The Secondary Survey: Head to Toe Patient Examination

The secondary survey is the systematic head to toe check you carry out once the immediate life threats have been managed. Where the primary survey asks whether this person is about to die right now, the secondary survey asks what else is wrong that could get worse if it goes unnoticed.

Table of Contents

When to Move to the Secondary Survey

Only begin the secondary survey once danger has been controlled, the airway is clear, breathing is confirmed, and any major bleeding has been managed. Checking a broken finger while someone is still bleeding heavily elsewhere or has an unmanaged airway problem is a genuine and dangerous ordering mistake.

Working Head to Toe

Examine the patient systematically from head to toe so nothing gets missed, working through each region in turn.

Head

Feel the scalp for bleeding, lumps or depressions. Check the ears, nose and mouth for bleeding or clear fluid, since clear fluid from the ear or nose can indicate a skull fracture. Check the jaw for deformity and feel the neck for obvious deformity.

Back

Feel along the back for bleeding, and refer to spinal injury recognition if the mechanism of injury suggests it, such as a fall from height or a high speed collision.

Chest

Look for unnatural movement of the chest wall, gently feel both sides of the rib cage for fractures, and look and feel for wounds.

Abdomen

Feel for rigidity or muscle spasm, look for distension, and check for any wounds.

Pelvic Region

Check for incontinence of urine and look for outward rotation of the legs, which can both suggest pelvic injury. Do not spring or press on the pelvis to test for fracture, since this outdated technique can worsen an existing pelvic fracture.

Limbs

Feel and look for deformity, irregularity and swelling in the arms and legs, working from the shoulders to the fingers and the hips to the toes. Check for sensation as well as obvious injury.

Checking for Sensation

Ask a conscious patient whether they can feel you touching their hands and feet, whether they have any pins and needles or numbness, and whether they can move their fingers and toes and form a fist. Loss of sensation or movement is one of the most important indicators of a possible spinal cord injury, and it is easy to miss if you only look for obvious deformity.

Why History Matters as Much as Examination

How an injury happened often tells you more than what you can see on the surface. A high speed rollover collision or a fall from height should raise suspicion of a spinal injury even if the patient currently reports no pain, since spinal cord injury can occur without immediately obvious external signs. If you do not actively consider the mechanism of injury, you can miss the exact injury that matters most.

Frequently Asked Questions

What is the secondary survey in first aid?
A systematic head to toe examination carried out after life threatening problems have been managed, to identify other injuries that need attention.

Should you spring or press on the pelvis to check for a fracture?
No. This outdated technique can worsen an existing pelvic fracture and is not recommended.

Why is checking sensation in the hands and feet important?
Loss of sensation or movement can indicate a spinal cord injury even when there is no obvious external deformity.

References and Last Reviewed

American Heart Association, Guidelines for First Aid
International Liaison Committee on Resuscitation (ILCOR), Consensus on Science and Treatment Recommendations

Jurisdiction: General first aid guidance, internationally applicable.
Last technically reviewed: September 2026
Reviewed by: EHS Guidelines Editorial Team

This article is educational and does not replace accredited first aid training or professional medical care. In a real emergency, call your local emergency number immediately.

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The Secondary Survey: A Head to Toe Patient Examination