Secondary Surveys in Occupational First Aid Level 3

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As an OFA Level 3 attendant, your job doesn’t end with the primary survey—you also need to conduct a secondary survey to ensure no injuries or conditions are overlooked. This step provides a comprehensive assessment of the patient, helping you determine the full extent of their condition and make the right transport decisions.

Let’s walk through the secondary survey process so you can perform it efficiently and effectively.

Why the Secondary Survey Matters

The secondary survey is a more detailed evaluation than the primary survey, but it should still be completed within 10 minutes. It’s typically conducted after the primary survey, once critical interventions have been performed and a transport decision has been made.

  • If the patient is in the Rapid Transport Category (RTC), the secondary survey should be performed en route to the hospital or while waiting for transport.

  • If the patient is not RTC, it can be done at the scene.

  • If a patient’s condition worsens during the secondary survey, stop immediately and prepare them for rapid transport.

Now, let’s break down the key components of the secondary survey.

Step 1: Checking Vital Signs

A complete set of vital signs helps monitor the patient’s condition over time. These should be reassessed regularly:

  • Every 10 minutes for RTC patients.

  • Every 30 minutes for non-RTC patients.

  • Every 5 minutes for urban attendants waiting for BCEHS resources.

What to Check:

✅ Pulse – Assess the rate, strength, and regularity. Use a pulse oximeter or count beats for 15 seconds, then multiply by four to get BPM.

✅ Level of Consciousness (GCS Scale) – Use the Glasgow Coma Scale (GCS) to assess eye-opening, verbal response, and motor response. If GCS drops to 13 or lower, the patient is RTC.

✅ Pupils – Check for size, equality, and reaction to light, especially for head injuries. Pupils should be equal, round, and reactive to light.

✅ Skin Condition – Assess color, temperature, and moisture for signs of shock or circulation issues.

Step 2: Gathering a Detailed History

A thorough patient history provides valuable insight into the injury or illness. Use these questions:

Chief Complaint 🩹

  • What is bothering the patient the most?

  • When did the pain or issue start?

Mechanism of Injury 📋

  • How did the injury or illness occur?

  • Were there any witnesses?

Pain Assessment (PPQRRST) 🏥

  • P – Position: Where is the pain located?

  • P – Provoke: What makes it worse or better?

  • Q – Quality: How does the pain feel (sharp, dull, burning)?

  • R – Radiation: Does the pain spread?

  • R – Relief: What provides relief?

  • S – Severity: Rate the pain on a scale of 1-10.

  • T – Timing: When did it start? Has it changed over time?

Additional Medical History 💊

  • Allergies – Any known allergies, particularly to medications?

  • Medications – What are they currently taking (dose, frequency, purpose)?

  • Past Medical History – Any chronic conditions (diabetes, heart disease, high blood pressure, seizures)?

  • Associated Symptoms – Any numbness, dizziness, nausea, blurred vision, or difficulty breathing?

  • Witness Information – If the patient is unresponsive, get details from bystanders or coworkers.

Step 3: Head-to-Toe Physical Examination

This systematic assessment helps uncover any hidden injuries.

✅ Head – Look for wounds, swelling, or deformities. If consciousness is altered, do a neurological exam.

✅ Neck – Check for swelling, wounds, or spinal deformities.

✅ Chest, Abdomen, and Pelvis – Assess for tenderness, deformities, or internal injuries.

✅ Back – If an open wound is found, log-roll the patient to inspect and dress the wound.

✅ Extremities – Compare both sides of the body for any deformities, swelling, or weakness.

✅ Neurological Exam –

  • Upper Body: Ask the patient to squeeze your fingers.

  • Lower Body: Ask them to wiggle their toes or perform ankle flexion and extension.

  • Sensation Check: Lightly touch the patient’s arms and legs and ask if they feel normal.

✅ Spinal Injury Reassessment – If spinal motion restriction wasn’t ruled out before, use the modified NEXUS rule now.

Step 4: Adjusting the Secondary Survey When Needed

Not all injuries require a full head-to-toe assessment. In minor cases, you may:

  • Focus only on the injured area.

  • Modify history-taking to only relevant details.

Step 5: Ongoing Reassessment

Your job doesn’t stop once the secondary survey is complete! Keep monitoring the patient for signs of deterioration, such as:

  • Falling GCS score

  • Worsening pain or new symptoms

  • Changes in breathing, pulse, or skin color

Communication & Documentation

Clear communication and thorough documentation are essential:

  • Keep the patient informed about what you’re doing.

  • Log all vital signs, assessments, and history in the First Aid Record.

  • If transferring care, provide a detailed handover to medical responders.

Final Thoughts

The secondary survey is a critical skill for OFA Level 3 attendants. By taking a structured approach, gathering the right information, and staying alert for changes, you’ll be prepared to provide the best possible care for injured workers.

🚑 Want to refine your skills? Consider enrolling in an OFA 3 course or refreshing your OFA 3 training to stay sharp!

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