Primary Survey

Airway – Maintenance with cervical spine (C spine) control

Breathing

Circulation and Haemorrhage Control

Disability/drugs – Assessment of neurological status

Expose – Protect the player against hypothermia

The primary survey begins with a general impression of the player’s overall condition.

If the player is alert and talking in a normal voice, and has no complaint of neck pain or evidence of haemorrhage, the primary survey is complete.

First Responders should call for help as soon as they are aware that the player has a life or limb threatening condition.

Airway with Cervical Spine Protection

The player’s airway is the first priority.

Manual-in-line stabilisation of the neck should be initiated during opening of the airway to protect the player’s spine from unnecessary movement.

Without moving them, kneel or lie at the head end of the person.

Place your hands gently on either side of their head, with your elbows resting on the ground.

Hold their head in its natural position. What you’re doing here is immobilising the neck to prevent any further damage.

The jaw thrust manoeuvre is performed by grasping the angles of the jaw, one hand on each side, and pulling the jawbone (mandible) forward.

Since the jaw thrust manoeuvre does not hyperextend the neck, it is the method of choice for a player with a possible neck (cervical spine) injury.

Breathing

If the player is not breathing on their own (spontaneously breathing) the player needs to be articially ventilated.

This can involve using;

(A) your mouth and breathing in to a mask placed in the players mouth or

(B) using a bag and mask device, depending on availability and your experience.

Circulation and Controlling Any Bleeding (Haemorrhage Control)

The players circulation is best assessed by looking at their skin colour and feeling for the pulse in their wrist (radial artery) or neck (carotid artery). Note the strength and rate of the pulse.

Normally capillary refill should occur within two seconds. You can check this by pressing on the player’s fingernail between your thumb and index finger until it turns white. Let go and count the seconds until it returns to its normal colour. This the known as the ‘capillary refill time’.

Obvious blood loss should be identified and controlled with direct pressure using a sterile dressing or bandage.

Disability

A rapid neurological assessment is performed towards the end of the primary survey in order to assess if the player is alert, responds to verbal stimuli, responds to painful stimuli or is unconscious.

The acronym AVPU can be used to guide the assessment:

A alert
V responds to vocal stimuli
P responds to painful stimuli
U unresponsive

  • Is the player awake, do they know their own name?
  • Do they know where they are and can they tell you what happened?
  • Is the player responding to pain such as a pinch?
  • Are they unconscious and not reacting to pain or a pinch?

Any unconscious player or any player who complains of numbness, weakness, paralysis or neck pain should be treated as if they have a cervical spine injury until proven otherwise.

Immobilization (not able to move position) is best managed with the player lying at (supine position) on a flat surface with their head and neck maintained in a neutral position by ‘cervical in line’ immobilization as pictured.