After completing the primary survey and dealing with any life-threatening conditions, it is safe to examine the casualty head to toe to check for other illnesses in a methodical manner. The assessment can be carried out on a conscious or unconscious casualty.

Start by considering the:

HISTORY – What happened? How did the accident happen? What is their medical History?

SIGNS – Are there any external clues such as swelling, pale skin, deformity? This information is gathered by a first aider using all his/her senses.

SYMPTOMS – This is details given by a conscious casualty: How are they feeling? Do they have any pain?

Next check the Casualty from head to toe. Ensure you protect their dignity and ask their permission before doing so, if possible. Wear disposable gloves and do not move the casualty more than necessary.

Protecting the airway takes priority, so if a casualty is unconscious and breathing but you are concerned about the airway for any reason (e.g. vomiting), place them in the recovery position (see topic xx). If a casualty is already in the recovery position, perform the check with them in that position.

Head to Toe Survey:

• Head, face and neck – Are they breathing normally? Is their pulse normal? Are their pupils dilated? Check the whole head and face including inside their ears and nose for any signs of injury. Consider if they have had an accident that might have injured their neck.
• Chest and shoulders – Compare opposite shoulders and collar bones looking for any signs of a fracture or dislocation. If the casualty is conscious, ask them to take a deep breath and watch how the chest moves – is it equal on both sides? Can they do this easily or does it cause pain? Feel the rib cage at both sides and compare. Look for any other injuries such as stab wounds or bleeding.
• Abdomen and pelvis – Gently feel the abdomen checking for any abnormalities or signs of pain which could indicate internal bleeding. Look for incontinence or external bleeding. DO NOT squeeze or move the pelvis (visual examination only)
• Arms, legs and extremities – Feel both arms and legs for any abnormalities or signs of fracture. If the casualty is conscious ask them if they can move their arms, legs and all the joints without causing pain.
• Pockets and Clues – Check the casualty’s pockets for any clues as to what could have happened to them (ensure you have a reliable witness before removing any items from pockets) but be very careful if you suspect there could be any sharp objects such as needles. Also check for other clues such as medical alert bracelets, needle marks, medication bottles etc. Ensure that you loosen any tight clothing.