treatment performed prior to your arrival? Results?

  • Results of your interventions (with ongoing reassessments of the patient)?

  • Recommendations for further referral, assessments or treatments that may be appropriate as part of a comprehensive care pathway?

 

 

This secondary survey can be remembered using the mnemonic ‘I see I had vitals assessed and treated’1:

 

I                            Identify the patient

C                          chief Complaint or Condition

I                           nature of the Incident (incident history)

H                          History (medical, family, social)

A                          Allergies

D                          Drugs

Vitals                    Vital signs

Assessed             Physical Examination

Treated                 Treatment Plan (and ongoing evaluation)


 

Note that this format is also the preferred format to use for giving a patient handover to another health care professional.

 

 

 

 

References:

1.        Colbeck, M. A. et al. International Examination and Synthesis of the Primary and Secondary Surveys in Paramedicine. Irish J. Paramed. 3, 1–9 (2018).