Primary Survey

What are the components of a Primary Survey?

A Primary Survey can be broken down into 7 sequential parts

Danger

Ensure that there are no dangers that could cause further injury to death to yourself, the patient or other bystanders. Examples of dangers can include traffic, live wires, leaking fuel, fire or other, potentially agitated or impaired, people. If possible, remove any dangers before proceeding to assist the patient. If there is a potential danger that you can't remove, such as leaking fuel, consider removing the patient from the danger if it is safe to do so. Remember, if it is unsafe to approach or care for the patient, then do not approach the patient. 1 injured person is better than someone rushing into help without checking for danger, and them potentially becoming a patient as well.

Response

The patient's responsiveness can be classified using the acronym "AVPU"

• Alert - the patient is alert and aware of their surroundings

• Voice - the patient isn't alert, but responds to voice

• Pain - the patient doesn't respond to voice, but responds to a painful stimulus

• Unresponsive - the patient doesn't respond to anything

To check the responsiveness of the patient, start by asking if they can hear you. Now is also a good time to introduce yourself by name so that the patient knows who you are, and also to apply some gloves if you have them, before you touch the patient. If the patient doesn't respond to voice, check if they respond to pain by tapping firmly on their collarbone or rubbing their sternum. If they don't respond to pain, then they are unresponsive.

Airway

You need to check that their airway is clear of any obstructions. If the patient is on their front or in an awkward position, it is often easier to roll the patient onto their back so you can access the airway. Take care if you do this, as you don't want to further injure the patient.

If the patient is conscious and it appears they're breathing normally (e.g. they're not struggling to breathe), chances are their airway is clear.

In an unconscious patient, their airway could be blocked by vomit, a foreign object, or the patient's tongue. Open their mouth and tilt their head back (if they're lying on their back, this will 'point' their chin to the sky). Check for any obstruction to the airway - if there is an obstruction you can see, scoop it out with two fingers.

Breathing

Once you've checked the airway is clear, check to see if the patient is breathing. This can be done by placing your cheek and ear over their mouth and nose, looking down the patient's chest. You can also place a hand on their chest if you wish. Watch to see if the patient's chest moves up and down, and feel for breath against your check as they breath out. You may also be able to hear their breathing.

If a patient is conscious and they're able to speak with you, then they are breathing.

Variations to the Primary Survey

In some environments, such as in the NZ Defence Force, patients are more likely to have a trauma related injury compared to them stopping breathing. As such, sometimes in cadets you may hear a slightly different version of the primary survey.

DRSAB remain the same. If the patient is not breathing, C is still for CPR and D is still for Defib. However, if the patient is breathing we replace the 'CD' with 'CS'. The C stands for Circulation, and the S stands for Severe Bleeding.

Circulation / Severe Bleeding

Circulation and severe bleeding can be assessed easily. Sometime, you will see a pool of blood around a patient. Otherwise, to check for circulation and severe bleeding, we do a blood sweep. To do this, move your hands down their head, chest, arms, back, abdomen and legs. Check your gloved hands throughout this process to see if you have any blood on your hands. If you find blood, expose the wound and apply pressure to help control the bleeding.

If you find no blood, you can also press on the a nailbed of one of the fingers on each hand, and one of the toes of each foot. Normally when you press over a nail, it goes white because you squeeze the blood out from under the nail. Release your grip, and watch the colour return to under the nail. This should be the same for both hands and for both feet. If not, it could be because the patient is bleeding from that arm or leg, so you will need to expose and examine that limb.

Note that we're checking for severe bleeding, not just any bleeding. Severe bleeding is where you lose a lot of blood, for example if any artery was cut or if the patient had a large, deep cut or wound. Patients can die in less than a minute from severe bleeding, so it is important to reduce blood loss quickly.