Mastering the Primary Survey as an OFA Level 3 Attendant

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If you’re an OFA Level 3 attendant, you play a vital role in workplace safety. When an injury happens on the job, your ability to quickly assess the situation and make smart transport decisions can make all the difference. In this guide, we’ll break down the primary survey step by step and discuss how to determine the best transport options for your patient.

The Priority Action Approach: Why It Matters

As an Occupational First Aid Level 3 attendant, you don’t have time to waste in an emergency. That’s why everything you do is based on the priority action approach—a systematic way to focus on the most critical issues first. Ideally, your primary survey, critical interventions, application of the modified NEXUS rule, and patient packaging should all be completed in under 15 minutes.

Let’s dive into the primary survey and how to perform it efficiently.

The Primary Survey: A Step-by-Step Guide

A primary survey is a rapid assessment designed to identify and address life-threatening conditions. This process should take no longer than two minutes. Here’s how to do it:

1. Scene Assessment

Before approaching the patient, take a moment to assess the scene for hazards—you don’t want to become a casualty yourself! Determine:

  • Are there any dangers to you, your helpers, or the injured worker?

  • What’s the mechanism of injury?

  • How many patients are involved?

  • Do you need to activate workplace emergency response procedures?

2. Level of Consciousness (AVPU Scale)

Check the patient’s level of responsiveness using AVPU:

  • A – Alert: Is the worker awake and aware?

  • V – Verbal: Do they respond to your voice?

  • P – Pain: Do they respond to pain?

  • U – Unresponsive: Are they completely unresponsive?

3. Spinal Motion Restriction (SMR)

If the injury suggests a spinal issue, stabilize the head and neck manually. Do not force movement if resistance is felt. If a spinal cord injury is suspected, use the jaw thrust maneuver to open the airway instead of tilting the head.

4. Airway

Ensure the airway is open and clear:

  • If the patient is unresponsive and the airway is blocked, roll them onto their side to clear it, then roll them supine to complete the survey.

  • If conscious, assess whether they can speak clearly—a good sign the airway is open.

  • Watch for stridor, inhalation injuries, or breathing distress and be ready to assist with ventilation if necessary.

5. Breathing

  • Look, listen, and feel for breathing.

  • Assess the rate, rhythm, and quality of respirations.

  • If the patient is not breathing and has no pulse, start CPR and use an AED.

  • If the patient isn’t breathing but has a pulse, provide assisted ventilation.

6. Circulation

  • Check for a pulse.

  • If there is severe bleeding, control it immediately.

  • Assess the patient for signs of shock (cool, pale, clammy skin).

7. Rapid Body Survey

Perform a quick head-to-toe check for major injuries, such as:

  • Open wounds

  • Fractures

  • Pools of blood

  • Sharp objects or needles

  • Indicators that place the patient in the Rapid Transport Category (RTC)

This shouldn’t take longer than 30 seconds.

Critical Interventions: What to Do Next

If you’ve identified any life-threatening conditions, act immediately. Interventions may include:

  • Clearing the airway (suctioning if needed)

  • Assisting with ventilation

  • Stopping severe bleeding

The Modified NEXUS Rule: When to Apply Spinal Motion Restriction

Not all injuries require full spinal motion restriction (SMR). Use the modified NEXUS rule to determine if additional precautions are needed. Ask the patient:

  • Do you have midline neck pain?

  • Do you feel numbness, tingling, or weakness in your extremities?

  • Are you fully alert and sober?

  • Do you have any distracting injuries or multi-system trauma?

If a spinal cord injury is suspected, the patient is RTC.

Transport Decisions: What Happens Next?

Once the primary survey is complete and critical interventions are addressed, you need to decide how the patient should be transported. Here are your three options:

1. Rapid Transport Category (RTC)

The patient needs urgent transport due to an unstable condition. Transport may be by ambulance, helicopter, or an employer’s emergency transport vehicle (ETV). Examples include:

  • Airway obstruction

  • Altered level of consciousness (GCS ≤ 13)

  • Amputation

  • Electrical injury

  • Penetrating chest wound

  • Smoke inhalation

  • Spinal cord injury

  • Unstable fractures

2. Medical Aid Required

The patient needs medical attention but is stable and does not require rapid transport.

3. No Transport Required

The patient is well enough to return to work without further medical aid.

After the Primary Survey: What’s Next?

  • If the patient is RTC, start packaging them for transport while arranging emergency transportation. The secondary survey can happen en route.

  • Reassess ABCs frequently.

  • If the patient isn’t RTC, conduct a secondary survey at the scene.

Communication is Key

Throughout the process, clear communication is essential. Stay calm and reassuring when speaking with the patient, co-workers, and emergency responders. Provide:

  • The number of patients

  • The location

  • The nature of injuries

  • All relevant patient details when handing off to medical aid

Final Thoughts

As an OFA Level 3, OFA 3, or Occupational First Aid Level 3 attendant, your ability to conduct a thorough primary survey and make transport decisions quickly is a critical skill. By following the priority action approach, recognizing rapid transport criteria, and practicing these skills regularly, you’ll be ready to provide the best possible care for injured workers.

🚑 Want to sharpen your skills? Enroll in an OFA 3 course or refresh your OFA 3 training today!

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