Patient Assessment
The assessment sequence, why its order never changes, and what each step is looking for.
By the end of this lesson you can
- Describe the scene size-up and why it comes first
- Perform a primary assessment in the correct order
- Distinguish life threats from everything else
- Explain what the secondary assessment adds
Lesson Notes
Read through the key concepts before you try the challenge.
The order is the point
You arrive at a call with a visibly injured patient.
There is an obvious open fracture, and it draws every eye in the room. While everyone looks at the leg, the patient's airway is compromising. The injury you can see is rarely the one that kills first.
Your task: Learn the sequence, and learn to follow it even when something dramatic is pulling your attention.
Patient assessment follows a fixed order because the order reflects how quickly things kill. An obstructed airway kills in minutes; a fracture does not. Following the sequence is what stops the most visible problem from displacing the most urgent one, and it is why the sequence is drilled until it is automatic.
| Step | What it establishes |
|---|---|
| Scene size-up | Is the scene safe, how many patients, what happened, what resources are needed |
| Primary assessment | Life threats, in order: airway, breathing, circulation |
| History | What happened and what is relevant — often using SAMPLE |
| Secondary assessment | A focused or full physical examination |
| Reassessment | Whether the patient is improving, unchanged, or deteriorating |
| Letter | Asks about |
|---|---|
| S | Signs and symptoms |
| A | Allergies |
| M | Medications |
| P | Past medical history |
| L | Last oral intake |
| E | Events leading up to this |
Not being pulled off sequence
A patient has an obvious deformed, bleeding lower leg. Family are distressed and pointing at it.
- 1
Complete the scene size-up before approaching.
The mechanism that broke the leg may still be present. Stepping past a hazard because the patient is visible is how responders are injured, and it takes seconds to check.
- 2
Start the primary assessment at the airway, not the leg.
The dramatic injury is competing for your attention with things that kill faster. Airway, breathing, circulation — in that order, every time, regardless of what is visible.
- 3
Control major bleeding as part of circulation.
Life-threatening hemorrhage is addressed in the primary assessment because it kills quickly. This is where the leg enters the sequence — as bleeding, not as a fracture.
- 4
Tell the family what you are doing and why.
'I'm checking his breathing first, then I'll deal with the leg' takes three seconds and stops the pressure to skip ahead. Distressed families push you off sequence, and explaining is easier than resisting.
- 5
Address the fracture in the secondary assessment.
Splinting matters and is not time-critical in the way an airway is. It is done once the things that kill in minutes have been ruled out or managed.
Result: Life threats identified and managed first, with the visible injury treated in its proper place.
The sequence exists so that the most visible problem does not displace the most urgent one.
You arrive to find a patient with a severe open fracture. What do you assess first?
Challenge
Apply what you've learned in this lesson.
These sequences must become automatic, which means practicing them out loud.
- Write out the full assessment sequence from memory, then check it.
- Practice SAMPLE on a willing volunteer until you can take it without prompting.
- Research the difference between a rapid trauma assessment and a focused examination, and when each is used.
- For three scenarios you invent, write down what you would check in the scene size-up before approaching.
Finished this lesson?
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