The secondary assessment in lifeguarding is a systematic procedure performed on a victim to identify any non-life-threatening injuries or illnesses. This process moves beyond immediate survival concerns to gather a more comprehensive picture of the victim’s condition and the events that led to the incident. Its purpose is to determine the nature of the injury or sickness so a lifeguard can provide appropriate care until emergency medical services (EMS) arrive.
Understanding the Timing: Primary Assessment First
The secondary assessment is never the first step in a rescue situation; it follows the completion of the primary assessment. The primary assessment focuses exclusively on identifying and managing immediate threats to life, such as issues with the airway, breathing, or severe bleeding. If a victim is unresponsive, not breathing, or has profuse hemorrhaging, those life-threatening conditions demand immediate intervention before any other steps are taken. Only after the victim is stabilized, or if the primary assessment reveals no immediate life threats, does the lifeguard proceed to the secondary phase. The secondary assessment shifts the focus from managing the ABCs (Airway, Breathing, Circulation) to identifying the chief complaint, obtaining a medical history, and performing a physical examination.
Performing the Secondary Assessment on a Conscious Victim (SAMPLE)
When a victim is conscious and able to communicate, the secondary assessment primarily involves taking a medical history using the SAMPLE mnemonic. The “S” stands for Signs and Symptoms, where the lifeguard asks the victim what they feel and what visible indicators of injury or illness are present.
The “A” for Allergies and “M” for Medications are then addressed, asking about any known sensitivities to drugs or foods and any prescription or non-prescription substances currently being taken. Next, “P” addresses Past medical history, which includes any chronic conditions, previous surgeries, or similar incidents that could be relevant to the present complaint.
“L” is for Last oral intake, documenting when the victim last ate or drank. Finally, “E” covers Events leading up to the incident, asking the victim to describe what they were doing and what happened right before they started feeling unwell or were injured. Following the history, the lifeguard conducts a focused physical exam, checking only the area of the body the victim identifies as the source of their pain or discomfort.
Performing the Secondary Assessment on an Unconscious Victim (Head-to-Toe)
When the victim is unresponsive or unable to answer questions, the secondary assessment must rely entirely on a systematic physical examination, often called a head-to-toe check. The examination begins at the head, checking the scalp and face for any deformities, open wounds, tenderness, or swelling.
The lifeguard then moves down the body, examining the neck, shoulders, and chest, feeling for instability or unusual breathing patterns. The abdomen is gently palpated in all four quadrants to check for hardness or tenderness, which may indicate internal bleeding or injury. The hips and pelvis are checked for stability, and then all four extremities—arms and legs—are examined for fractures, dislocations, or sensory deficits.
The process involves looking, listening, and feeling for subtle clues, such as blood, clear fluid from the ears or nose, or unusual positioning of limbs. The entire procedure is performed with care, especially if a spinal injury is suspected, ensuring the victim is moved as little as possible while checking the back and sides.
Continuous Monitoring and Documentation
After the secondary assessment is complete and initial care has been provided, the lifeguard’s responsibility shifts to continuous monitoring of the victim’s condition. The victim’s level of consciousness, breathing rate, and pulse are checked regularly to detect any signs of deterioration or improvement. For an unstable victim, reassessment should occur approximately every five minutes, while a stable victim can be checked every fifteen minutes. This ongoing assessment ensures that if a non-life-threatening condition suddenly worsens, the lifeguard can immediately return to the primary assessment steps and manage the new crisis.
The final step is the accurate and thorough documentation of all findings, including the results of the primary and secondary assessments and the care provided. This detailed record is then transferred to the arriving EMS personnel, providing them with a complete timeline and clinical picture to facilitate seamless, informed medical care.