When should a secondary assessment be initiated during trauma care?

The initiation of a secondary assessment during trauma care is critical and should take place after the primary assessment is complete and any immediate life threats have been addressed. This approach is based on the principles of the trauma assessment sequence, which prioritizes interventions that are essential for patient survival.

The primary assessment focuses on identifying and managing life-threatening conditions related to the airway, breathing, circulation, disability, and exposure (the ABCDEs). Once these urgent needs have been evaluated and treated, a secondary assessment can be performed. This involves a more comprehensive evaluation aimed at discovering other injuries, obtaining the patient’s medical history, and performing a thorough head-to-toe examination.

Conducting the secondary assessment after addressing life threats ensures that the provider's focus remains on stabilization first. Performing a thorough physical exam before addressing critical issues would not be appropriate, as it could delay the necessary interventions that are crucial for survival. Additionally, initiating a secondary assessment immediately upon arrival at the hospital would not maximize the efficiency of trauma care and could lead to oversight of immediate life-threatening conditions that need pre-hospital stabilization.