How To Do The Secondary Survey

You may proceed to the secondary survey after completing a primary survey and handling any life-threatening problems. Learn what you need to do.

Last reviewed: September 2026 — checked against Resuscitation Council UK Guidelines 2025.

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What Is the Secondary Survey?

The secondary survey is the calm, systematic head-to-toe check you carry out once the primary survey is complete and any immediate threats to life – an obstructed airway, absent or abnormal breathing, or life-threatening bleeding – have been dealt with. Its job is to find the injuries and clues the primary survey was never designed to pick up, and to build a picture you can hand to the ambulance crew.

Work through it in the same order every time. A fixed routine is what stops you missing the quiet injury: the fractured wrist masked by a painful ankle, or the medical bracelet on the arm you never looked at.

Three rules apply throughout:

• Only begin the secondary survey once the primary survey is finished and any life-threatening problems are under control.
• Keep reassessing. If the casualty stops responding at any point, abandon the secondary survey and go straight back to the primary survey.
• Under Resuscitation Council UK Guidelines 2025, if you find a casualty who is unresponsive you call 999 immediately – before you assess their breathing. Rescuers no longer have to confirm that the breathing is abnormal first. If they are not breathing normally, start CPR.

What to do

Inquiry:

• Once you’ve completed a primary survey and addressed any life-threatening issues, it’s time to do a secondary survey. Inquire about every event that may have taken place with a responsive casualty and those around him or her. The goal of this part is to learn more about the victim’s background, signs, and symptoms.
• Leave the victim in place until you are confident that it is safe to move them into a more appropriate position for their injuries or illnesses.

History:

• Find out more about the casualty’s history. Use the mnemonic AMPLE as an easy reminder. Look for jewellery with any medical warnings that might give you information about their medical history or any allergies.
  • Allergy – Do they have any allergies? Do they take certain medicines, such as penicillin or aspirin?
  • Medication – Is he or she using any medicines?
  • Previous medical history – Do they have any medical issues, such as diabetes, epilepsy, or heart disease? Have they previously suffered an injury or had surgery?
  • Last meal – When did they last eat or drink?
  • Event history – What occurred and where? Is it a sickness or an accident that is to blame? Inquire of any people in the area what occurred and whether you may find anything useful.

Signs:

• Make sure to look, listen, feel, and smell for any indications of injury such as, deformation, bleeding, swelling, discolouration, or unusual smells. When comparing them, you should always compare the injured side of the body to the unaffected one. Are they able to walk and bend their legs? Is there anything else that might be affecting their movement, such as health problems or other concerns? Check for any minor injuries while you’re doing the exam.

Symptoms:

• Ask the injured person basic, brief questions about any symptoms or feelings they are experiencing. They should give as much information as possible. A structured approach such as the SOCRATES pain assessment mnemonic can help you cover every detail. Inquire of them:
• • Are you in pain? If so, whereabouts?
  • When did you begin to feel pain?
  • What is the nature of the pain, is it constant or intermittent, sharp or dull?
  • Is it exacerbated by activity or breathing?

The Head-to-Toe Examination

The head-to-toe examination is the physical part of the secondary survey. Explain what you are doing and ask permission before you touch anyone. Keep the casualty warm, protect their dignity, and remove or loosen only as much clothing as you genuinely need to.

Look, listen and feel as you work, and compare one side of the body with the other – the uninjured side shows you what is normal for that person. Do not move anyone with a suspected spinal injury unless their airway is at risk. Take care with pockets and clothing in case there is broken glass or a needle inside.

Head and neck

• Run your hands gently over the scalp, feeling for bleeding, swelling, softness or depressions, and check your gloves for blood as you go.
• Look at the face for bruising, swelling and symmetry, and check behind the ears.
• Compare the pupils: are they equal in size, and do they react to light?
• Check for clear or blood-stained fluid coming from the ears or nose, which can point to a serious head injury.
• Look inside the mouth for anything obstructing the airway – broken teeth, blood, vomit or a displaced denture – and note any unusual smell on the breath.
• Feel gently along the back of the neck for tenderness or deformity, without moving the head.

Chest

• Watch the chest rise and fall. Does it move evenly on both sides?
• Feel along the collarbones and ribs for tenderness, deformity or grating.
• Listen for noisy, laboured or unusually quiet breathing, and ask whether breathing in makes the pain worse.

Abdomen and pelvis

• Feel the abdomen gently in four quarters, watching the casualty’s face for signs of pain or guarding.
• Do not rock or squeeze the pelvis. Look instead for bruising, obvious deformity or incontinence, and ask about pain.

Arms and legs

• Work down each limb in turn, feeling for deformity, swelling, tenderness or unusual movement.
• Check that each hand and foot is warm and a normal colour, and that the casualty can feel your touch and move their fingers and toes.
• Look for medical alert jewellery, insulin pumps, injection sites or needle marks.

Back

• If they can safely be moved, or are already on their side, slide a hand along the back to feel for bleeding, tenderness or deformity. Blood can pool underneath someone and be missed entirely.

Recording the Casualty’s Vital Signs

Vital signs are the measurements that show how a casualty is doing over time. A single reading tells you little; it is the trend that matters, and it is one of the most useful things you can give the ambulance crew. Write each set down along with the time you took it.

• Level of response. Resuscitation Council UK uses the ACVPU scale: is the casualty Alert, newly Confused, responding to Voice, responding only to Pain, or Unresponsive?
• Breathing. Count the breaths for a full minute and note the depth, noise and effort. RCUK gives a normal adult rate of 12–20 breaths a minute; a rate above 25, or one that is climbing, warns that someone may deteriorate suddenly.
• Pulse. Count the rate and note whether it is strong or weak, regular or irregular. The British Heart Foundation gives a normal adult resting heart rate of 60–100 beats a minute.
• Skin. Note the colour and temperature – pale, grey, blue-tinged, clammy or unusually hot.
• Capillary refill. Press a fingertip for five seconds and time how long the colour takes to come back. RCUK gives a normal refill time of under two seconds; longer suggests poor circulation, though cold surroundings, poor light and older age can also lengthen it.
• Pupils. Note their size, whether they are equal, and whether they react to light.

Repeat the observations regularly. Every ten minutes is a common interval for a casualty who is stable, and more often if they are unwell or changing. Any deterioration – particularly a falling level of response – needs an urgent 999 call if you have not already made one.

Handing Over to the Ambulance Crew

A clear handover takes about thirty seconds and saves the crew a great deal of time. Resuscitation Council UK recommends the SBAR structure:

• Situation – who the casualty is, their age, and what you think the main problem is.
• Background – what happened, plus the AMPLE history: allergies, medication, previous medical history, last meal, and the events leading up to it.
• Assessment – what you found in the head-to-toe examination, and your recorded vital signs with the times you took them.
• Recommendation – what you have already done, and what you think is needed now.

RCUK also recognises RSVP – Reason, Story, Vital signs, Plan – which carries the same information in a different order. Either works; the point is to give the crew a structure rather than a story.

Hand over everything you have: your written observations, any medication you found, and the casualty’s own account. Say plainly if there is anything you were unsure about.

If the Casualty Deteriorates

Stop the secondary survey and act immediately if:

• They become unresponsive. Call 999 straight away – under RCUK Guidelines 2025 the call is made for any unresponsive person before you assess their breathing – then check their breathing and start CPR if it is not normal.
• You find life-threatening bleeding, the term now used in the Health and Safety Executive’s first aid guidance L74. Control it with firm direct pressure without delay.
• They show signs of shock – pale, cold, clammy skin, a fast weak pulse, rapid shallow breathing, thirst, or becoming restless, confused or drowsy.

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