The process of first aid begins with an assessment to determine what is wrong with an injured or ill person. This comprehensive evaluation starts with immediate threats to life and progresses to a more detailed investigation. The Focused Check, also known as the secondary survey, is that specific, detailed step performed after managing any immediate life-threatening problems. It represents a systematic search for injuries or medical conditions that require intervention and documentation for professional medical responders. The goal is to gain a complete picture of the person’s condition beyond the obvious emergency.
Context and Timing in First Aid Assessment
The decision to perform a Focused Check depends entirely on the victim’s initial status and stability. This check is part of the secondary assessment, initiated only after the primary assessment is complete and any immediate life threats are managed. The primary assessment checks for issues like blocked airways, absent breathing, or severe, uncontrolled bleeding, prioritizing the person’s ability to maintain life functions.
If a person is unresponsive, not breathing, or only gasping, the first aid provider moves directly to activating emergency medical services (EMS) and beginning cardiopulmonary resuscitation (CPR) or using an automated external defibrillator (AED). The Focused Check is reserved for individuals who are conscious and responsive, or those who have been stabilized after the primary survey. This evaluation provides valuable information to relay to the responding team while waiting for professional help to arrive.
The Physical Examination Checklist
The physical examination during the Focused Check involves a systematic, hands-on process to detect signs of injury. This assessment typically moves from the person’s head down to their toes, or vice versa, ensuring no injury is overlooked. First aid providers use the mnemonic DOTS to guide this search for specific signs of trauma.
DOTS stands for Deformities, Open wounds, Tenderness, and Swelling. Deformities refer to abnormal shapes of a body part, often indicating a fracture or dislocation. Open wounds, such as cuts or abrasions, must be located to control bleeding and prevent infection.
Tenderness is assessed by gently pressing or palpating suspected areas, looking for a reaction or verbal complaint of pain, which may indicate an underlying injury. Swelling, the enlargement of a body part due to fluid buildup, is a common sign of soft tissue injury, such as a sprain or a strain. The rescuer carefully inspects and feels the head, neck, chest, abdomen, pelvis, and all four extremities for these four indicators, without moving the person if a head, neck, or spinal injury is suspected.
Gathering Crucial Patient History
The second component of the Focused Check shifts from physical inspection to gathering verbal information about the person’s condition and medical background. This history-taking is distinct from the physical exam and is guided by the mnemonic SAMPLE. It helps the rescuer understand underlying medical conditions or the mechanism of injury that the physical check alone might miss.
The letters in SAMPLE stand for Signs and Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading up to the incident. Signs are objective observations (such as pale skin or sweating), while symptoms are subjective complaints (like dizziness or nausea). Allergies to medications or food are crucial, as are any current Medications, which may relate to the current illness or injury.
Past medical history includes any chronic conditions, like diabetes or heart disease, that could complicate the current situation. Last oral intake refers to what the person last ate or drank, which is important for potential surgery or conditions like low blood sugar. The Events leading up to the incident detail what the person was doing when the illness or injury started, providing context for the cause.