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Joined: 11/07/2011(UTC)
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Now I think that the secondary survey does have a place, it should never take long and should take in to account MI.
Two of my First Aiders were out for an evening with their wives just before last christmas when there was a commotion in the back of the pub, a man was found laying at the bottom of the stairs, the general concinnous of opinion from his friends was that as he had been drinking all afternoon he was drunk, leave him there he will sleep it off.
One of my First Aiders carried out his primary and secondary survey and found a very small trickle of yellow fluid in one ear, the ambulance was called and said gentleman had an emergency operation that night and spent his Christmas in hospital having suffered a serious skull fracture.
I have also carried out a secondary survey on an apparent "Feint" casualty, during the survey I noticed that one eye though not fully dilated was in a fixed condition and non responsive to light, an ambulance was called for a suspected stroke and sure enough the casualty was removed to the nearest stroke unit, from where I am happy to say he made a full and good recovery.
Teaching a secondary survey is never a waste of time.
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Rank: Advanced Member Groups: Registered Users, Subscribers
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May I request care with abbreviations please?
I see MI in some posts.
Is this Myocardial Infarct? Probably not. It is probably meant to be 'Mechanism of Injury' which is less ambiguously abbreviated as MoI.
Mechanism of Injury is significant because if there is indication of spinal insult then this may influence the decision to move the casualty to the 'safe airway position'.
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 Rank: Member Groups: Registered, Registered Users, Subscribers
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Just a quick thought - I work in the emergency services and whilst I would like to think that I'm pretty good first aid wise, I still think that during a secondary survey, whilst I could find things that I could presume were 'wrong' it would be difficult to say what they were unless they were major injuries such as catastrophic bleeds, breaks etc. Someone on an efaw or faw would not know what they were looking for but would obviously have to deal with these major issues as they would be able to see them without having to really get into a secondary survey.
I would also say that someone on these courses would not spot equal and responsive pupils.
With regard to the recovery position - does this not go back to when people didnt have phones and had to leave them to ring the emergency services ??? I cannot think of any situations that I have been in where someone did not have a phone - therefore they don't have to leave the patient, therefore they don't need to be put in the recovery position. You can manage the airway and if they vomit, then you can turn them. If I was with someone I'd leave them exactly where they are til the professionals arrive....
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 Rank: Newbie Groups: Registered, Registered Users, Subscribers
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Hi, I am new on here, hope you don't mind me joining in with this interesting discussion. I am a moderately experienced trainer but I have appreciated the comments above by those with more experience of training.
Just a thought - Isn't the issue more to do with balance of what is emphasised on the course? The primary survey and CPR issues obviously take precedent, but a secondary survey, if not done aggressively, may at least flag up complications. I agree that new first aiders may not get it right, but they still need the skills to become more experienced with; just because new first aiders might not be so effective initially, they still need a start point with the range of skills. Improving is what monthly training is for, where companies provide it (I am mainly in pool and sports centre work where it is compulsory). I agree this is moreof an issue where the "first aider" is simply doing 6 hours to cover them for the next 2 or even 3 years. So less black and white "is it good or not?" but more about making it secondary in importance as well as in name. I disagree that it can simply be seen as a waste of time for training in an absolute sense, though I would agree it has more of a place on an FAW course than the shorter EFAW.
Plus I agree with the importance of the "what if" discussions. Synthesising knowledge into new answers, rather than regurgitating the same rote repetitively, is a higher level of learning skill which engages more parts of the brain. This will facilitate more common sense and a problem solving mentality in trainees. So approaching it by "what if they have a broken leg?", "what do you do if they are not breathing and have a head wound?", etc can maintain th piority of the basics whilst getting what is useful from a secondary survey.
Ben
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Rank: Member Groups: Registered, Registered Users, Subscribers
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I get anxious when I read that you should only put unconscious casualties into the recovery position if they start to vomit.
Unconscious people by and large do not vomit (which is a reflexive action) the suffer from passive regurgitation caused by relaxation of the cardiac sphincter in unconsciousness. This may lead to liquid stomach contents silently collecting in the pharynx with two possible results.
The liquid obstructs the airway and they asphyxiate
The liquid enters the airways and lungs, either drawn in by breathing or running in due to gravity, compounded by lack of swallow and cough reflex. The person is then likely to suffer aspiration pneumonia which is often fatal.
The problem is that by the time stomach contents become visible or you become aware of them it is likely that one or both of these events have taken place and you have left it too long.
I see it is also suggested that placing them in the recovery position whilst someone who has completed a one day first aid course palpated their abdomen looking for "abnormalities"
Oh please
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Rank: Advanced Member Groups: Registered Users, Subscribers
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To put this into context as I think there are a lot of very good answers in this thread, but we are talking about lay first aiders and therefore very basic first aid.
DRSABCD is the new way forward (danger, response, shout, airway, breathing, consider starting cpr and defibrilation) so keeping this simple, so long as the casualty is breathing normally, there is nothing wrong with an extremely quick look just to see if there are any serious bleed evident, if there is plug the hole, then please place them into the recovery position, as airway superceeds breathing, which superceeds circulation which superceeds bones. Its the blocked airways and subsequent lack of ability to breath that kills not a broken arm or leg.
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Rank: Advanced Member Groups: Registered Users, Subscribers
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unless ur prepared to get down to skin and do a secondary survey properly then i dont see the point. someone on a FAW course hasnt the time to accustom themselves to all the touchy feely stuff so keep it simple. Look for obvious signs of injury.
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Rank: Member Groups: Registered Users, Subscribers
Joined: 27/05/2011(UTC)
Posts: 30
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Location: London
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No one as far as i can see has yet mentioned in 2nd survey looking for medical alert necklaces and/or wristbands, or checking pockets etc for medications like GTN spray, EPI-pens etc.
Obviously if present, any of these could offer good insight into the casualties condition.
Of course if the situation warrants it, be etreemly careful incase of sharps etc in pockets/bags.
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