Secondary Survey as a Level 2 First Aid attendant

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As an OFA Level 2 attendant, your job doesn’t stop once you’ve completed the primary survey and dealt with immediate life-threatening conditions. The secondary survey is where you go deeper—checking for hidden injuries, gathering a medical history, and monitoring for changes.

This detailed assessment helps ensure no injuries are missed and that the right care is provided until paramedics arrive. Whether you’re working on-site or responding in an OFA Level 2 Vancouver setting, mastering this skill is essential.

What Is the Secondary Survey and Why Does It Matter?

Once you’ve addressed critical interventions (ABCs), the secondary survey helps you:

  • Identify additional injuries that weren’t immediately obvious.
  • Monitor for changes—injuries can worsen over time.
  • Gather medical history to help emergency responders provide better care.
  • Check the effectiveness of your initial treatments.

When Should You Perform a Secondary Survey?

Timing is everything. You’ll typically start the secondary survey after completing the primary survey—but only if:

  • Critical issues are under control (breathing, circulation, severe bleeding).
  • The worker is stable enough for a more detailed assessment.
  • You’re waiting for an ambulance or ETV (Emergency Transport Vehicle).

If the situation requires rapid transport, focus on stabilizing the worker first—the secondary survey can be done en route to the hospital.

For walk-in workers with minor injuries, you can modify the secondary survey to focus on their complaint rather than a full-body check.

Steps for a Comprehensive Secondary Survey

The secondary survey follows a structured approach to ensure nothing gets overlooked.

1. Checking Vital Signs

Vital signs provide crucial insight into a worker’s condition. Track these over time to spot deterioration.

  • Level of Consciousness (LOC) – Use the AVPU scale:

    • A – Alert
    • V – Responds to Verbal stimuli
    • P – Responds to Pain
    • U – Unresponsive

  • Breathing – Count breaths per minute (normal: 12-20), check for deep, shallow, labored, or noisy breathing.

  • Skin Condition – Check color (pale, red, or blue), temperature (hot, cold), and moisture (dry, moist, clammy).

  • Pulse (Heart Rate) – Assess rate, rhythm, and strength, especially in critical cases.

🔹 Pro Tip: Always record the time you take vital signs so you can track changes. Reassess every 5 minutes for unstable workers, every 10-30 minutes for stable cases.

2. Gathering Medical History – The SAMPLE Method

Use the SAMPLE mnemonic to gather important background info:

  • S – Signs & Symptoms: What are they feeling? Any pain, nausea, dizziness?
  • A – Allergies: Medications, foods, environmental allergies?
  • M – Medications: Any prescription drugs or over-the-counter meds?
  • P – Past medical history: Any pre-existing conditions (diabetes, heart issues, etc.)?
  • L – Last oral intake: When did they last eat or drink?
  • E – Events leading to the injury: What happened? (Mechanism of injury is crucial).

This info helps determine hidden risks—for example, a diabetic worker feeling dizzy may not be injured but could be experiencing low blood sugar.

3. Performing a Head-to-Toe Examination

A physical exam helps uncover hidden injuries that could become serious.

🔍 Start at the head and work down:

  • Head & Scalp – Look for bumps, lacerations, bruising.
  • Face – Check for asymmetry, bruising, or bleeding.
  • Eyes – Test pupil reaction and look for foreign objects or bleeding.
  • Ears & Nose – Any blood or fluid leakage? (Could indicate a skull fracture).
  • Mouth & Throat – Any obstructions, swelling, or burns?
  • Neck – Spinal injuries? Keep the head stabilized!
  • Chest – Watch for uneven chest movement, bruising, or open wounds.
  • Abdomen – Gently press to check for tenderness, swelling, or internal bleeding.
  • Pelvis – Check for instability or pain.
  • Arms & Legs – Look for swelling, deformities, or reduced movement.
  • Back – If safe, log-roll the worker to check for injuries.

💡 Important: Always explain what you’re doing, especially with a conscious worker, to keep them calm.

4. Reassessing Your Initial Treatments

If you’ve already provided first aid, check:

  • Is bleeding still controlled?
  • Is the splint holding the limb properly?
  • Is pain getting worse or better?

Adjust treatments as needed and watch for changes.

5. Monitoring for Changes in Condition

Even stable workers can deteriorate. Keep watching for:

  • Worsening breathing or changes in skin color.
  • Increased confusion or reduced responsiveness.
  • Worsening pain or new symptoms appearing.

Any decline? Update emergency responders immediately.

Adapting the Secondary Survey for Different Situations

🔹 For a Responsive Worker:

  • Ask questions about their symptoms.
  • Let them guide you to areas of concern.
  • Keep them engaged and reassured.

🔹 For an Unresponsive Worker:

  • Rely on bystanders for information.
  • Conduct a full-body check since they can’t tell you what hurts.
  • Be extra cautious about spinal injuries.

Communicating with Emergency Services

When the ambulance or ETV arrives, provide clear and structured information:

✅ Worker’s name and age
✅ What happened (mechanism of injury)
✅ Chief complaints (pain, breathing issues, etc.)
✅ Primary survey findings (ABCs, any interventions done)
✅ Vital signs & time recorded
✅ Relevant medical history (allergies, medications, past conditions)
✅ Any changes since your initial assessment

💡 Assign someone to meet paramedics and guide them in.

Documentation – Don’t Skip This Step

Your first aid record is legally required. Make sure you document:

📌 What happened and when
📌 All injuries found
📌 Treatment provided
📌 Vital signs & time recorded
📌 Transport decisions (ambulance, ETV, etc.)

Employers must keep records for three years—so make sure it’s accurate!

Final Thoughts – The Role of an OFA Level 2 Attendant

A proper secondary survey ensures you don’t miss anything and helps paramedics provide better care when they arrive.

  • Stay systematic—follow the steps.
  • Keep reassessing the worker—things can change fast.
  • Communicate clearly—both with the worker and emergency services.

By mastering the secondary survey as a Level 2 First Aid attendant, you’re not just providing first aid—you’re making a real difference in someone’s recovery. Keep training, stay sharp, and trust your skills. You’ve got this. 

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